Association Between Health Plan Design and the Demand for Naloxone: Evidence From a Natural Experiment in New York.

Abstract

Although supply-side barriers to naloxone have been reduced, receipt remains low in the U.S. Demand-side barriers, such as out-of-pocket costs, may contribute to low receipt. This study evaluated the association between health plan design and receipt of naloxone, leveraging a natural experiment arising from the passage of a naloxone coprescribing law in New York state. This study used administrative claims data on naloxone and opioid dispensing for the commercially insured population in New York from the Merative MarketScan Database from January 2021 to March 2023. Difference-in-difference models were estimated, comparing codispensed naloxone between individuals enrolled in high-deductible healthcare plans and those enrolled in non-high-deductible healthcare plans before and after New York's passage of the law on December 30, 2021. Data were collected and analyzed in 2025. The policy change was associated with a 4.6 percentage point (95% CI=4.1, 5.0) and 1.3 percentage point (95% CI=0.3, 2.1) increase in the probability of being codispensed naloxone for non-high-deductible healthcare plan and high-deductible healthcare plan groups, respectively, equating to a 131% and 39% increase from their respective baselines. This change in probability among high-deductible healthcare plan enrollees was 3.4 percentage point (95% CI= -4.4, -2.4) lower than that among non-high-deductible healthcare plans enrollees. Individuals facing higher out-of-pocket costs were less likely to fill naloxone prescriptions than those facing lower out-of-pocket costs after the naloxone coprescribing mandate. Supply-side naloxone access policies may be unevenly distributed across patient populations owing to variations in insurance design and associated financial barriers. Addressing demand-side barriers to naloxone uptake may be an important overdose prevention strategy.