Suboxone Insurance Coverage & Cost Guide (With & Without Insurance)

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  • Is Suboxone Covered by Insurance?
  • Which Health Insurance Plans Cover Suboxone?
  • What is Suboxone?
  • Why do People Use Suboxone?
  • What is Suboxone Used For?
  • Preferences for Suboxone
  • How Much Does Suboxone Cost Without Insurance?
  • Is There Cost Assistance for Suboxone?
  • How do I Get Suboxone?
  • Who Can Prescribe Suboxone?
  • Verify Your Insurance
  • What Substance Addiction Does Health Insurance Cover?

Medication-assisted treatment (MAT) is the standard of care for treating opioid use disorders. Access to medications such as buprenorphine has proven to be a critical component in managing the opioid addiction crisis our country continues to face. As a special formulation of buprenorphine, Suboxone has contributed to many peoples’ recovery from opioid use disorders.1

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Suboxone is an effective form of medication-assisted treatment that has contributed to many peoples’ recovery from opioid use disorders.2 Read on to learn more about Suboxone and the financial factors associated with Suboxone treatment. American Addiction Centers (AAC) offers various forms of medication-assisted treatment, including Suboxone, at our treatment centers across the United States. We’re also in-network with various insurance companies, such as Aetna, Blue Cross Blue Shield, United Healthcare, and more.

Is Suboxone Covered by Insurance?

Yes, the majority of health insurers do generally cover the cost of Suboxone treatment.3 However, whether your Suboxone treatment will be covered depends on your specific insurance plan and the particular Suboxone provider you choose.

Since the passing of the Mental Health Parity and Addiction Equity Act, most health insurance companies that offer mental health and substance use benefits are required to provide coverage that is equivalent to the benefits that are offered for physical health conditions.3 This has worked to improve access to addiction treatment and medications like Suboxone.4 Treatment for addiction and mental health is now viewed as an essential health benefit.4

Which Health Insurance Plans Cover Suboxone?

Suboxone doctors, clinics, and providers do accept many forms of health insurance, which may offer full or partial coverage for Suboxone treatment. Common health insurance companies that cover the cost of Suboxone treatment include (but are not limited to):

Suboxone clinic fees may vary based on the provider, the location, and the patient.

American Addiction Centers strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.

What is Suboxone?

Suboxone is FDA-approved for use in medication-assisted treatment of opioid use disorders.2,5 Suboxone is a combination of buprenorphine (a long-acting partial opioid agonist) and naloxone (an opioid receptor antagonist) and can be used to stabilize people during detox and withdrawal management as well as for longer-term maintenance therapy for opioid use disorders.2,6,7,8 Like other opioid agonist drugs, buprenorphine functions by binding to the body’s opioid receptors; however, as only a partial agonist at these receptors, buprenorphine elicits relatively less pronounced opioid effects when used within prescribed guidelines.5,6

With a strong binding affinity for opioid receptors, buprenorphine can also competitively prohibit other illicit and prescription opioids from attaching to these receptors, blocking them from having their reinforcing euphoric effects on the user to discourage continued misuse while on Suboxone treatment.2 Buprenorphine also has a ceiling to its opioid effects, which lowers the risk of overdose.2,5

Keep in mind that Suboxone does have the potential to cause euphoria in some people. However, this euphoric potential is generally much milder than that of other opioids, such as heroin. Naloxone has no effect when Suboxone is taken as directed (i.e., oral routes), but it is included in the formulation as an abuse deterrent, as intentional misuse—such as attempts to dissolve the Suboxone to be injected—can result in the onset of unpleasant withdrawal symptoms.2,5,6,7 

Why do People Use Suboxone?

People utilize Suboxone as one component in a more comprehensive treatment plan to minimize uncomfortable opioid withdrawal symptoms and control opioid cravings. By managing withdrawal and controlling cravings, Suboxone can help a person to remain focused on their recovery and prevent them from relapsing. Suboxone has been shown to be effective at helping people remain abstinent from opioids and improve their treatment outcomes.2,5,7,9

What is Suboxone Used For?

Suboxone treatment cost

Suboxone is a medication used to treat opioid use disorder in the United States. As part of an effective MAT strategy, Suboxone may be used as a part of a larger treatment plan that includes behavioral therapeutic interventions, monitoring, and support, and mental health care (if needed). This ensures a whole-person approach to treatment rather than simply addressing one aspect of a substance use disorder.5,7,8,9

It is important to wait until you have been abstinent from opioids long enough to be experiencing withdrawal symptoms before starting to take Suboxone. This generally means staying off opioids for at least 12 hours and up to 48 hours, depending on the type of opioids you were using, since taking Suboxone while you are under the influence of opioids can make withdrawal symptoms begin earlier than they normally would. Using Suboxone as a long-term maintenance medication encourages you to stay abstinent from opioids, especially since this medication reduces cravings and decreases the potentially rewarding effects of other opioids if you do relapse.2,5,9,11 Withdrawal symptoms can be extremely uncomfortable and make it difficult to stop using opioids. Suboxone film or tablets can ease many symptoms of opioid withdrawal. Opioid withdrawal symptoms include:8,11

  • Body aches.
  • Anxiety.
  • Inability to sleep.
  • Agitation.
  • Sweating.
  • Teary eyes.
  • Runny nose.
  • Goosebumps.
  • Yawning.
  • Stomach pain, nausea, vomiting.
  • Diarrhea.

Preferences for Suboxone

There are several different MAT options available to people in the United States, but people may choose Suboxone over other forms of MAT for various reasons. A range of factors can influence a person’s decision to opt for treatment using Suboxone rather than methadone or naltrexone.

For example, Suboxone tends to offer:2,5,9,11

  • Fewer restrictions. In some instances, Suboxone may be more readily accessible than methadone, which is only dispensed in hospital and certified clinic settings. Medical professionals who have been authorized to provide Suboxone can prescribe it in a greater range of settings, including from their office.
  • Lower misuse potential. Suboxone is formulated to discourage misuse and diversion. The opioid effects are relatively weaker than full opioid agonist drugs, and a person is unlikely to experience pronounced feelings or euphoria or intoxication from taking Suboxone, when used as prescribed for the treatment of opioid use disorder. If it is taken differently than prescribed, such as snorted or injected, it may cause immediate withdrawal due to the presence of naloxone in the medication.
  • Increased safety. The risk of overdose on methadone is more than 4 times higher than on Suboxone. It is unlikely that a person will experience an overdose on Suboxone unless it’s combined with other central nervous system depressants like alcohol or benzodiazepines. Buprenorphine may be safer for pregnant and breastfeeding women to use than methadone.

Studies show that buprenorphine, not just the Suboxone formula, has positive recovery outcomes. While it can be difficult to track progress over long periods of time, research shows that people who take buprenorphine or methadone are more likely at 18 months to remain abstinent, maintain employment, and engage in 12-step or mutual help meetings to support their recovery. Buprenorphine is associated with a lower likelihood of dropping out of treatment, relapse, overdose deaths, and improved quality of life vs. methadone.2,9 Opioid maintenance on buprenorphine also is associated with a lower risk of contracting infectious diseases like HIV or hepatitis C, and having new legal issues. In one study, the majority of people, 75% on buprenorphine were successful in their recovery attempts.9

How Much Does Suboxone Cost Without Insurance?

The cost of Suboxone depends on a variety of factors. Different insurance companies offer varying levels of coverage, and not all insurance plans provide the same level of coverage for treatments or medications. Suboxone costs can be different depending on the provider that you obtain your prescription from, whether it is through a doctor’s office, an inpatient facility, or an outpatient clinic.

Suboxone’s cost without insurance depends on whether you receive the brand name or generic version of Suboxone, as well as your dosage. However, receiving Suboxone treatment without insurance may involve higher out-of-pocket costs than using health insurance to cover part or all of your Suboxone treatment.

Does Medicaid Cover Suboxone?

Medicaid generally does cover Suboxone for treatment of opioid use disorder, but the extent of coverage depends on various factors. Suboxone is listed on the preferred drug list for Medicaid in all but one state, although the majority of these states require prior authorization.7

Prior authorization means that the medical professional prescribing Suboxone has to obtain approval from Medicaid before the medication will be approved, and may have to submit documentation showing that it is medically necessary, or that the person is receiving counseling in addition to medication. Medicaid imposes limits on how long a person can stay on Suboxone, although the limit depends on your state and some states set lifetime limits. If you exceed this lifetime limit, coverage for Suboxone may be denied through Medicaid.7

Is There Cost Assistance for Suboxone?

Two cost-assistance programs are available for Suboxone, depending on whether you have private health insurance or no health insurance coverage. A cost-assistance program is when part or all of the cost of the medication is paid for by another source, making it more affordable. If you have private health insurance, a copay assistance program is available that reduces your copay by up to $75 monthly. If you have no health insurance, the cost assistance program provides a discount card that offers a discount on your prescriptions, depending on the dosage.13  You can learn more about the INSUPPORT program here.

How do I Get Suboxone?

To obtain a prescription for Suboxone, you must find a qualified practitioner who is specially-wavered to prescribe and dispense the medication.2,7 This practitioner waiver and a modified DEA registration number are provided upon completion of a training program, allowing a provider to prescribe Suboxone.5,7,11 You may be able to get Suboxone by visiting your family doctor, provided that they possess a buprenorphine waiver. There is nothing to be ashamed of by asking your family doctor if they can prescribe Suboxone, or discussing the fact that you struggle with opioid addiction. Talking honestly with your doctor can help them direct you towards the most appropriate treatment to meet your needs.

You can also get it by going to a rehabilitation center or Suboxone clinic that is qualified to treat patients with Suboxone and other forms of MAT.5 American Addiction Centers has a full range of treatment programs, from detox to inpatient care to outpatient care, providing the highest quality treatment across the country. You can receive Suboxone at American Addiction Centers facilities while receiving evidence-based treatment to address your opioid use disorder.14,15

For more information on how and where to attain Suboxone for the treatment of your opioid use disorder, call American Addiction Centers at .

Who Can Prescribe Suboxone?

Suboxone is available through a range of providers and settings. SAMHSA-certified opioid treatment programs are able to prescribe Suboxone to their patients. Additionally, various qualified providers who are able to prescribe medications can write prescriptions for Suboxone, making this medication much more accessible than some other forms of MAT.2,5,11,15 You can get Suboxone prescribed by a wavered doctor, physician assistant, or nurse practitioner.2,7,15

Verify Your Insurance

What Substance Addiction Does Health Insurance Cover?

Many major health insurance providers cover treatment for the various substance use disorders, including addictions to alcohol, cocaine, and heroin. Attending rehab for drug addiction can also address when you have an issue with multiple substances.

Sources:

  1. Substance Abuse and Mental Health Services Administration. (2020). Treatment Improvement Protocol—TIP 63: Medications for Opioid Use Disorder.
  2. Velander, J.R. (2018). Suboxone: Rational, science, misconceptions. The Ochsner Journal, 18(1), 23-29.
  3. U.S. Department of Health and Human Services. (2020). Does insurance cover medication for opioid addiction?
  4. CMS.gov. The Mental Health Parity and Addiction Equity Act (MHPAEA).
  5. Substance Abuse and Mental Health Services Administration. (2020). Buprenorphine.
  6. National Alliance on Mental Illness. (2019). Buprenorphine/naloxone (Suboxone).
  7. Substance Abuse and Mental Health Services Administration. (2014). Medicaid coverage and financing of medications to treat alcohol and opioid use disorders. HHS Publication No. SMA-14-4854. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  8. U.S. National Library of Medicine. (2020). Opiate and opioid withdrawal.
  9. National Institute on Drug Abuse. (2018). How effective are medications to treat opioid use disorder?
  10. Donaher, P.A., & Welsh, C. (2006). Managing opioid addiction with buprenorphine. American Family Physician, 73(9), 1573-1578.
  11. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  12. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  13. Indivior. InSupport for patients.
  14. Substance Abuse and Mental Health Services Administration. (2020). Statutes, regulations, and guidelines.
  15. Department of Health and Human Services. (2018). Using Telehealth to support opioid use disorder treatment.

 

Last Updated on March 25, 2021
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