Are Butrans Patches Covered By Medicare/Medicaid Or Private Insurance?

Butrans patches, a prescription medication used in the treatment of opioid dependence and chronic pain, are covered by most private and public health insurance plans. This includes Medicare, Medicaid, and many private insurance providers, though the level of coverage can vary depending on the specific plan a person holds. For those using Butrans as part of a medication-assisted treatment program, understanding what their insurance covers can make a significant difference in out-of-pocket costs.

Coverage details for Butrans will differ from one insurance provider to the next, and some plans may require prior authorization or a step therapy requirement before approving coverage. It is worth contacting your insurance provider directly to verify your benefits and confirm what costs to expect before filling a prescription. For those whose insurance does not fully cover Butrans, manufacturer assistance programs or sliding scale payment options may help offset the remaining expense.

Learn more about using Butrans for opioid addiction

Prior Authorization For Butrans Patches

Many companies will require prior authorization to cover a Butrans prescription.

This means the health provider will review all of the other medications a patient is using and determine whether the prescription is necessary.

If prior authorization is not obtained by the insurance providers that require it, a person may need to pay more or cover the cost of Butrans patches out of pocket.

Which Healthcare Providers Cover Butrans Patches?

It’s important to note that while some healthcare providers offer coverage for Butrans patches, these companies have different levels of care that may or may not cover Butrans.

Many insurance plans and levels of Butrans insurance coverage also vary based on each state, whether it’s an individual, family, or employer plan, and other factors.

Contact your health insurance provider for more information on your plan if you are unsure whether Butrans is covered.

Here are some of the major health providers that cover Butrans:

• Aetna
• Blue Cross Blue Shield
• Cigna
• Humana
• Kaiser Permanente
• Liberty Advantage
• MassHealth
• Medicare
• Medicaid
• United Healthcare

What Does Medicare/Medicaid Or Private Insurance Cover For Butrans?

Each health insurance provider will have a different level of coverage when it comes to Butrans patches.

Here is what each of the major healthcare providers will cover for Butrans patches.

Aetna

Doses offered:

• 5 mcg/hr
• 7.5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

Aetna offers a zero copay for some members with a prescription from your provider when obtained at an in-network pharmacy.

Blue Cross Blue Shield

Doses offered:

• 5 mcg/hr
• 7.5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

Dispensing limits and prior authorization apply.

Cigna

Doses offered:

• 5 mcg/hr
• 7.5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

Dispensing limits and prior authorization apply.

Humana

Doses offered:

• 5 mcg/hr
• 7.5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

The quantity limit for Butrans patches with Humana is set at four patches per 28 days.

Humana also requires step therapy when seeking Butrans treatment. Step therapy is trying a less costly medicine before ‘stepping up’ to a more expensive option.

Because Butrans is a costly drug, Humana will require the patient to try a less expensive medicine before beginning Butrans treatment to see if a different prescription might work.

Kaiser Permanente

Kaiser Permanente covers both generic and brand-name prescriptions of buprenorphine treatment. These prescriptions have quantity limits.

Butrans patches are not offered in every state.

Liberty Advantage

Here, patients can obtain a generic prescription for buprenorphine patches.

Doses offered:

• 5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

The quantity limit is set at four patchers per 28 days.

MassHealth

With this insurance provider, a person seeking Butrans treatment can get a prescription for a dose of 20 mcg/hr. There’s a quantity limit for Butrans of four patches per 28 days.

Medicare

Only 38% of Medicare prescription drug plans cover Butrans. Most of these plans have quantity limits for each prescription. Medicare Part D covers Butrans patches. Medicare Part B covers opioid use disorder (OUD) treatment services in opioid treatment programs. If a person receives treatment for an OUD in an opioid treatment center that’s enrolled in Medicare, it’s free with Medicare.

Medicare offers both generic (buprenorphine) and brand-name (Butrans) patches.

Medicaid

Medicaid covers Butrans patches and requires prior authorization. There is a quantity limit set for this prescription. Medicaid considers Butrans a preferred product, meaning the generic brand is not available.

United Healthcare

Doses offered:

• 5 mcg/hr
• 7.5 mcg/hr
• 10 mcg/hr
• 15 mcg/hr
• 20 mcg/hr

United Healthcare only covers a maximum of four patches per 28 days and requires prior authorization.

Cost Of Butrans Patches With Medicare/Medicaid Or Private Insurance

The out-of-pocket cost of Butrans with the help of private or government-funded health insurance can range between $15 and $381. This will depend on the specific coverage and copay needed for each health insurance company. Some plans cover most of the cost, while others have more restricted plans.

Learn More About Butrans Treatment

If you or a loved one are looking for treatment options for an opioid use disorder, help is available in several addiction treatment centers. Participate in medical detox, outpatient rehab, medication-assisted treatment (MAT), and more options that utilize Butrans patches as a part of a holistic recovery plan.

Written by the Addiction Resource Editorial Staff