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Suboxone is a brand of buprenorphine / naloxone. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 848 of 5,492 Medicare Part D and Medicare Advantage drug plans (15.4%) list Suboxone on their formulary, across 4 of 286 formularies. The most common placement is tier 4 (848 plans, 100% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 0 a quantity limit. Generic buprenorphine / naloxone is on 5,492 of 5,492 plans (100%).
11 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 11 of them $0; 837 charge coinsurance instead — median 27% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 883 of 5,496 plans covered it (16.1%); 2027: 848 of 5,492 (15.4%).
Of 4,367 plans offered in both years, 0 added it to the formulary and 29 dropped it.
Among plans covering it both years, 0 moved it to a higher tier and 0 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 4 | 848 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 73 of 323 | 22.6% | 0% |
| Medicare Advantage with drugs (MA-PD) | 413 of 3,200 | 12.9% | 0% |
| Special needs plans (SNP) | 362 of 1,969 | 18.4% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 830 of 830 | Tier 4 | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 0 of 631 | No tier listed | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 0 of 74 | No tier listed | 0 |
| Wellpoint | 0 of 63 | No tier listed | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 0 of 36 | No tier listed | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 16 of 114 | 14% |
| Alaska | 2 of 9 | 22.2% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 20 of 147 | 13.6% |
| Arkansas | 12 of 85 | 14.1% |
| California | 42 of 397 | 10.6% |
| Colorado | 22 of 106 | 20.8% |
| Connecticut | 9 of 54 | 16.7% |
| Delaware | 9 of 43 | 20.9% |
| District of Columbia | 5 of 12 | 41.7% |
| Florida | 55 of 545 | 10.1% |
| Georgia | 20 of 149 | 13.4% |
| Guam | 1 of 1 | 100% |
| Hawaii | 8 of 50 | 16% |
| Idaho | 16 of 45 | 35.6% |
| Illinois | 21 of 132 | 15.9% |
| Indiana | 23 of 138 | 16.7% |
| Iowa | 13 of 64 | 20.3% |
| Kansas | 15 of 84 | 17.9% |
| Kentucky | 21 of 121 | 17.4% |
| Louisiana | 23 of 125 | 18.4% |
| Maine | 12 of 52 | 23.1% |
| Maryland | 6 of 49 | 12.2% |
| Massachusetts | 11 of 89 | 12.4% |
| Michigan | 13 of 182 | 7.1% |
| Minnesota | 9 of 63 | 14.3% |
| Mississippi | 19 of 104 | 18.3% |
| Missouri | 29 of 170 | 17.1% |
| Montana | 4 of 27 | 14.8% |
| Nebraska | 9 of 51 | 17.6% |
| Nevada | 20 of 100 | 20% |
| New Hampshire | 7 of 25 | 28% |
| New Jersey | 12 of 73 | 16.4% |
| New Mexico | 30 of 68 | 44.1% |
| New York | 29 of 215 | 13.5% |
| North Carolina | 29 of 176 | 16.5% |
| North Dakota | 6 of 26 | 23.1% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 28 of 171 | 16.4% |
| Oklahoma | 20 of 81 | 24.7% |
| Oregon | 10 of 92 | 10.9% |
| Pennsylvania | 23 of 323 | 7.1% |
| Puerto Rico | 1 of 64 | 1.6% |
| Rhode Island | 11 of 29 | 37.9% |
| South Carolina | 11 of 89 | 12.4% |
| South Dakota | 4 of 30 | 13.3% |
| Tennessee | 23 of 156 | 14.7% |
| Texas | 72 of 407 | 17.7% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 15 of 53 | 28.3% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 37 of 144 | 25.7% |
| Washington | 25 of 114 | 21.9% |
| West Virginia | 11 of 69 | 15.9% |
| Wisconsin | 23 of 96 | 24% |
| Wyoming | 2 of 13 | 15.4% |
Medicare Part D paid for 150,184 30-day fills of Suboxone in 2024 for about 18,356 enrollees, at an average total cost of $499.50 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Suboxone and the rest of a client's list on every plan in their county.
Estimate Suboxone costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.