Medicaid doesn’t usually cover brand-name medications if there is a generic alternative, which Suboxone has. However, that generic alternative is covered and works the same as brand-name Suboxone.
Will Medicaid Cover Suboxone Therapy?
Medicaid coverage is different by state, but generally, brand-name medications are only covered when a generic alternative is not available. In the case of Suboxone, a generic combination drug of buprenorphine and naloxone can usually serve an identical purpose to the brand-name medication with no side effects.
Fortunately, Medicaid programs usually include this generic alternative in their associated formulary, which is a list of drugs that a plan covers. For example, this New York list of Medicaid reimbursable drugs includes most generic variants of buprenorphine-naloxone drugs a person might benefit from using as part of their treatment, including sublingual film, which is the same mode of delivery as Suboxone.
What Affects the Level of Coverage?
The most relevant aspect of coverage when discussing Medicaid is the state you live in. Each state decides how its Medicaid programs work, with the coverage provided sometimes varying significantly.
Assuming you qualify, you can generally rely on a generic version of Suboxone to be covered. However, whether other addiction treatment options are also covered will depend on your state and the specifics of its Medicaid program.
Medicaid MAT Coverage
Suboxone and generic equivalents aren’t the only Medication for Addiction Treatment (MAT) option that can help a person struggling with opioid use disorder (OUD). In addition to chemically similar buprenorphine-naloxone options that just come in a different delivery form (such as tablets), naltrexone and methadone are two other accepted medication options.
As already mentioned, coverage depends on the state, but most states (possibly all of them) will cover naltrexone in some form, including New York. More complicated is methadone, which under current U.S. policy has to be administered at specialized sites rather than given to patients so they can take it at home on a schedule like with other prescription medications.
You will have to research the specifics of your state’s program to see if their Medicaid program covers methadone treatments.
Is Addiction Treatment Other Than MAT Covered by Medicaid?
While it isn’t a requirement, many states have chosen to cover substance use disorder (SUD) treatments beyond just MAT through their Medicaid programs. States will often cover behavioral health services relating to addiction treatment, which is often a key part of managing addiction.
Beyond ethical motivations, this approach is also practical, as treating substance use disorder is often cheaper for a state overall than failing to treat it.
Checking Your Medicaid Coverage
A good place to start learning more about Medicaid is Medicaid.gov, a government resource intended to help people sign up for Medicaid and answer questions they may have. You will also want to research the specifics of your state’s program and check the website associated with that program, as it may have information not included on Medicaid.gov.
Medically Reviewed By 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 ... Read More
- New York State Department of Health List of Medicaid Reimbursable Drugs. New York State Department of Health. https://www.emedny.org/info/fullform.pdf. 2022. Accessed September 2022.
- Substance Use Disorders. Medicaid.gov. https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders/index.html. Accessed September 2022.
- Medicaid.gov. https://www.medicaid.gov/. Accessed September 2022.