Does Medicaid Cover Vivitrol?

Vivitrol (naltrexone) is a prescription medication for alcohol and opioid use disorder. It is covered by Medicaid health plans in all 50 U.S. states and the District of Columbia.

Eligibility requirements for receiving Medicaid coverage for Vivitrol may vary according to your state of residence and the type of Medicaid coverage plan you have.

Read more about using insurance to pay for Vivitrol

Medicaid Insurance Coverage For Vivitrol

Vivitrol is an extended-release, injectable form of naltrexone that is received in the form of a once-a-month shot. It is FDA-approved to treat alcohol and opioid use disorder. Vivitrol is prescribed alongside other support services as part of a medication-assisted treatment (MAT) program, which is the first-line treatment for opioid use disorder.

Vivitrol use has grown significantly over the past decade as more states and treatment providers have recognized the importance of medication-assisted treatment for opioid and alcohol addiction. The medication has become increasingly accessible through Medicaid coverage as states work to expand access to addiction treatment services.

Is Prior Authorization Required For Medicaid Coverage Of Vivitrol?

Prior authorization for Medicaid coverage of Vivitrol is required in 15 U.S. states, the District of Columbia (D.C.), and Puerto Rico, as of 2017.

States and territories that require pre-authorization include:

• Colorado
• District of Columbia
• Florida
• Idaho
• Kentucky
• Louisiana
• Maryland
• Mississippi
• Minnesota
• Montana
• Nevada
• Ohio
• Puerto Rico
• Rhode Island
• Tennessee
• Texas
• Utah

Prior authorization requirements may apply in states not listed here. Prior authorization is a process that can be initiated by a primary care physician for medication approval.

How Much Does Vivitrol Cost With Medicaid?

The cost of monthly Vivitrol shots with Medicaid coverage can vary. A single Vivitrol prescription costs about $1,200 a shot, before adjusting for federal basic and inflation rebates. But with Medicaid coverage, pharmacy coupons, and drug discounts, this is not a cost you may be responsible for covering by yourself.

To learn how much Vivitrol costs with your Medicaid plan, you’ll need to refer to your individual policy or contact an insurance representative for more information.

Who Is Eligible For Vivitrol?

Vivitrol is an addiction treatment medication that is prescribed for alcohol or opioid dependence in adults over the age of 18. In order to receive Medicaid coverage for Vivitrol, a clinical diagnosis of an alcohol or opioid use disorder may be required.

How To Get Vivitrol Covered By Medicaid

Getting Vivitrol covered by your Medicaid plan starts with finding a healthcare provider or rehab center that can prescribe the medication and verify that you meet the clinical criteria for treatment. Your doctor will need to diagnose you with alcohol use disorder or opioid use disorder and confirm that you’ve been opioid-free for at least seven to 14 days. If your state requires prior authorization, your provider will submit the necessary paperwork to Medicaid explaining why Vivitrol is medically necessary.

The prior authorization process can take a few days to a few weeks, so start early and follow up regularly. Many rehab centers and addiction treatment clinics that offer medication-assisted treatment are experienced with navigating Medicaid coverage and can help guide you through the process. If your request is denied, you have the right to appeal with additional documentation from your provider.

Written by the Addiction Resource Editorial Staff