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Drug - Narcan ® (naloxone HCl) Nasal Spray [Adapt Pharma, Inc]; MHCP naloxone rescue kit; Evzio™ (naloxone HCl injection) [kaleo, Inc.]

April 2017

Therapeutic area - Opioid antagonist

Prescribers: writing prescriptions for Naloxone

Effective June 1, 2014, enrolled prescribers may write outpatient prescriptions for naloxone to be used as a rescue medication. ”Steve’s Law” was passed by the Minnesota Legislature and signed by Governor Dayton in May of 2014 allowing for expanded use of naloxone for heroin or other opiate overdose prevention. The medication can be administered to the patient by a family member or friend in the event of a potentially life-threatening overdose.

MHCP fee-for-service covers the following naloxone products:

  • Narcan Nasal Spray: No prior authorization is required.
  • MHCP naloxone rescue kit: No prior authorization is required.  The MHCP naloxone rescue kit consists of:
    • 2mg/2mL naloxone syringe, NDC 76329-3369-01 AND
    • LMA MAD Nasal Mucosal Atomization Device without syringe NDC 00042-2718-02 
  • Evzio: Excluded from coverage effective 4/1/2017. Kaleo, the manufacturer of Evzio, terminates its participation in Medicaid Drug Rebate Program effective 4/1/2017

Pharmacies: dispensing Naloxone kit prescriptions

Stocking the materials

  • 2mg/2mL naloxone is available from IMS/Amphastar (NDC 76329-3369-01). It is available through major pharmacy wholesalers.
  • The mucosal atomization device (LMA MAD Nasal) is available from some wholesalers or directly from the manufacturer, Teleflex.

Dispensing the prescriptions

  • The quantity limit for naloxone rescue prescriptions is two syringes (4mL) and two nasal mucosal atomization devices. 
  • Use NDC 00042-2718-02 to bill DHS for the LMA MAD Nasal Mucosal Atomization Device.
  • The prescriptions may be provided only to recipients with opiate dependency or addiction. 
  • Do not bill MHCP for naloxone prescriptions intended for use by the recipient’s family members or friends with opiate dependency. 
  • Provide patient counseling and information to the patient about the dangers of overdose and the appropriate use of naloxone. offers patient education materials on overdose prevention and naloxone administration.
  • Remind patients that naloxone should be stored at room temperature and away from direct sunlight. For example, avoid storage in a vehicle glove box due to potential temperature extremes.

Quantity limits

  • Narcan: 2 sprays (1 carton)
  • MHCP naloxone kit: 2 syringes (4 mL) and two nasal mucosal atomization devices


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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