How to get Vivitrol covered by insurance

Vivitrol (extended-release naltrexone) is a once-monthly injection that blocks opioid effects and reduces alcohol cravings. It is FDA-approved, evidence-based, and recommended by every major addiction medicine organization. Despite this, getting insurance to cover it can be frustrating. Here is how to navigate the process.

What Vivitrol costs

The wholesale cost of Vivitrol is approximately $1,800-$2,000 per injection. With insurance, your out-of-pocket cost may range from $0-$150 per injection depending on your plan's formulary tier, copay structure, and deductible status. Without insurance, the cost is prohibitive for most people — but patient assistance programs exist (more on this below).

Getting insurance approval

Most insurance plans cover Vivitrol but require prior authorization. Your prescribing physician submits a prior authorization request documenting your diagnosis (opioid use disorder or alcohol use disorder), that you have completed detox and are opioid-free for 7-14 days (required for safe initiation), and that Vivitrol is medically appropriate for your situation. Common denial reasons include missing documentation, the insurer preferring a cheaper alternative first (step therapy requiring you to try oral naltrexone before the injection), or administrative errors. If denied, appeal — many denials are reversed.

Patient assistance programs

Alkermes (Vivitrol's manufacturer) operates the Vivitrol Co-Pay Savings Program for commercially insured patients, which can reduce copays to as low as $5. For uninsured patients, the VIVITROL Patient Assistance Program may provide the medication at no cost for qualifying individuals. SAMHSA grants also fund Vivitrol access at some treatment providers. Ask your prescriber about these programs before assuming the cost is out of reach.

Opioid treatment programs

Authoritative sources

This article references guidelines from: SAMHSA · NAMI

Frequently asked questions

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.