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Table 1 State-level naloxone access laws

From: Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process

Category Policy Definition
Liability policies Liability protections for prescribers Provide legal protections for healthcare professionals who prescribe naloxone in accordance with state law. Protections can extend to criminal liability; civil liability; and administrative, licensing, and professional disciplinary action by the prescriber’s professional licensure (or similar) entity
Liability protections for dispensers Provides liability protections for pharmacists who dispense naloxone in accordance with state law. Protections can extend to criminal liability; civil liability; and administrative, licensing, and disciplinary action by the state board of pharmacy (or similar entity)
Liability protections for administration of naloxone Provide liability protections to laypersons or nonmedical professionals (e.g., law enforcement officers) who administer naloxone. Protections can extend to criminal liability; civil liability; and professional sanctions
Education/training requirements Prescriber provision of education or training to naloxone recipients Requires prescribers of naloxone to offer overdose training and/or education to the recipient of a naloxone prescription
Dispenser provision of education or training to naloxone recipient Requires pharmacists to offer overdose training and/or education to the recipient of a naloxone prescription
Co-prescribing naloxone Co-prescribing laws based on opioid dosage only Require doctors to prescribe naloxone to patients taking high doses of opioid painkillers
Co-prescribing laws based on more than opioid dosage Require doctors to prescribe naloxone to patients who have other risk indicators for opioid overdose above and beyond taking high doses of opioid painkillers (e.g., patients in opioid treatment programs, patients with a prior history of opioid use disorder or overdose)
Layperson accessibility Third party prescription Allows a healthcare provider with naloxone-prescribing authority to prescribe to an at-risk person’s family member, friend, and/or other person in a position to assist the at-risk person in the event of an opioid-related overdose
Over-the-counter pharmacy supply Makes naloxone available as an ordinary retail purchase that does not require a prescription. For this policy, assume that the US Food and Drug Administration has changed the prescribing status of naloxone from prescription‐only to over‐the‐counter status
Expanded pharmacy access Population-based collaborative agreement Pharmacists are given permission to voluntarily enter into collaborative agreements (or standing orders) with physicians and other providers to dispense naloxone to eligible patients without a patient-specific prescription according to patient criteria and instructions defined by the authorizing prescriber
Statewide standing or protocol order Establish a statewide framework that allows any pharmacist in the state (who meets qualifications specified in the protocol) to dispense naloxone without a patient-specific prescription under the pre-defined conditions outlined in the order. Unlike collaborative practice agreements, this policy does not require pharmacists to have a partnering prescriber
Pharmacist prescriptive authority Involves the legislature expanding pharmacist scope of practice to allow pharmacists to directly prescribe or furnish naloxone to patients without any physician involvement
Cost subsidization Insurance coverage Requires health insurance plans to provide coverage for at least one generic opioid antagonist and device approved to treat opioid overdose (e.g., naloxone) without prior authorization
State subsidies for naloxone purchase through insurance Involves states providing co-pay assistance to individuals purchasing naloxone through health insurance plans that include prescription coverage, including Medicaid and Medicare as well as commercial insurance
Statewide “free naloxone” Allows any resident to visit any pharmacy across the state and anonymously obtain naloxone at no cost without an individual prescription or appointment