If you are currently navigating for an OUD (Opioid Use Disorder), understanding the fiscal investment is deemed the first vital step. For the majority of investments, Sublocade cost with insurance ranges between $0-$100 every month. Without insurance, the listed price for the medication can go beyond $1,900 per month, making health coverage as well as assistance programs compulsory. 

Overcoming an Opioid Use Disorder is a very courageous journey, and being worried about how to pay for MAT (Medication-Assisted Treatment) should not be in your recovery’s way. Sublocade is an extended-release, monthly buprenorphine injection that removes the requirement for everyday dosing, aiding you in remaining focused on reconstructing your life. 

In this detailed guide, we break down precisely how distinct insurance policies cover Sublocade, what hidden expenses you need to look out for, and how AllianceMD’s clinical team offers you assistance: 

Understanding What Sublocade is and How It Works?

Sublocade is buprenorphine’s brand name formulation. As opposed to oral medications such as Suboxone, Sublocade is administered like a subcutaneous injection once per month by an officially-certified healthcare professional. 

Once it gets injected, the liquid medication creates a small-sized gel depot under the person’s skin. It steadily and consistently releases a steady dosage of buprenorphine into the individual’s bloodstream over the month’s course. 

Since buprenorphine is deemed a partial opioid agonist, it binds directly to the opioid receptors of the brain. This specific mechanism offers a type of “ceiling effect” that prevents you from experiencing the severe highs associated with other forms of opioids, while still simultaneously blocking cravings in addition to minimizing acute symptoms of withdrawal. For patients who are struggling to remember everyday medicine or who need a discreet option for treatment, Sublocade is deemed highly-effective for sustaining outpatient recovery. 

Breaking Down Sublocade Costs With Insurance

Since Sublocade must be administered by an experienced medical professional in a renowned clinic, insurance firms generally process the medication under your medical advantages as opposed to standard pharmacy prescription advantages. Here is a look at what you can expect as per your type of coverage: 

1. Commercial & Private Insurance

If you secure health insurance through an employer or the private marketplace (like Blue Cross Blue Shield, Cigna, Humana, or Anthem), there is a high chance that your plan covers Sublocade.

• Estimated Expenses: $0-$100 every month.

• Important Details: Your precise out-of-packet expense will rely on your particular deductible, copay, or rates of co-insurance. However, with the help of programs of manufacturer assistance, a significant majority of commercially-insured patients end up paying nothing out of pocket for Sublocade itself. 

2. Indiana Medicaid

Programs of State Medicaid majorly subsidize MAT in the case of Substance Use Disorders. AllianceMD proudly accepts an extensive range of state plans, such as Indiana Medicaid, Anthem HIP, CareSource, and more. 

• Estimated Costs: $0 – $4 monthly.

• Important Details: In numerous states, Medicaid prioritizes treatments with extended-release buprenorphine. The significant majority of Medicaid-sponsored patients are subjected to zero out-of-pocket expenses, or at most, a very nominal copay of only a few dollars. 

3. Medicare (Part B)

For older adults/individuals having qualifying disabilities, Medicare manages Sublocade under Part B (Medical insurance), mainly because it is a treatment that is administered. 

• Estimated Costs: $82 – $87 every month (on average). 

• Important Details: While the out-of-pocket expenses for Medicare patients averages approximately $97, this might fluctuate from mere pennies to higher amounts as per your annual maximums, if you carry a backup (secondary) or supplement plan of insurance, it will generally cover the left-out balance, bringing your out-of-pocket expense down to $0

Additional Treatment Expenses to Factor In

When planning the budget for your recovery journey, it is vital to ensure remembering that the physical medication is one a single part of the complete addiction treatment. In order to surprise billing, here are some standard clinical expenses you should keep in mind:

• Initial Oral Stabilization: Prior to safely getting a Sublocade injection administered, clinical guidelines demand that you consume a transmucosal buprenorphine medication (such as Suboxone) for a minimum of seven days. This makes sure that the body properly tolerates the medication. This specific short-term prescription gets processed through your generic pharmacy benefits. Moreover, it carries its very own copy. 
• Administration & Office Visit Charges: Since you cannot self-administer the injection, you will be required to visit a clinic every month. Your insurance might need a standard specialist copay for visiting the doctor as well as the injection’s medical administration. 
• Behavioral Healthcare: Medication-Assisted Treatment or MAT is majorly more effective when paired with behavioral therapy. Comprehensive plans of treatment generally include addiction counseling along with dual-diagnosis support for co-occurring mental health issues such as anxiety, trauma, or depression. Check with your chosen insurance regarding copays for officially-licensed counseling sessions. 

How to Minimize Your Out-of-Pocket Costs

Navigating health insurance can prove to be an overwhelming process, but the good part is that you do not need to do it alone. There are foolproof tactics to aid in minimizing your fiscal burden: 

• Manufacturer Copay Assistance: The manufacturer of the medication provides a “Sublocade Savings Program”. If you possess commercial insurance, this copay card has the power to cover your left-out balance, thereby frequently minimizing your medication expenses to $0. (Note: Federal guidelines restrict Medicaid and Medicare patients from leveraging manufacturer copay cards. However, the state subsidies generally keep these expenses extremely low regardless).
• Secure Prior Authorization (PA): Insurance firms usually need a PA prior to paying for Sublocade. This means that your doctor must necessarily submit documentation authenticating your medical OUD diagnosis. 

Commence Your Recovery Journey With AllianceMD!

To achieve lasting recovery, you do not need to sacrifice your career, family life, or your day-to-day activities. AllianceMD’s certified medical professionals are dedicated to offering compassionate, free-of-stigma outpatient care specifically-tailored to your unique requirements. 

Whether you require assistance authenticating the benefits of your insurance, submitting prior authorizations, or exploring Medication-Assisted Treatment options such as Vivitrol, Sublocade, or Brixadi, our team of experts is ready to advocate for you!

Take the very first step towards a happier and healthier tomorrow. Get in touch with us today to get started!

Frequently Asked Questions (FAQs)

Q. Does Medicaid cover injections of Sublocade? 

A. Yes. Medicaid majorly subsidizes MAT or Medication-Assisted Treatment. As per the specific guidelines of your state, the majority of Medicaid patients pay between $0 – $4 out of pocket to get monthly Sublocade injections. 

Q. Can I obtain a Sublocade prescription at a regular pharmacy? 

A. No. Sublocade is not dispensed at retail drugstores. Since it is a specialized subcutaneous injection, it must necessarily get ordered by, delivered to, as well as administered by a professional, certified healthcare professional in a clinical setting. 

Q. How do I qualify for the Sublocade Copay Assistance Program? 

A. In order to qualify for the manufacturer’s savings program, you must possess a valid prescription for the medication, possess commercial/private health insurance that encompasses a certain portion of the medication’s cost, and not be a part of any state/federal healthcare program (such as Medicare, Medicaid, or VA benefits).