Drug Coverage for Opioid Use Disorder
PharmaCare covers the following drugs as treatment for opioid use disorder:
- Several formulations of methadone
- Buprenorphine/naloxone (generics at the full cost, brand name Suboxone® up to the cost of the generics)
- Kadian® 24-hour slow release oral morphine
PharmaCare covers the above medications under Fair PharmaCare. It also provides 100 percent coverage under PharmaCare Plan C (Income Assistance), Plan G (Psychiatric Medications), and Plan W (First Nations Health Benefits).
Currently, only generic versions of buprenorphine/naloxone are fully covered. With the brand-name product, Suboxone®, PharmaCare provides partial coverage of the product, covering up to the cost of the equivalent generic product under the Lowest Cost Alternative policy. For partial benefit products, the pharmacy may charge you an additional cost for the brand name product over what PharmaCare covers. In certain circumstances, such as an allergic reaction, your prescriber may request Special Authority for the full cost of a brand name product.
Drugs requiring Special Authority approval
PharmaCare covers long-acting injectable buprenorphine (brand name Sublocade®) only under specific medical circumstances, as a “limited coverage” drug. Your prescriber can submit a Special Authority request if they believe you would benefit from a limited coverage drug such as Sublocade®. If PharmaCare approves the request, you will be fully covered for the drug, subject to the rules of your PharmaCare plan. If approved, Sublocade® will be covered under Fair PharmaCare, Plan C (Income Assistance), Plan G (Psychiatric Medications), and Plan W (First Nations Health Benefits).
Some OAT medications, such as high-dose buprenorphine with naloxone, are only covered on an exceptional basis. Coverage of these products requires your prescriber to submit a Special Authority request.
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