Does Insurance Cover Suboxone Treatment?

Most insurance plans, including private and public plans, will cover Suboxone treatment. But your out-of-pocket costs can vary, as some plans come with large copayment requirements.

The best way to find out if you’re covered is to contact your insurance company directly. 

Insurance Coverage for MAT Explained

Health insurance is complicated, as the rules vary from state to state.

When determining your coverage for Medication for Addiction Treatment (MAT), it’s always wise to read the fine print. But in general, here’s what you need to know about coverage. 

Medicare 

If you’re 65 or older, you are eligible for Medicare, which is a government-sponsored health insurance for older adults. Medicare generally covers MAT including Suboxone, however you may have a deductible or copay [2] 

Medicaid 

Medicaid is state sponsored insurance for people with low income or certain disabilities. If you have ongoing health conditions or disabilities or you have a low income, you could be eligible for Medicaid in your state. As of 2020, all states are required to cover drugs and therapies for MAT, including Suboxone. [3] Therefore, patients on Medicaid in their state tend to have good coverage of their Suboxone. 

Private Insurance Plans

The federal government mandates that public insurances must cover MAT, which includes Suboxone. However, this is not necessarily true for private insurance plans. Most private health insurance plans do cover mental health treatments just as they would cover medical treatments, however this may vary state by state [1]

Your insurance plan may have limitations involving these things:

• Prior authorization: Some insurance companies require a prior authorization request in which the provider must submit a form to get Suboxone approved before prescribing it. This may require a note or a letter from your doctor in addition to your regular prescription for Suboxone. 
• Drug types: Some insurance companies also dictate the formulation (generic versus brand name) and whether they will cover sublingual films versus tablets. They also might specify a maximum daily dose and length of treatment.
• Deductibles and Copay Costs: Patients may be charged a copay or deductible based on their plan.

What if You Don’t Have Insurance?

In 2020, almost 10% of Americans didn’t have health insurance.[4] If you’re one of them, you can still get Suboxone treatment, but you may have a heavy bill.

The cost can vary based on the prescribed dose. A one-month supply of brand-name Suboxone could cost between $166 and $570, while the generic version could cost between $60 and $200.

Some states have certain “charity programs” that help to pay for medications for patients without insurance. If you do not have insurance and need a prescription for Suboxone, reach out to your doctor’s office for help. 

Financial Help if You Can’t Afford Suboxone

Patients unable to afford Suboxone (regardless of insurance coverage) can apply for cost assistance. The company that makes Suboxone offers this type of program to help reduce out-of-pocket expenses.

The InSupport program can drop your cost to $5 per month with insurance and $170 per month with no insurance.[5] But limitations apply.

If you have government insurance (like Medicare or Medicaid), you’re not eligible for this assistance program.

If you can’t get help through this program, talk to your doctor about your options. They can help you find another way to get the help you need.

Sources

1. Mental Health and Substance Abuse Coverage. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/. Accessed July 2022.
2. Opioid Use Disorder Treatment Services. Medicare.gov. https://www.medicare.gov/coverage/opioid-use-disorder-treatment-services. Accessed July 2022.
3. Mandatory Medicaid State Plan Coverage of Medication Assisted Treatment. Center for Medicare and Medicaid Services. https://www.medicaid.gov/federal-policy-guidance/downloads/sho20005.pdf. December 2020. Accessed July 2022.
4. Demographic Variation in Health Insurance Coverage: United States 2020. National Health Statistics. https://www.cdc.gov/nchs/data/nhsr/nhsr169.pdf. February 2022. Accessed July 2022.
5. InSupport for Patients. InSupport. https://www.insupport.com/suboxone/savings. Accessed July 2022.