Maximizing Insurance Reimbursement For Vivitrol Injection: A Guide For Medical Billing Professionals

Vivitrol is a prescription injectable medicine used to treat alcohol dependence and prevent relapse into opioid dependence. It is covered by many commercial, private, and public insurance plans, including Medicaid. The cost of Vivitrol without insurance is about $1,176.50 a month on average, but this can vary depending on the pharmacy visited. The cost of Vivitrol treatment includes not just the medication but also the administration of the drug and related support services. There are different ways to obtain and bill Vivitrol depending on the patient's health plan. For example, some health plans allow any network pharmacy to fill Vivitrol, while others require it to be filled through designated specialty pharmacies.

Medicaid covers Vivitrol in all 50 states and the District of Columbia

Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. It is jointly funded by the federal government and the states, with each state operating its own Medicaid program within federal guidelines.

Medicaid covers Vivitrol, a brand-name formulation of naltrexone, in all 50 states and the District of Columbia. Vivitrol is a long-acting, injectable medication used to treat alcohol and opioid use disorder. It is typically administered once a month and can help reduce cravings and prevent the euphoric effects of alcohol and opioids.

While Medicaid covers Vivitrol in all states, eligibility requirements and coverage specifics may vary depending on the state of residence and the type of Medicaid coverage plan. For example, prior authorization, copayment, and other eligibility requirements may apply in some states. Additionally, the cost of Vivitrol with Medicaid coverage can vary, and individuals may need to refer to their individual policies or contact an insurance representative to determine the exact cost.

It is important to note that the District of Columbia's Medicaid program provides free or low-cost health coverage to eligible individuals with low or very low incomes, including children, pregnant women, seniors, and individuals with disabilities. To be eligible for Medicaid coverage in the District of Columbia, individuals must meet specific residency, citizenship, and income requirements.

Commercial insurance plans cover Vivitrol

The VIVITROL Co-pay Savings Program covers up to $500/month of co-pay or deductible expenses for eligible patients with a VIVITROL prescription. 91% of eligible patients using the VIVITROL Co-pay Savings Program had no out-of-pocket expenses for VIVITROL. This is based on claims data from commercially insured patients enrolled in the program from January 2022 through December 2022.

Vivitrol is a prescription injectable medicine used to treat alcohol dependence and prevent relapse into opioid dependence after opioid detoxification. It is not known if Vivitrol is safe and effective in children.

To be effective, Vivitrol must be used with other alcohol or drug recovery programs such as counselling. It may not work for everyone.

Government insurance plans cover Vivitrol

Vivitrol is a prescription injectable medicine used to treat alcohol dependence and prevent relapse into opioid dependence. It is a brand-name formulation of naltrexone, which is used to treat certain types of drug dependence.

Insurance coverage for Vivitrol

99% of people with insurance are covered for Vivitrol, including most government and commercial plans. However, there are some exceptions. Patients using federal or state healthcare programs to cover the cost of their Vivitrol prescription are not eligible for the Vivitrol Co-pay Savings Program. These programs include:

• Medicare
• Medicaid
• Veterans Administration
• Department of Defense
• State-funded programs such as medical or pharmaceutical assistance programs and residential correctional programs

Cost of Vivitrol without insurance

Without insurance, the cost of Vivitrol is about $1,176.50 a month on average, when administered as part of an opioid treatment program. The retail cost of Vivitrol per unit can vary, ranging from $1,000 to $1,500 for a 380-milligram extended-release shot, depending on the pharmacy visited.

How to pay less for Vivitrol

A reduced cost for Vivitrol may be available through a patient assistance program, or a co-pay savings program for those with commercial, public, or private insurance.

Patients with no insurance may pay as little as $0 per prescription

Vivitrol is a prescription injectable medicine used to treat alcohol and opioid dependence. It is covered by many commercial, private, and public insurance plans. Without insurance, Vivitrol typically costs upwards of $1,000 per shot, on average.

The VIVITROL Co-Pay Savings Program

The VIVITROL Co-Pay Savings Program covers up to $500/month of co-pay or deductible expenses for eligible patients with a VIVITROL prescription. Eligible patients who have commercial insurance or no insurance may pay as little as $0 per prescription of VIVITROL. The maximum savings per prescription is $500, up to 12 prescriptions per calendar year, with maximum savings of $6,000 per calendar year. Patients' out-of-pocket expenses may vary. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Additional terms and conditions apply.

How to get help paying for Vivitrol

If you are uninsured, you can look into patient assistance programs or co-pay savings programs. These programs can reduce out-of-pocket costs to $0 per month for people with and without insurance. You can also research generic or lower-cost medication options, or reach out to your insurance company to inquire about coverage exceptions or appeals processes.

The average cost of Vivitrol without insurance is $1,176.50 per shot

Vivitrol is a brand-name formulation of naltrexone, a prescription injectable medicine used to treat alcohol and opioid dependence. It is not a cure, but it helps reduce cravings and prevents the euphoric effects of these substances. It is usually administered once a month.

If you are paying without insurance, you can use a SingleCare Vivitrol coupon to reduce the cost of Vivitrol. CVS, Target, Walmart, and Walgreens are some local pharmacies that accept SingleCare cards and coupons.

Vivitrol is covered by many commercial, private, and public insurance plans, including Medicaid. Whether your insurance plan covers Vivitrol treatment depends on your specific insurance policy and the treatment setting in which the shot is received. Prior authorization, copay, and deductible requirements may apply.

The VIVITROL Co-pay Savings Program covers up to $500 per month of copay or deductible expenses for eligible patients with a Vivitrol prescription.

Frequently asked questions