University of Wisconsin–Madison

Paying for Buprenorphine

Changes to health care laws implemented in 2014 required Medicaid and private insurance companies to provide full coverage for treatment of substance use disorders. In spite of the expansion of health care coverage, finding a way to pay for buprenorphine remains a challenge for many publicly-funded addiction treatment providers.

According to the SAMHSA publication, Medicaid Coverage and Financing Medications to Treat Alcohol and Opioid Use Disorders, Medicaid covered buprenorphine in all 50 states in 2013.1

However, a 2016 study that published results of a nationwide survey of state Medicaid programs found that states vary considerably in how they cover medications for opioid use disorders.2

See the related article: Medicaid Coverage for Addiction Treatment Varies Dramatically

Most private insurance companies also now cover buprenorphine and other FDA-approved medications to treat addiction. Coverage is often tightly controlled due to restrictions such as:

  • Prior authorizations
  • Limits on dosage and duration
  • “Fail first” policies that require patients to try non-medication based treatments first
  • Covering the medication, but not the doctor’s office visit

Treatment organizations may want to explore any of the following options when looking for ways to fund buprenorphine treatment.

 


1 Substance Abuse and Mental Health Services Administration, Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders. HHS Publication No. SMA-14-4854. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

 

2 Grogan, C. M., Andrews, C., Abraham, A., Humphreys, K., Pollack, H. A., Smith, B. T., & Friedmann, P. D. (2016). Survey highlights differences in Medicaid coverage for substance use treatment and opioid use disorder medications. Health Affairs35(12), 2289-2296.

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