Does Insurance Cover Suboxone?

What Is Suboxone?

Suboxone is a combination of buprenorphine and naloxone that is often considered the gold standard in treatment for opioid use disorder (OUD).[2] Buprenorphine manages withdrawal symptoms and cravings, while naloxone works as an abuse-deterrent, sending a user into immediate withdrawal if Suboxone is misused.[3]  

Suboxone is dissolved under the tongue as a sublingual tablet or film, which makes absorption very efficient. 

How Much Is Suboxone Treatment With Insurance?

There isn’t a set amount you can expect to pay for Suboxone with insurance. The cost varies significantly, depending on your specific insurance plan as well as your geographic location.[4] 

To determine what you will pay for Suboxone, contact your insurance provider. Your MAT provider can also check your insurance and clearly outline what you can expect to pay out of pocket. 

Private Insurance Coverage

Most private insurance plans will offer coverage for Suboxone (or an equivalent) treatment.[1] Some plans require high out-of-pocket contributions from policyholders, while others cover a significant amount of the total cost. 

Restrictions might involve prior approval before Suboxone treatment can begin. Sometimes, requirements include evidence of the medical necessity of Suboxone use, the patient showing some duration of sobriety before Suboxone treatment starts, or the patient participating in counseling or therapy programs. 

Check with your insurance provider for specific coverage details, such as prerequisites for accessing Suboxone treatment, deductibles, and copayments. Again, rehab centers and MAT providers will often confirm the specifics of insurance coverage for clients. 

Public Insurance Coverage

Public insurance programs, such as Medicare, cover Suboxone as part of the recognition of MAT for opioid addiction.[5] This extends to both the administration of Suboxone as a medication and the associated medical services (like counseling and therapy). 

There are limitations, usually on the duration of the coverage, and how the medical necessity for Suboxone is defined. Patients who have Medicare coverage should ask about the restrictions and any special conditions that may apply. 

Medicaid Coverage

Medicaid covers Suboxone, although eligibility and coverage specifics will vary from state to state.[6] Medicaid requires prior authorization for Suboxone or buprenorphine, and factors like income will determine eligibility. 

Contact your local Medicaid office or check the Medicaid website to understand specific coverage details and restrictions in your state. 

Out-of-Pocket Costs

Even with insurance, you will likely have some potential out-of-pocket expenses for Suboxone treatment, such as copayments or deductibles. The extent of the expenses depends on the specifics of your insurance plan. 

Here is what you can expect in terms of out-of-pocket costs for MAT:[7,8]

The specifics of these costs will again vary greatly depending on your insurance provider and plan. Ask each treatment provider to check your insurance and give you a strong expert on what you can expect to pay out of pocket.

Other Ways to Save Money on Suboxone Treatment

You can reduce the amount you pay for Suboxone treatment with manufacturer coupons, as these can offer deep discounts on the medication.[9] Another way is via patient assistance programs, which offer income-based financial assistance.[9] 

Opting for a generic version of Suboxone can also result in significant cost savings for some people.[10] 

How Much Is Suboxone Treatment Without Insurance?

Without insurance, the full cost of Suboxone treatment is influenced by factors like pharmacy location, whether you choose name brand or generic versions, and dosage. The overall price can range from as low as $36 per month to upwards of $500 per month. 

Incorporate the tips above to save money on Suboxone without insurance. Manufacturer discounts, such as coupon savings cards, are often the best way to reduce your costs. You may also be able to get Suboxone cheaply at community clinics and other resource centers.

Suboxone Treatment at Boca Recovery Center

At Boca Recovery Center, we offer complete medical detox services, ensuring our clients stay comfortable and safe in this early phase of recovery. Withdrawal symptoms and cravings stay managed with medications like Suboxone, so clients can focus on the work they are doing in therapy. 

With our compassionate care, clients can progress through medical detox into ongoing addiction treatment. We’re here to provide a full continuum of care, ensuring you achieve and maintain recovery.   

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More