Does Medicare Cover Vivitrol? 

Vivitrol is the brand name for naltrexone, a Food and Drug Administration (FDA)-approved medication to treat opioid and alcohol use disorders. Naltrexone is one facet of an overarching drug abuse treatment program encompassing counseling, behavioral therapy, lifestyle change, compliance, monitoring and psychosocial support. 

Naltrexone, one of a class of drugs called opiate antagonists, is available as a pill and an injection. Naltrexone oral medication is on the market as ReVia and Depade, which you can buy with a prescription at your pharmacy. Vivitrol is a naltrexone extended-release (ER) injectable suspension your doctor injects into your gluteal muscle.

Medicare drug coverage

Medicare covers self-administered pharmaceutical drugs under Part D. Whether your Part D coverage is a stand-alone Medicare Prescription Drug Plan or part of a Medicare Advantage Prescription Drug Plan with drug coverage (MA-PD), the specific drug coverage varies. Insurers offering Part D policies develop their own approved drug lists (formularies) and cost-sharing responsibility. When searching your plan’s formulary for naltrexone, look for naltrexone in the lower tiers (generic versions) of psychotherapeutic drugs.

Medicare Part B covers a limited range of drugs, including injections your doctor administers in the medical office and sometimes drugs a healthcare provider gives you in a hospital outpatient setting. The Part B deductible applies for Medicare-approved drugs, and you pay 20% of the amount Medicare approves if you have met your deductible for the year.  

Other Part B Medicare services 

You may be eligible for alcohol misuse screenings and counseling if you are an adult who uses alcohol but is not alcohol-dependent according to medical criteria. Benefits include up to four face-to-face counseling meetings every year. Your primary care physician (PCP) delivers the counseling in the doctor’s office or similar primary care setting. If your doctor is a Medicare-participating PCP who certifies that you are misusing alcohol, you do not incur any out-of-pocket expense for this service.

Opioid use disorder treatment involves assessments, counseling, therapy, drug tests and medication like naltrexone. Evaluations are generally live but can be virtual under specific circumstances. If you have Original Medicare, you pay the Part B deductible but no copayments for services delivered under a Medicare-enrolled opioid treatment program. Your healthcare provider can help you identify a qualified program provider. Medicare Advantage may require copayments, so check with your plan if you are a Medicare Advantage member.

Vivitrol treatment requirements

The expectation is that Vivitrol is most effective when you participate in a comprehensive drug management program. If you take the drug for alcohol dependence, you must be able to refrain from alcohol consumption in an outpatient setting and at the start of Vivitrol treatment. Patients with opioid use disorders prescribed Vivitrol to prevent relapse must complete detoxification before starting treatment.

Alkermes, the Vivitrol manufacturer, offers safety information and potential adverse reactions on its website. To report any side effects, contact Alkermes at usmedinfo@alkermes.com or the FDA at 1-800-FDA-1088.