Is Suboxone Covered by Medicare?

Like Medicare Part D, you may be covered for Suboxone if you have a Medicare Part C plan.

Also called Medicare Advantage, Medicare Part C plans cover benefits from original Medicare (Medicare Part A – hospital insurance and Medicare Part B – medical insurance). Many Medicare Part C policies also include prescription drug coverage and other coverage not included in original Medicare, such as vision and dental.

Both Medicare Part D and Medicare Advantage are provided by private insurance companies approved by Medicare. Both typically have:

• premiums (the amount you pay for the policy)
• deductibles (the amount you pay before the plan pays anything)
• coinsurance and copays (the amount you pay after the plan pays its share)

If your Medicare plan does not cover Suboxone, it’s likely that your plan will cover the generic form of the drug, buprenorphine/naloxone. Some plans do not cover either Suboxone or its generic buprenorphine/naloxone.

According to the Department of Health and Human Services, Medicare does not have a distinct benefit category for substance abuse treatment. Treatment for substance abuse disorders would be covered if deemed medically reasonable and necessary. Typically, services include:

• inpatient treatment
• outpatient treatment

Inpatient treatment

Inpatient treatment, if deemed necessary, would include:

• part of the inpatient stay under Medicare Part A for professional services not recognized for separate billing
• professional billing for the provided services considered separate from the inpatient stay under Medicare Part B

Outpatient treatment

Outpatient treatment, like inpatient treatment, would depend on the provider of the services. Medicare doesn’t recognize treatment facilities as an independent provider type. As such, for any services recognized by Medicare, coverage and payment would be determined on a service by service basis.

Eligible Medicare service suppliers

Eligible suppliers include:

• physicians
• physician assistants
• nurse practitioners
• clinical nurse specialists
• clinical psychologists
• clinical social workers
• certified nurse-midwives

Coverage may include combination products like Suboxone when medically necessary as well as single entity products such as Subutex.

Some drugs, like methadone may also be covered by a Medicare Part D policy. But this drug, used to treat opioid dependence, cannot be dispensed as a prescription medicine. As such, coverage may vary depending on circumstances and indication.

Suboxone is a prescription drug used to treat opioid drug dependence. It’s not covered by original Medicare (Part A and Part B). If you have original Medicare, however, you can purchase Medicare Part D for prescription drug coverage or a Medicare Advantage plan.

Depending on the details of the policy, a Medicare Part D policy, or Medicare Advantage Plan (Medicare Part C) may help cover the cost of Suboxone or its generic buprenorphine/naloxone.