The opioid epidemic has affected individuals of every age in the United States, but individuals eligible for Medicare due to age or disability can be especially vulnerable. Medicare recipients may be more likely to receive an opioid prescription for managing various painful conditions, but the risk of addiction and abuse should be acknowledged before taking opiod drugs. If prescribed by your physician, take the medication as directed, and report any side effects to your doctor immediately.

Unfortunately, opiod addiction is an epidemic. Patients under the care of a physician for their addiction may enter a wide range of treatments to overcome their addiction. One common treatment in opioid addiction is a drug called Suboxone. If you are eligible for Medicare, you will need to understand your coverage and costs for Suboxone.

What Is Suboxone?
Suboxone is a combination of two other drugs: buprenorphine and naloxone. This combination helps reduce a patient’s cravings for opioids while also cutting down on the severity of withdrawal symptoms. The drug can be prescribed by a general practitioner, such as your family doctor.

Suboxone is one treatment available for opioid dependence, but it’s typically not used alone. As a general rule, it is prescribed as part of a larger drug rehabilitation program that includes a variety of other treatments, including:

  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Group therapy
  • Individual therapy
  • Relapse prevention
  • Family therapy

Suboxone can only treat the physical manifestations of addiction, such as cravings and withdrawal symptoms. It cannot treat the underlying emotional, mental, or social causes that drive addiction. Underlying issues can be addressed through recovery therapy.

Medicare Coverage for Suboxone
Medicare Part D prescription drug coverage may help cover the cost of your Suboxone if your doctor participates in Medicare, accepts assignment, and deems your prescription medically necessary. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). If you choose to join a Medicare Advantage plan, you will have the same coverage as Original Medicare Part A and Part B, but many MA plans include additional coverage, including prescription drug benefits.

Cost for Suboxone Under Medicare Part D
While most prescription drug plans provide some coverage for Suboxone, your exact cost will depend on your prescription drug plan benefits. Each PDP or Medicare Advantage plan with prescription drug coverage (MA-PD) will have its own formulary, or list of covered drugs. Each plan will have its own tiers of pricing, as well. Costs will vary based on whether you get a brand-name or generic medication, visit a pharmacy within the plan’s network, or use the plan’s mail order service. Check with your plan directly to find out your exact cost and coverage for Suboxone.

Related articles: Frequently Asked Questions (FAQ)

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