Increasing competition, improving access, and lowering the cost of naloxone in California

Naloxone is an opioid antagonist that can reverse opioid overdoses and save lives. In 2023, the California Department of Health Care Access and Information mobilized its affordable drug manufacturing program, CalRx, to develop a more affordable naloxone nasal product that could help increase access for all Californians. Partnering with a new market entrant, CalRx offered a stable demand forecast for an initial 3-year agreement. In exchange, the selected manufacturer launched a new generic over-the-counter naloxone nasal product at a transparent price 40% lower than the state's previously contracted rate. In its first 6 months, internal calculations suggest that the CalRx generic naloxone has saved the state over $2.6 million, which could be used to provide more than 108 000 additional units of naloxone free of charge to communities across California. Overall generic naloxone prices declined by 22% in a single quarter immediately following CalRx entry. The CalRx experience has helped disrupt the naloxone market by increasing competition and reducing prices. The experience also demonstrates that leveraging states' substantial purchasing power to negotiate lower prescription drug prices can have immediate market impact.