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Does Insurance Cover Suboxone Treatment?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Sep 16, 2023 • 5 cited sources

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.

What insurance providers cover Suboxone therapy?

Quick Answer

Most insurance companies cover Suboxone therapy and MAT, including private insurance providers, Medicaid, Medicare, and TRICARE.

Insurance Coverage for Suboxone Explained

Thanks to the Affordable Care Act (ACT) and the Mental Health Parity and Addiction Equity Act (MHPAEA), most insurance companies provide at least partial, if not full, coverage for Suboxone and other forms of MAT.

This is true of plans sold on the Healthcare Marketplace, employer-sponsored group health plans, individually-purchased insurance plans, as well as public health insurance plans, including Medicare and Medicaid.

Which Health Insurance Plans Cover Suboxone?

Most health insurance providers cover Suboxone for opioid use disorder, although the extent of your coverage will depend on your specific plan. Common private and public insurance providers that cover Suboxone and other forms of MAT include:

This is by no means an exhaustive list, so if you don’t see your provider on here, make sure to give them a call to learn more about their Suboxone coverage.

Private Insurance Plans

Most private health insurance plans do cover mental health treatments, including MAT and Suboxone, just as they would cover medical treatments; however, this may vary state by state. [1]

Your insurance plan may have limitations involving these things, such as:

  • 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.

Medicare 

If you’re 65 or older, you are eligible for Medicare, which is 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 for Suboxone treatment. 

TRICARE

TRICARE is a government-funded healthcare program providing health insurance for members of the U.S. military, including active duty, Reserves, retirees, and their family members.

TRICARE covers MAT options, such as Suboxone, for people with opioid use disorder. Make sure to contact TRICARE directly to learn more.

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. You may also be able to use Suboxone coupons to help pay for your OUD medication.

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.

Frequently Asked Questions About Insurance and Suboxone

Does Aetna Insurance Cover Suboxone?

Yes, you can expect most Aetna insurance plans to at least partially cover Suboxone, though you’ll need to confirm the details of your particular plan.

Does Cigna Insurance Cover Suboxone?

Yes, most Cigna health insurance plans cover Suboxone, although you’ll have to check the details of your specific plan.

Does Health Insurance Cover Suboxone?

Yes, most health insurance providers cover Suboxone (buprenorphine/naloxone) and other medications for addiction treatment (MAT) like methadone and naltrexone.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

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.

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