Data Watch: Naloxone Prescription in Response to the Opioid Epidemic in Arkansas

In response to the opioid epidemic, policies to expand access to the overdose-reversal drug naloxone have emerged across the country. In Arkansas, Act 651 of 2021, which went into effect on July 28, 2021, requires a co-prescription of naloxone in certain situations, including when a dosage for an opioid prescription is 50 or more morphine milligram equivalents (MME) per day. In 2017, licensed pharmacists became authorized to dispense naloxone to individuals without a prescription under a state protocol.

Since 2020, ACHI has conducted annual analyses of naloxone and opioid prescriptions for individuals enrolled in Medicaid or commercial insurance. Data for the analyses are from the Arkansas All-Payer Claims Database, part of the Arkansas Healthcare Transparency Initiative, for state fiscal years (FY) 2017 through 2024. The results of our analyses are contained in an updated installment of our Data Watch series.

Key findings:

• The percentage of enrollees who filled at least one opioid prescription decreased from 9.3% in FY 2023 to 8.5% in FY 2024.
• From FY 2023 to FY 2024, there was a 25.4% decrease in naloxone prescription fills and a 25.0% decrease in enrollees who filled a naloxone prescription. These decreases may reflect that some enrollees had naloxone prescription fills from prior years that they had not used or had access to naloxone through other means.
• The percentage of enrollees who filled opioid prescriptions decreased overall from FY 2017 to FY 2024. During the same period, the number of enrollees who filled naloxone prescriptions increased.
• Among enrollees who filled opioid prescriptions of 50 or more MME per day, the rate of fills from naloxone co-prescribing increased from 0.1% in FY 2017 to 14.6% in FY 2024.
• Among enrollees who filled opioid prescriptions of 90 or more MME per day, the rate of fills from naloxone co-prescribing increased from 0.1% in FY 2017 to 17.8% in FY 2024.
• In FY 2024, 3,262 out of 19,833 naloxone prescription fills, or 16.4%, were initiated by pharmacists.