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How Much Does Sublocade Cost? With & Without Insurance

July 2, 2022

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Sublocade is an injectable form of Suboxone and therefore has a slightly higher cost per dose than other forms of Suboxone. However, insurance can cover much of this cost. Any remaining cost may be covered by copay support programs through the pharmaceutical manufacturer.

Sublocade is a newer, brand-name medication that is administered as a subdermal injection once per month. This medicine cannot be administered by the patient or a general physician, only by a certified Sublocade provider.

Sublocade: A Monthly Dose Helps Maintain Abstinence

Sublocade is a brand name for a buprenorphine injection to help maintain abstinence after much of the opioid addiction treatment process has been completed.[1] This medication is injected once per month by a trained health care provider in a treatment setting.

Usually, patients begin by taking sublingual (oral) suboxone strips or tablets for a period of time until they have achieved their goals for abstinence. For some people who have been on Suboxone stably, they may prefer to switch to a long acting injection like Sublocade so that they do not have to take Suboxone strips on a daily basis. Sublocade is usually for people who have been stably abstinent from opioids on Suboxone for a period of at least months to years.

The passage of the Affordable Care Act (ACA) expanded requirements for health insurance companies to cover at least part of mental health and substance abuse treatment, and this includes lifesaving medications used to manage opioid use disorder (OUD).[2] Although Sublocade is a new medication, it is covered by many insurance plans.

How Can I Get Sublocade Treatment?

If your treatment program recommends monthly injections of Sublocade to help you maintain abstinence from opioids, you will need to find, or get are referral for, a Sublocade Risk Evaluation and Mitigation Strategy (REMS) program.[3] This program ensures your medication provider has the training needed to safely inject this subdermal medicine, evaluate any side effects, and support you if any issues arise.

Sublocade is an injection medication that releases buprenorphine into the bloodstream at a measurable, regular rate over 28 days. You should not receive these injections more frequently than every 26 days. If you feel cravings or withdrawal symptoms before that time has passed, you should report these to your physician.

Sublocade cannot be administered by you, the individual, or by a general practitioner. Only a doctor who has received training through the REMS program can administer this medicine.

Will My Insurance Cover Sublocade Treatment? How Much Does It Cost?

How Much Does Sublocade Cost

Sublocade is not available in retail pharmacies or regular physicians’ offices, so finding a provider who accepts your insurance is an important first step.[4] Most insurance plans cover at least part of your Sublocade costs, but the pharmaceutical company that manufactures Sublocade also offers copay assistance since individual injections can become expensive.

Here are the estimated Sublocade costs based on the type of insurance used:[5]

  • Commercial insurance has an average out-of-pocket cost of $212, although your specific price can vary from $0.01 to$1,742 per month. This estimate is based on a survey of pharmacy and medical claims for Sublocade before any discounts or copay card applications were applied.
  • Medicaid coverage lowers the average monthly Sublocade cost to $3, but the range could be $1 to $4 per month.[6]
  • People using primarily Medicare coverage report the average monthly cost as $59, but the range could be $3 to $950 per dose each month. (1) If you have Medicare Part B, your supplemental, commercial insurance may cover all or part of your medication costs, including Sublocade. (2) If you have Medicare Part C, there is an out-of-pocket maximum that you will pay, depending on your plan’s benefits and other expenses you have in the year.

People without insurance are subject to paying the list price for Sublocade, which is $1,829.05 per month, according to the pharmaceutical manufacturer. Whether you have insurance or not, you may be eligible for some discounts through the manufacturer.

Additional Support to Cover the Cost of Sublocade

The INSUPPORT Copay Assistance Program can help eligible individuals cover the total cost of Sublocade.[7] Any amount not covered by your insurance program may be covered by this form of assistance, so you can access the treatment that works best for you. The INSUPPORT Copay Assistance Program specifically covers the cost of the first two Sublocade injections in a calendar year, so your first two months of treatment will be free.

Additional support can apply for your future Sublocade doses. You may also be able to combine types of insurance coverage, depending on what you are eligible for in your state.

Bicycle Health provides Suboxone therapy for opioid use disorder. Bicycle offers educational resources on Belbuca, Subutex and Sublocade, but does not currently offer those therapies.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Highlights of Prescribing Information: Sublocade. U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/209819s012lbl.pdf. November 2017. Accessed January 2022.
  2. Mental Health & Substance Abuse Coverage.Healthcare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/. Accessed January 2022.
  3. Risk Evaluation and Mitigation Strategy (REMS).SublocadeREMS.com. https://www.sublocaderems.com/.Accessed January 2022.
  4. FAQs: Sublocade. Sublocade.com. http://www.sublocade.com/frequently-asked-questions.Accessed January 2022.
  5. Understanding the Price for Sublocade. Sublocade.com.https://www.sublocade.com/cost-savings.Accessed January 2022.
  6. RE: Mandatory Medicaid State Plan Coverage of Medication Assisted Treatment. Centers for Medicare & Medicaid Services (CMS). https://www.medicaid.gov/federal-policy-guidance/downloads/sho20005.pdf. December 2020. Accessed January 2022.
  7. INSUPPORT® Copay Assistance Program for SUBLOCADE® (buprenorphine extended-release) Injection, for Subcutaneous Use(CIII). in Support Copay Assistance. https://www.insupport.com/pdf/copay-assistance-brochure.pdf. 2021. Accessed January 2022.

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