Medicare Part D Coverage Gap
Buprenorphine/Naloxone Cost in the Medicare Donut Hole
In the Medicare Part D coverage gap, patients pay 25% of drug costs for Buprenorphine/Naloxone (Buprenorphine/Naloxone). That means approximately $50 per fill at retail. Script Unlock cash prices start from $100 — compare to find your best option.
Buprenorphine/Naloxone Cost Comparison — Donut Hole vs Cash Pay
Retail price
$200
Donut hole (25%)
$50
Script Unlock cash
from $100
How the Medicare Donut Hole Works for Buprenorphine/Naloxone
- Initial coverage: you pay your plan copay
- Coverage gap (donut hole): you pay 25% of Buprenorphine/Naloxone cost
- Catastrophic coverage: you pay very little once TrOOP reached
- Script Unlock cash price may beat your gap cost-sharing
FAQs — Buprenorphine/Naloxone and Medicare Donut Hole
How much does Buprenorphine/Naloxone cost in the Medicare donut hole?
In the Medicare Part D coverage gap (donut hole), you typically pay 25% of the drug cost for Buprenorphine/Naloxone. Based on a retail price of $200, that would be approximately $50. Compare this to Script Unlock's cash price of from $100 — you may save by paying cash instead of using your Medicare coverage.
Is it cheaper to pay cash for Buprenorphine/Naloxone during the donut hole?
It depends on the pharmacy and your specific plan. Script Unlock cash prices start from $100 — compare this to your specific Medicare plan's donut hole cost for Buprenorphine/Naloxone. Some patients find cash pay cheaper; others find Medicare still wins.
Does paying cash for Buprenorphine/Naloxone count toward my Medicare deductible or donut hole?
Generally no — paying cash typically does not count toward your Medicare Part D True Out-of-Pocket (TrOOP) spending that helps you exit the coverage gap. However, this can be worthwhile if the cash price is significantly lower than your donut hole cost-sharing. Consult your Medicare plan's EOB for your specific situation.
This information is for educational purposes. Medicare Part D coverage gaps vary by plan. Consult your plan's EOB and a Medicare counselor for personalized guidance.