Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

Tennessee has one of the highest rates of opioid prescribing in the United States; therefore, the objectives of this study were to examine availability, pricing, and pharmacist-initiated recommendations of naloxone in retail community pharmacies in Eastern and Western Tennessee; to identify the most common barriers to naloxone dispensing and strategies to improve access; and to determine regional differences in access to naloxone. A cross-sectional survey conducted via telephone. All retail community pharmacies located in the most populous counties in the eastern and western regions of Tennessee were eligible for inclusion, as were all retail community pharmacies in the 5 counties in each region that had the highest rates of opioid prescriptions (316 pharmacies identified in 12 counties). Outcome measures included availability, price, and pharmacist-initiated recommendations of naloxone products, barriers to dispensing, and suggestions to improve naloxone access. Survey responses were summarized as descriptive statistics. Chi-square, independent samples t test, and inductive content analysis were conducted. Response rate was 56.3%. Most participants (92.7%) reported that naloxone (Narcan) was available from their pharmacies at a mean cash price of $132.49, with no statistically significant differences between regions. The most commonly reported barrier was cost (70.2%). When queried about recommendations to various groups at a high risk of overdose, as advised by the U.S. Department of Health and Human Services, 42.1% to 69.1% of pharmacies reported recommending naloxone to at least 50% of high-risk patients. Suggestions to increase naloxone access included lowering the cost and improving naloxone-related education for patients, pharmacists, and other providers. Although Narcan was widely available, cost was a frequently cited barrier to dispensing. Pharmacist-initiated recommendations for coprescribing and dispensing naloxone to patients at a high risk of overdose were limited. Addressing cost issues in addition to increasing patient and pharmacist education concerning the use and benefit of naloxone were suggested to improve naloxone access.