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Is Probuphine covered by insurance?

Medically reviewed by Sally Chao, MD. Last updated on May 12, 2021.

Official answer

by Drugs.com

Probuphine (buprenorphine) is covered by most private insurance companies, Medicare plans and Medicaid.

It is not available in retail pharmacies. If your doctor is trained and certified to treat opioid use disorder (OUD) with Probuphine, your doctor can purchase Probuphine from the pharmaceutical company and then bill your insurance carrier. Your doctor may also write a prescription for you that is sent to a specialty pharmacy, and the pharmacy will then bill your insurance.

  • As of January 2018, close to 90% of major private insurance companies were covering Probuphine treatment given in a certified doctor’s office.
  • Medicaid programs are required to provide coverage if the treatment is medically necessary.
  • Medicare Part B may require your doctor to purchase Probuphine and then bill your insurance.

Braeburn Pharmaceuticals, the company that makes Probuphine, also has a program to help people who have a high out-of-pocket cost.

Probuphine is the first buprenorphine implant. It was approved to treat OUD by the U.S. Food and Drug Administration in 2016. Buprenorphine is a weak opioid that binds to opioid receptors and prevents stronger opioids like heroin from giving a pleasurable effect. It also reduces opioid cravings and withdrawal symptoms. When used in an OUD treatment program along with counseling and support therapy, buprenorphine reduces treatment relapse and overdose deaths from opioids.

Probuphine comes as 4 one-inch inserts that a certified provider can insert under the skin of your upper arm. The inserts will provide a continual release of buprenorphine over 6 months. After 6 months, the inserts are removed, and new inserts can be placed into the opposite arm for another 6 months if needed. Probuphine is approved for people with OUD who have been stabilized on daily buprenorphine. Sustained release by the inserts assures compliance and avoids the inconvenience of daily, oral dosing.

The average cost of Probuphine treatment is about $250 per month or about $3,000 per year. Side effects of Probuphine include insertion site reactions, such as pain, irritation and itching. There is also a chance that the implants can come out or move. Common side effects of buprenorphine include headache, constipation, nausea and vomiting.

If you have been stabilized on buprenorphine oral medication and your doctor recommends long-term maintenance with Probuphine, talk to your doctor about the risks and benefits. Check with your insurance carrier for coverage. If you do not have insurance coverage, the company that makes Probuphine may be able to help you.

References
  1. U.S. Food and Drug Administration (FDA). FDA approves first buprenorphine implant for treatment of opioid dependence. June 8, 2016. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-buprenorphine-implant-treatment-opioid-dependence. [Accessed April 15, 2021].
  2. Substance Abuse and Mental Health Services Administration (SAMHSA). Buprenorphine. March 12, 2021. Available at: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. [Accessed April 15, 2021].
  3. National Center for Biotechnology Information. Pharmacoeconomic Review Report: Buprenorphine extended-release injection (Sublocade): (Indivior Canada, Ltd.): Indication: For the management of moderate-to-severe opioid use disorder in adult patients who have been inducted and clinically stabilized on a transmucosal buprenorphine-containing product [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jul. Appendix 1, Cost Comparison. Available at: https://www.ncbi.nlm.nih.gov/books/NBK546359/. [Accessed April 16, 2021].
  4. Braeburn. Braeburn Access Program FAQs. February 2018. Available at: https://braeburnaccessprogram.com/wp-content/uploads/2018/03/PRO-10047-FAQ-AFD-03.02.2018.pdf. [Accessed April 16, 2021].

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