Because "over the counter" is a bit of a misnomer. You must go to a pharmacy and speak to the pharmacy rep or pharmacist, who has access to the standing order t

Because "over the counter" is a bit of a misnomer. You must go to a pharmacy and speak to the pharmacy rep or pharmacist, who has access to the standing order that creates a prescription that's automatically rubber-stamped by an issuing physician. Now you've been "prescribed" Narcan, for all intents and purposes. The pharmacy now fills it via the normal procedures, including submitting to insurance as required to obtain payment for it behind the scenes. So... your insurance knows now you have (at least) once "taken" Narcan. Same thing happens when you go to a pharmacy for a flu or COVID shot or other vaccines: a remote physician "writes" the prescription for the vaccine, to which the pharmacist then draws and administers.