Buprenorphine / naloxone (Suboxone, Zubsolv, and others)

How Medicare covers it

Part D (sublingual films and tablets used at home taken at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Treatment of opioid dependence (opioid use disorder). SUBOXONE sublingual film should be used as part of a complete treatment plan that includes counseling and psychosocial support.

What it is for, in depth

SUBOXONE (buprenorphine and naloxone) sublingual film is prescribed for people with opioid dependence — opioid use disorder — as one part of a complete treatment plan that also includes counseling and psychosocial support. It sits in the treatment path as a daily maintenance medicine after a careful induction: treatment starts only once clear withdrawal signs are present, the first days use the divided and then single doses described above (with buprenorphine-only induction recommended for people coming from methadone or long-acting opioids), and the usual maintenance range is 4 mg/1 mg to 24 mg/6 mg a day. The pinned label is the Suboxone film label: an orange film supplied in four strengths — 2 mg buprenorphine/0.5 mg naloxone, 4 mg/1 mg, 8 mg/2 mg, and 12 mg/3 mg — in cartons of 30 films in child-resistant pouches. The package record matches a wider set of forms in the CMS formulary file: the same four Suboxone film strengths (plus the generic film listings) and sublingual tablets, including the 2 mg/0.5 mg and 8 mg/2 mg tablets and the Zubsolv tablet strengths; those tablet forms have their own product directions, so use the exact form your prescriber chose. The package record describes the combination in plain terms — buprenorphine lowers cravings and withdrawal, and naloxone is included to discourage misuse by injection — which matches how the label's pharmacology section describes the two ingredients.

How it works

This film combines two drugs in a 4-to-1 ratio. Buprenorphine is a partial agonist at the mu-opioid receptor — it partly turns on the same receptor that full opioids turn on fully — and an antagonist (blocker) at the kappa-opioid receptor. Naloxone is a potent antagonist (blocker) at mu-opioid receptors, and it produces opioid withdrawal signs and symptoms in people who are physically dependent on full opioid agonists when it is given parenterally (by injection). That pairing is the point of the combination as described in the label's pharmacology section: the buprenorphine does the treatment work when the film is used as directed under the tongue or in the cheek, while the naloxone is there to bring on withdrawal if the product is misused by injection.

How it is taken

As a film that dissolves in the mouth, given as a single daily dose. For sublingual use, place one film under the tongue, close to the base on the left or right side, and let it dissolve completely; for buccal use, place one film on the inside of the left or right cheek and let it dissolve completely. The film must be given whole — do not cut, chew, or swallow it. To avoid bringing on withdrawal, induction (starting treatment) should begin only when objective, clear signs of withdrawal are evident, and the film should be given in divided doses when used as initial treatment. For people dependent on short-acting opioids who are in withdrawal: on Day 1, up to 8 mg/2 mg in divided doses; on Day 2, up to 16 mg/4 mg as a single dose. For people dependent on methadone or long-acting opioids, the label recommends induction with buprenorphine alone (monotherapy) on Days 1 and 2. The maintenance dose is generally 4 mg/1 mg to 24 mg/6 mg per day, based on clinical response. When treatment is stopped, the dose should be tapered gradually to avoid withdrawal. The label also strongly advises considering recommending or prescribing an opioid overdose reversal agent (such as naloxone or nalmefene) when SUBOXONE is started or renewed, because of relapse and overdose risk.

Common side effects

The FDA label extract for this product does not list common, non-serious side effects with percentage rates the way many labels do. Its adverse reactions section does not give a table of frequent effects; instead, it lists the serious adverse reactions that are described elsewhere in the labeling — addiction, abuse, and misuse; respiratory and central nervous system (CNS) depression; neonatal opioid withdrawal syndrome; adrenal insufficiency; opioid withdrawal; hepatitis and hepatic (liver) events; hypersensitivity (allergy) reactions; orthostatic hypotension (blood pressure dropping on standing); raised cerebrospinal fluid pressure; and raised intracholedochal (bile duct) pressure. Because the extract gives no common-effects list, this page does not fill one in from other sources — ask your prescriber or pharmacist what everyday effects to expect with the film.

Serious warnings

This label has no boxed warning, but it carries serious warnings. Buprenorphine can be abused in a similar manner to other opioids, so patients should be monitored for diversion and for progression of opioid dependence and addictive behaviors, and multiple refills should not be prescribed early in treatment or without appropriate follow-up visits. Life-threatening respiratory depression (slowed or stopped breathing) and death have occurred with buprenorphine use, and patients should be warned about the danger of self-administering benzodiazepines or other CNS depressants during treatment. Children can have severe, possibly fatal, respiratory depression from buprenorphine, so the film must be stored safely out of the sight and reach of children. Prolonged opioid use in pregnancy can cause neonatal opioid withdrawal syndrome in the newborn, which the label describes as an expected and treatable outcome. Other warnings cover adrenal insufficiency, withdrawal if treatment is abruptly stopped, hepatitis and liver events (liver function tests should be checked before starting and during treatment), precipitation of withdrawal if the film is misused by injection or taken before other opioids have worn off, and overdose in opioid-naive patients — deaths have been reported in opioid-naive individuals who received a 2 mg sublingual dose, and the label says this product is not appropriate as a pain reliever (analgesic).

Who should be careful

People with a history of hypersensitivity (allergy) to buprenorphine or naloxone must NOT use this film — that is the label's contraindication, and serious reactions including anaphylactic shock have been reported. Be careful and tell your prescriber if you are pregnant (the newborn can have opioid withdrawal syndrome), if you are breastfeeding (buprenorphine passes into mother's milk, per the label's populations section), if you have liver problems (liver tests should be monitored; buprenorphine/naloxone products are not recommended in severe liver impairment and may not be appropriate in moderate liver impairment), or if you are an older adult (the label advises monitoring for sedation and respiratory depression in geriatric patients). Anyone in a household with children must store the film securely out of children's sight and reach, because accidental exposure can be fatal to a child. This product is not for opioid-naive patients and is not appropriate as a pain reliever.

Major interactions

Benzodiazepines and other CNS depressants, including alcohol, are the biggest concern: because their effects add together, using them with buprenorphine raises the risk of respiratory depression, profound sedation, coma, and death; the label says stopping the benzodiazepine or other depressant is preferred in most cases, or tapering it, or using the lowest effective dose, with an overdose reversal agent strongly considered. Examples in the label include alcohol, sedatives/hypnotics, anti-anxiety drugs, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, gabapentinoids (gabapentin or pregabalin), and other opioids. CYP3A4 inhibitors (such as erythromycin, ketoconazole, and ritonavir) can raise buprenorphine levels and increase or prolong opioid effects, while CYP3A4 inducers (such as rifampin, carbamazepine, and phenytoin) can lower buprenorphine levels and bring on reduced effect or withdrawal. Certain HIV medicines also interact: some protease inhibitors, notably atazanavir with or without ritonavir, raised buprenorphine levels and sedation, so monitoring and possible dose reduction are advised. Taking opioids with other serotonergic drugs has resulted in serotonin syndrome, so patients should be watched carefully, especially when treatment starts or doses change, and the film stopped if serotonin syndrome is suspected.

Cost and saving notes

Medicare facts: buprenorphine/naloxone is sold as a generic as well as under brand names — the package record names Suboxone and Zubsolv — so ask whether a generic film or tablet is the lower-cost option on your plan. In the package record's 2027 CMS formulary file, the most common (modal) tier for this combination was tier 4, so what you pay can vary a lot by plan and by form. If your own Part D plan places it on a higher tier than expected, you or your prescriber can ask the plan for a tier exception when the lower-tier options would not work as well for you. If you qualify for Extra Help (the Part D Low-Income Subsidy), your premiums and copays drop a lot. In 2027, what you pay out of pocket for covered Part D drugs is capped at $2,400 for the year, and the Medicare Prescription Payment Plan lets you spread those costs into monthly payments instead of paying large amounts at the pharmacy counter. Ask your pharmacist or your plan what you would actually pay before you fill.

Why it is in its tier

Buprenorphine / naloxone (Suboxone, Zubsolv, and others) sits on Tier 4 in 43.26% of the plans that list it (2377 of 5495 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is sold both as a brand product and in generic form, and the CMS dashboard puts its average Part D spending at about $1,230 per beneficiary for 2024 — a mid-cost drug, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• SUBOXONE (BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE) FILM, SOLUBLE [INDIVIOR INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Buprenorphine Sublingual and Buccal (Opioid Dependence)

What official patient guides say

Buprenorphine and naloxone comes as a sublingual (under the tongue) tablet and as a film to apply between the gum and cheek. It is taken once a day, at around the same time every day, exactly as directed — do not take more, less, or take it more often than prescribed. If you are taking the sublingual tablets, place them under your tongue until they completely melt (up to two at a time); do not chew them or swallow them whole, and do not eat, drink, or talk until they dissolve completely. If you are using the film in your cheek, rinse your mouth with water first, apply the film with a dry finger against the inside of your cheek, and leave it until it dissolves — do not cut, tear, chew, swallow, touch, or move the film while it dissolves, and do not eat or drink anything until it has dissolved completely; the same rules apply if you place the film under your tongue. After the tablet or film has dissolved completely, take a sip of water, swish it around your teeth and gums, and swallow — and do not brush your teeth for at least one hour afterward. Your doctor may start your treatment with buprenorphine alone in the office and may adjust your dose depending on your response. Do not stop taking it without talking to your doctor; stopping suddenly can cause withdrawal symptoms. If you miss a dose, use it as soon as you remember. If it is almost time for the next dose, skip the missed dose and go back to your regular schedule. Do not use a double dose. Keep it in the packaging it came in, tightly closed and out of reach of children, stored at room temperature away from extra heat and moisture and not in the bathroom — and store it in a safe place, because it can be a target for people who misuse prescription medications.

Source: MedlinePlus — Buprenorphine Sublingual and Buccal (Opioid Dependence)

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 4.26535 per unit (BUPRENORPHINE-NALOXONE 12-3 MG SL FILM) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Buprenorphine / naloxone (Suboxone, Zubsolv, and others) — 100% of plans. Most of those plans put it on Tier 4: 2,377 plans, 43.3% of the plans that list it. Other plans place it on Tier 3 (1,480 plans), Tier 2 (1,202 plans) or Tier 1 (426 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 2; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 2; Aetna Medicare Value Plus (PPO) puts it on Tier 2. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.