The best (and only legal) way to get buprenorphine/naloxone (Suboxone) treatment for free is to get a prescription from a licensed prescriber.
Almost all insurance providers cover Suboxone, although the medication may require prior approval from your insurance company. Your provider can help you get “prior approval” for Suboxone if necessary.
Suboxone can be an expensive medication to pay for “out of pocket” (a.k.a. without health insurance). However, if you do have a health insurance plan, most plans cover the cost of Suboxone. Depending on your state, there are also certain government programs that subsidize the cost of Suboxone.
Getting coverage for Suboxone treatment starts with a prescription from a qualified physician. Follow these steps:
It is likely you will not pay anything upfront to begin Suboxone treatment, although you may pay a small amount for subsequent prescription doses of Suboxone. This depends on your prescription drug coverage from your health insurance provider. Current legislation requires that health insurance companies provide the same level of coverage for mental health and substance use disorders as they do for other medical and surgical care. Therefore, Suboxone is covered by most insurance plans.
Depending on your health insurance provider, you will receive at least some coverage for Suboxone treatment. Depending on your plan, Suboxone may be entirely covered or you may be required to pay a small copay for your prescription - usually on the order of $10-25 per month.
People who qualify for Medicaid receive coverage for treatment with Suboxone or another buprenorphine/naloxone combination regardless of where you live in the United States. Medicare Part D covers buprenorphine for chronic pain, but it does not cover Suboxone treatment, so you may need additional health insurance for greater pharmacy benefits.
Without insurance coverage, the estimated average cost of Suboxone sublingual film is $166 for a pack of 30 film strips, or about a month’s supply. However this varies greatly by State.
Suboxone’s pharmaceutical manufacturer offers a copay card to eligible participants. Those who have commercial health insurance may pay no more than $5 per month for their prescription and receive two refills in the first month for free.
They offer a Suboxone savings card for people who pay cash or do not have health insurance. Your physician can also refer you to additional savings programs.
Prior approval, also called prior authorization, is a step in the American health care process when a physician or other prescribing health care provider must obtain approval for a treatment from a health insurance provider before the patient qualifies for coverage. If this is the case, your doctor will need to submit the prior approval request, which usually takes a few days to a week.
For decades, health insurance companies in the U.S. required prior approval for addiction treatment, including medications like methadone or buprenorphine. Fortunately, the passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, and amendments in the Affordable Care Act (ACA) of 2010, addressed this problem. Now, medications for opioid use disorder often do NOT need prior approval.
If you struggle with opioid addiction and want treatment, you can find a treatment provider using the Substance Abuse and Mental Health Service Administration’s (SAMHSA) online Treatment Finder. We’re also ready to help you here at Bicycle Health. Reach out today.