Medicare covers a variety of generic and brand-name prescription drugs, including Suboxone, to treat opioid use disorder (OUD).

Suboxone is a brand-name prescription medication containing buprenorphine and naloxone.

Buprenorphine is a partial opioid agonist that can help ease or prevent symptoms of withdrawal. It’s a long-acting drug that can block the effects of shorter-acting opioids and opiates associated with misuse.

Naloxone is an opioid antagonist, which means that it can help block the effects of opioid and opiate use. It’s added to buprenorphine to reduce the risk of misuse.

Generic buprenorphine/naloxone is available as a tablet or film. Both forms can be used sublingually (dissolved under the tongue). The film can also be administered buccally (dissolved inside the cheek).

Suboxone is only available as a film. Brand-name Suboxone tablets are no longer in production. Zubsolv is the only brand-name tablet available.

Original Medicare (Parts A and B), Medicare Advantage (Part C), and prescription drug (Part D) plans cover different aspects of treatment for OUD.

The part of Medicare that covers buprenorphine/naloxone depends on where you receive the medication.

Part A is hospital insurance. It covers inpatient services at a general or psychiatric hospital, rehabilitation center, or other approved facility.

This includes counseling and administering medication-assisted treatment (MAT) drugs like brand-name or generic Suboxone.

Most people do not have to pay a monthly premium for Part A. If you don’t meet the criteria for premium-free Part A, you’ll pay $278 or $505 each month.

Here are the basic costs for an inpatient hospital stay in 2024:

  • $1,632 deductible for each benefit period
  • $0 coinsurance for days 1 to 60 of treatment after you pay your deductible
  • $408 coinsurance per day for days 61 to 90 of treatment
  • $816 coinsurance per day for days 91 to 150 of treatment while using your 60 lifetime reserve days
  • 100% of the treatment costs for days 151+

Part B is medical insurance. It covers outpatient care, including partial hospitalization services, mental health counseling, and administering MAT drugs like brand-name or generic Suboxone.

Part B also covers services related to Screening, Brief Intervention, and Referral to Treatment (SBIRT).

SBIRT is an early detection and intervention approach for people who may be at risk of developing a substance use disorder like OUD.

If you have already received an OUD diagnosis, Part B covers intensive outpatient programs and services at a:

  • hospital
  • community mental health center
  • federally qualified health center
  • rural health clinic
  • opioid treatment program (OTP)

In 2024, most people will pay a monthly premium of $174.70. Your premium may be higher depending on your income.

After you pay a $240 deductible, you’ll generally pay 20% of all Medicare-approved costs for covered services. This is known as “cost-sharing.”

If you receive MAT drugs or other services at an OTP, you do not have a copayment, coinsurance, or other out-of-pocket cost. Cost-sharing is not permitted at OTPs.

Medicare maintains a directory of approved OTP providers that you can search to find one near you.

Part C is an alternative to Original Medicare that must offer the same hospital and medical insurance as parts A and B. Many Part C plans also include Part D coverage for prescription drugs.

Each Part C plan sets its own cost and coverage amounts. The premiums, deductibles, copayments, and coinsurance amounts you’ll pay ultimately depend on your specific plan.

Staying in network — which means getting care from a list of approved healthcare professionals and facilities, including OTPs — typically costs less than going out of network.

Unlike Original Medicare, Part C plans can require you to pay a copayment for OTP services.

Part C plans limit what you’ll pay out of pocket each year for covered services. Once you reach the plan’s out-of-pocket maximum, it will pay 100% of all approved costs for the rest of the calendar year.

Part D is prescription drug coverage. You can purchase it as an add-on to Original Medicare. It’s generally included in Medicare Advantage, so you typically can’t enroll in a separate Part D plan.

Each Part D plan sets its own cost and coverage amounts. The amount of coverage each plan provides depends on its formulary and tier system.

A 2023 study looked at Part D coverage of buprenorphine/naloxone film before and after the Food and Drug Administration approved generic versions in 2018.

They found that brand-name Suboxone film has “accounted for the bulk of the buprenorphine market in the past decade.”

Buprenorphine/naloxone film

Suboxone film coverage decreased from 76% in 2019 to 42% in 2020. In comparison, 82% of Part D plans covered generic buprenorphine/naloxone film in 2020.

In 2022, the mean (which is the sum of all values divided by the number of figures) out-of-pocket cost for a 30-day supply of Suboxone films without insurance ranged from $160 to $570.

The median (which is the middle number in a list arranged from least to greatest) out-of-pocket cost for a 30-day supply of brand-name buprenorphine/naloxone film with Part D increased from $85 in 2015 to $100 in 2022.

The median out-of-pocket cost for a 30-day supply of buprenorphine/naloxone film with Part D decreased from $99 in 2019 to $42 in 2020, driven by the lower price of generic films.

Buprenorphine/naloxone tablets

The researchers also examined changes in the coverage of buprenorphine-naloxone tablets during this time. Generic buprenorphine/naloxone tablet coverage increased from 68% in 2015 to 85% in 2022.

Brand-name Zubsolv tablet coverage increased from 15% in 2017 to 34% in 2018. However, it has slightly decreased since 2021.

Overall, the researchers “observed large decreases in the out-of-pocket costs” for generic and brand-name buprenorphine/naloxone tablets.

Part A covers inpatient administration of MAT drugs like brand-name or generic buprenorphine/naloxone. Part B covers outpatient administration, including OTP services that do not have cost-sharing.

Part C covers inpatient and outpatient administration, as well as prescription drug coverage. If you have Original Medicare, you can enroll in a separate Part D plan for prescription drug coverage.

Your out-of-pocket costs depend on what part of Medicare you have, whether you’re accessing inpatient or outpatient services, and whether you receive brand-name or generic buprenorphine/naloxone film or tablets.