Suboxone Medicare Coverage

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.

How much does Buprenorphine/Naloxone cost with Medicare?

Buprenorphine/Naloxone coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Buprenorphine/Naloxone?

According to GoodRx, 90% of Medicare Advantage plans and Medicare Part D plans covered Buprenorphine/Naloxone, the generic form of Suboxone, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Buprenorphine/Naloxone include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.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 Buprenorphine/Naloxone. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

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.