Suboxone® Medicare Coverage

Suboxone®
Chemical name: Buprenorphine/Naloxone

Typical dosage: 8mg/2mg

Typical type: Tablet or film1

Suboxone® is a medication used to treat opioid dependence. It is available in both brand and generic versions and can be taken in the form of a sublingual tablet or film.

Suboxone is a schedule III prescription medication that contains the active ingredients buprenorphine and naloxone. It is taken once daily for treatment and long-term maintenance of opioid dependence.

Buprenorphine is a mild opioid receptor agonist that can help to inhibit symptoms of withdrawal, while naloxone is an opioid receptor antagonist used to prevent the euphoric effects of opioids to deter patients from relapsing.

Common side effects of Suboxone include headache, sweating, nausea, constipation and lower back or abdominal pain.

Does Medicare cover Suboxone?

Yes! 84% of Medicare Advantage plans and Medicare Part D plans cover Suboxone.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Suboxone.

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Average costs for Suboxone with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.		 After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$2 – $490 $1 – $469

Additional information

Suboxone is used in combination with counseling and psychosocial support for the treatment of opioid dependence. It may only be prescribed by licensed providers and dispensed at registered pharmacies.

Because Suboxone is a schedule III drug, each prescription expires six months from the date it was written and can only be refilled five times.

Symptoms of withdrawal may arise with abrupt discontinuation of Suboxone. Hepatitis has been associated with this medication, and your provider may request labs to monitor your liver function.

Other serious adverse effects include impaired physical or mental abilities, low blood pressure, fainting and difficulty breathing.

While most patients can safely use Suboxone, it is not recommended for patients who are pregnant and/or breastfeeding.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Suboxone. Retrieved May 2019, from www.goodrx.com/suboxone.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.