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.
How Do You Get a Suboxone Prescription Paid For?
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:
- Find a medical provider who is licensed to prescribe Suboxone.
- Set up an appointment.
- Discuss your health history and motivation to seek treatment.
- Complete the intake assessment.
- Receive your first one to two doses of Suboxone to begin treatment at home or enter an inpatient treatment program.
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, online Suboxone is covered by most insurance plans.
Will My Health Insurance Cover Suboxone Treatment?
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.
What Is Prior Approval? Do I Need It for Suboxone?
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.
- Offering Emergency Buprenorphine Without a Prescription. Journal of the American Medical Association (JAMA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048041/. April 2021. Accessed February 2022.
- Opioid Use Disorder. American Psychiatric Association (APA). https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder#:~:text=The%20Diagnostic%20and%20Statistical%20Manual,a%20longer%20period%20than%20intended. November 2018. Accessed February 2022.
- A Patient’s Guide to Starting Buprenorphine at Home. American Society on Addiction Medicine (ASAM). https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed February 2022.
- Does Insurance Cover Treatment for Opioid Addiction? US Department of Health and Human Services (HHS). https://www.hhs.gov/opioids/treatment/insurance-coverage/index.html. September 2020. Accessed February 2022.
- UnitedHealthcare Makes a Difference on the Opioid Front. United Healthcare. https://www.uhc.com/broker-consultant/news-strategies/resources/unitedhealthcare-makes-a-difference-on-the-opioid-front. June 2018. Accessed February 2022.
- Medicaid Coverage of Medication-Assisted Treatment for Alcohol and Opioid Use Disorders and of Medication for the Reversal of Opioid Overdose. Substance Abuse and Mental Health Services Administration (SAMHSA). https://store.samhsa.gov/sites/default/files/d7/priv/medicaidfinancingmatreport_0.pdf. 2018. Accessed February 2022.
- Suboxone Prices, Coupons and Patient Assistance Programs. Drugs.com. https://www.drugs.com/price-guide/suboxone. Accessed February 2022.
- Prior Authorization Practice Resources. American Medical Association (AMA). https://www.ama-assn.org/practice-management/sustainability/prior-authorization-practice-resources#:~:text=Prior%20authorization%E2%80%94sometimes%20called%20precertification,to%20qualify%20for%20payment%20coverage. Accessed February 2022.
- The Mental Health Parity and Addiction Equity Act (MHPAEA). Centers for Medicare & Medicaid Services (CMS). https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet. Accessed February 2022.
- Find Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/find-treatment. July 2021. Accessed February 2022.
By: Elena Hill, MD, MPH
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