Recovering from substance abuse can present a variety of challenges, but some medications may be able to help people maintain their sobriety. Medicare benefits may help pay for the cost of these medications under certain circumstances.

Understanding How Vivitrol Works

Vivitrol is an injectable form of naltrexone, a medication most commonly used to help patients combat their opioid or alcohol addiction. By interfering with the effect opioids have on the body’s opioid receptors, this drug can effectively cancel out the “high” sensation that taking opioids or drinking alcohol provides.

It does not prevent impairment from intoxication, but it can be used to reduce a person’s desire to abuse opioids and alcohol due to the lack of euphoric experiences that occur during successful treatment with Vivitrol. Physicians will typically start treatment with Vivitrol only after they are certain a patient has stopped taking opioids or ingesting alcohol for a week or more as a safety measure.

Because this form of naltrexone requires intramuscular injection, it is administered by a qualifying health professional. The dosing timeline usually follows a once-a-month or every 4- weeks pattern. Patients should be prepared to follow the schedule their physician establishes to avoid any complications or risk of relapse.

Side Effects and Risks Associated with Vivitrol

As with many injectable medications, there may be irritation, redness, swelling or itching at the site of injection. If deeper tissue damage is suspected, it should be reported to a physician immediately.

Some patients have described gastrointestinal distress or withdrawal-like symptoms after receiving a Vivitrol injection. Doctors may monitor patients closely in case the medication reacts with any narcotics that may still be in a patient’s system.

Patients with liver disease or who may be deemed at risk of liver toxicity may not be able to take Vivitrol. Other over-the-counter medications used to treat certain symptoms of common ailments, such as the flu or a cold, may cause adverse reactions while taking Vivitrol.

Taking opioids or drinking alcohol while under treatment with Vivitrol can increase the risk of overdose or alcohol poisoning. Because this medication inhibits the euphoria people are seeking from using these substances, they may increase the amount they take to life-threatening levels to try to bypass the effects of Vivitrol.

Medicare Coverage for Vivitrol

Substance abuse treatment programs may be subject to different billing practices depending on how a recipient participates in these programs. Inpatient hospitalization for substance abuse treatment that includes Vivitrol may be eligible for Medicare Part B coverage if the way the medication is administered and the circumstances under which the facility bills the cost of that medication meets the requirements of Medicare Part B benefits. Representatives of the inpatient facility should be able to provide recipients with detailed information about their Medicare share-of-cost obligations in that setting.

Treatment with Vivitrol through an outpatient substance abuse program may be ineligible for Part B coverage, but some Part D Prescription Drug Plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MA-PDs) may provide coverage for Vivitrol injections. These PDPs and MA-PDs are managed by private insurers who determine which medications are included on their formularies, or list of covered drugs. As costs and coverage can vary, recipients should check with their providers to verify Vivitrol is included and at what cost tier in order to determine their cost-sharing obligations.

Dual-eligibles who qualify for Medicaid services in addition to their Medicare benefits may be able to access enhanced prescription drug coverage or substance abuse treatment options. This can include coverage of certain premiums, deductibles, copays or coinsurance amounts. Medicaid income and asset limitations are set by each state, so recipients should contact their local state office for more information about these options.

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