Does Medicaid Cover Suboxone?
- Explore Medicaid coverage for opioid addiction treatment. Find out if Medicaid covers the cost of Suboxone or if you'll need to pay for the drug out of pocket.
In 2019, 10.1 million people over the age of 12 took opioids for non-medical reasons, according to the U.S. Department of Health and Human Services. These staggering numbers reflect the size of the opioid addiction epidemic in the United States. Breaking the cycle of addiction is difficult, but treatments like Suboxone can increase the chances of success. This drug is available only with a doctor's prescription and is often covered by Medicaid.
Does Medicaid Cover Suboxone?
Medicaid funding is provided in part by the federal government, but states set their own program rules. As a result, what's covered under Medicaid depends on where you live. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 50 out of 51 Medicaid programs cover buprenorphine, one of the two medications found in Suboxone. Most plans include the brand name version Suboxone on their formularies, indicating that the medication is a covered drug.
Although Suboxone is likely to be covered under your Medicaid plan, you must follow certain rules to get help paying for the medication. No matter where you live, Suboxone must be prescribed by a physician who has received special training and registered with the Drug Enforcement Agency (DEA).
Depending on where you live, other restrictions may limit buprenorphine coverage, such as:
- Requirements for prior authorization. Most states require you to obtain authorization for Medicaid before you begin taking buprenorphine. If you don't, your plan is likely to deny coverage.
- Behavioral therapy requirements. About 40% of states only cover buprenorphine if you are also enrolled in behavioral therapy for addiction. States may set strict guidelines for what qualifies as therapy, and you may need to continuously show proof of attendance for buprenorphine coverage to remain in effect.
- Quantity and time limits. More than half of all states limit how much buprenorphine you can receive at one time. Often, you can receive only a 30-day supply. Less than a quarter of state Medicaid programs place lifetime caps on coverage. Once you have reached the cap, Medicaid no longer covers the drug.
- Form restrictions. Your doctor may need to prescribe the generic form of Suboxone for Medicaid to cover it.
What Does Suboxone Do?
Suboxone is an oral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid addiction. It is a combination drug that contains buprenorphine and naloxone. The drug works by attaching to the same receptors as opioids. While this may alter mood the way that opioid drugs do, the intoxicating effects of Suboxone are much lower when the medication is used correctly.
Doctors prescribe Suboxone because the drug:
- Reduces withdrawal symptoms like body aches, anxiety, sweating, insomnia, gastrointestinal issues and agitation
- Blocks other illicit drugs from binding to receptors to help prevent euphoric feelings
- Lowers the likelihood of overdose
- Minimizes cravings for opioids
- Increases success rates for opioid addiction treatments
- Makes relapses less likely
Compared to methadone, another drug prescribed for opioid misuse disorder, Suboxone is:
- Simpler to administer. With methadone, you must visit a hospital or clinic to get your medication. Suboxone can be prescribed by eligible physicians from their offices.
- Less likely to be abused. Suboxone is weaker than methadone and less likely to cause feelings of euphoria. When misused, the drug causes unpleasant symptoms like withdrawal, discouraging abuse.
- Generally safer. Methadone is four times more likely to cause overdoses than Suboxone. Overall, the risk of Suboxone overdose is low unless it is mixed with alcohol or drugs that slow nervous system activity like benzodiazepines.
How Long Can You Be Prescribed Suboxone?
Before you can begin taking Suboxone, you must refrain from using opioids for 12 to 24 hours. After treatment begins and you're stabilized, your doctor is likely to begin changing your dosing schedule. You may begin to take the medication every other day rather than daily.
SAMHSA states that there's no limit on how long you can be prescribed Suboxone from a medical perspective. Your doctor will create a weaning schedule based on your individual needs. If your Medicaid plan has a lifetime limit on Suboxone use, the guidelines will likely be taken into consideration when creating the schedule.
Can You Get Free Suboxone?
GoodRx reports that as of October 2021 the retail price of 30 Suboxone tablets is around $300. The actual costs depend on where you live and choose to fill your prescription.
In some states, Medicaid completely covers the cost of Suboxone. Others require you to pay a copay. The amount that you're responsible for may be a flat fee or vary depending on the cost of the medication. As of 2018, Medicaid copays for Suboxone ranged from $0.50 to $5, according to the Kaiser Family Health Foundation.
The manufacturer of Suboxone offers the InSupport program to make the drug more affordable; however, individuals on Medicaid aren't eligible.