Drug coverage for opioid use disorder
Last updated: October 25, 2022
PharmaCare helps pay for opioid use disorder treatments. For some treatments, your prescriber needs to request special approval ("Special Authority") for coverage.
PharmaCare helps pay for these drugs for opioid use treatment without a special request from your prescriber:
- Several formulations of methadone
- Most dose strengths of buprenorphine/naloxone
- generic buprenorphine/naloxone products are fully covered;
- brand-name Suboxone® products are partially covered (up to the amount covered for the matching generic product). To learn more, see the Low Cost Alternative policy.
- Kadian® 24-hour slow-release oral morphine
The treatments are covered under these PharmaCare plans, subject to the rules of each plan and PharmaCare’s payment policies:
- Fair PharmaCare, with coverage subject to deductible and family maximum
- Plan C (Income Assistance), Plan G (Psychiatric Medications), and Plan W (First Nations Health Benefits), all of which cover 100% of the cost PharmaCare will pay
PharmaCare may cover the following drugs for opioid use treatment, in specific medical circumstances, with a special (“Special Authority”) request from your prescriber:
- Long-acting injectable buprenorphine (brand name Sublocade®)
- High-dose buprenorphine/naloxone
- Brand name version of a generic drug – full coverage
Your prescriber submits a Special Authority request. If PharmaCare approves the request, you will be fully covered for the drug, subject to the rules of your PharmaCare drug plan and PharmaCare’s payment policies.
Your doctor can request full coverage of a brand name drug if, for example, you have an allergy to the generic version.
- Fair PharmaCare has a deductible that people must spend on medications before PharmaCare starts to help. The deductible is based on your income. People with lower incomes do not have a deductible. You can register online for Fair PharmaCare, by phone, or by mail.
- If you have medical and financial need, talk to your prescriber about signing up for Plan G.
- If you are receiving income assistance, you are automatically enrolled in Plan C.
- For Plan W, you need to be enrolled with the First Nations Health Authority.
You can be on several PharmaCare plans at once.
A pharmacist enters your prescription in PharmaNet. PharmaNet determines what you pay, according to the plan you are on.
Questions about PharmaCare?
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