It wasn’t long ago that there were no Suboxone generic equivalents.
Buprenorphine and naloxone are the ingredients in Suboxone, the gold standard of office-based opioid treatment. Doctors prescribe Suboxone film for treating opioid use disorder. The buprenorphine in Suboxone reduces withdrawal symptoms and cravings.
A couple of years ago, buprenorphine-naloxone only came in the form of several brand products. There are ZubSolv, Bunavail, and Suboxone, all approved by the food and drug administration to treat opioid dependence.
Each of these brands of buprenorphine and naloxone has unique benefits.
Suboxone and ZubSolv are sublingual medications, meaning that you put them under your tongue to dissolve.
If your doctor prescribes Bunavail, you stick it to the inside of your cheek. It contains the same medication as Suboxone and ZubSolv, but you place it in your mouth differently to be absorbed.
How does ZubSolv differ from Suboxone? It is a fast-dissolving tablet that has a more pleasing taste compared to Suboxone as it dissolves under the tongue.
What about Suboxone itself? How does it differ from ZubSolv? Suboxone strips are in the form of a flexible rectangular film, not a tablet.
How do you take Suboxone strips? You place the strip under your tongue and allow it to dissolve.
Generic Suboxone first appeared in tablet form.
At some point in the past few years, a generic Suboxone tablet came out. Doctors, pharmacists, and patients were excited.
Finally, patients could get Suboxone at an affordable price. No longer did patients have to pay exorbitant costs for Suboxone.
Previously, the cost of a single dose of ZubSolv, Bunavail, or Suboxone strips, could run from ten to fifteen dollars each. The cost of a typical monthly prescription of sixty units might run $600 to $900!
When the generic Suboxone tablet came out, prices were as low as $2 to $3 per pill. You take the generic Suboxone pill in the same way as the strips. You place the medicine under your tongue and wait for it to dissolve fully.
Generic Suboxone tablets can take a long time to dissolve under your tongue.
Here is where the problem occurs. Suboxone generic tablets often do not dissolve quickly. Where a Suboxone film dissolves in just a few minutes, the generic pills can take 10, 15, or even 30 minutes.
Some patients have told me that they meditate, take a nap, or watch television while waiting for their tablet to dissolve. While this may work for some people, many people find that it is not easy to find 30 minutes free during the day.
To take Suboxone properly, or any buprenorphine-naloxone sublingual product, you have to keep your mouth shut until it dissolves. That means no talking, no drinking, no eating, and no smoking.
If you are a mother with young children, imagine how difficult it might be to have to keep your mouth shut for 30 minutes each day. And what about when you are at work? How do you get away and keep your mouth shut for that amount of time?
Suboxone dosing is often most effective when divided into two daily doses. Hence, you may find yourself having a full hour each day in which you cannot open your mouth.
When you are taking Suboxone, your addiction moves to the background. You can live your life, feeling as if you were never addicted to opioids. Unfortunately, generic Suboxone tablets that take a long time to dissolve do not let you forget that you are on medical treatment.
While those generic Suboxone tablets are an inconvenience, the price savings is worth it. Not only do cash-paying patients save a lot of money each month, but patients using their insurance also save themselves a lot of trouble.
The nightmare of insurance prior authorizations before generic buprenorphine-naloxone existed.
Before generic Suboxone film or tablets existed, health insurance companies made it challenging to get Suboxone prescriptions covered. Patients with insurance had to fight with their insurance company or pay high cash prices because the companies refused to pay. They sent out claim denial letters, leaving patients without their Suboxone.
Imagine that you have quit opioids, and you went in to see a Suboxone doctor for treatment. Already, you have made a major life-changing decision.
It is not easy to stop opioids. Picking up the phone to make a doctor’s appointment and then showing up is not easy either.
After you have finished seeing the doctor and leave with a prescription in your hand, it should be easy. Unfortunately, in the past, the difficulties were only getting started at that point.
If you have just quit heroin or pain pills and are standing in line at the pharmacy to get your Suboxone, you know that opioid withdrawal symptoms are coming soon. If you do not have your Suboxone, the moderate withdrawal will progress to severe withdrawal.
There is no way to express how difficult it can be for people who have not experienced opioid withdrawal syndrome. While I can describe the symptoms and how they progress over time, the discomfort is unimaginable.
To make matters worse, if you are suffering from opioid withdrawal for days, you will often think that going back to opiate use will take away the withdrawal symptoms. Having your insurance company send you a denial letter after several days of tortuous opioid withdrawal is not pleasant.
I remember my efforts in helping patients to file appeals to these denials on many occasions. I sat on the phone, waiting on hold, only to have a non-physician on the other end at the insurance company tell me that there was nothing they could do.
What if I wanted to talk to a physician at the insurance company to discuss the medical need for Suboxone? These “peer-to-peer” reviews can take days to schedule. Sometimes the “peer” would call back, and sometimes they would not.
Still, I made a considerable effort to figure out the system to get Suboxone film covered the first time around, with prior authorization. The “prior authorization” process is a rediculous process in which a doctor fills out forms, making a case to the insurance company for why the patient needs their medication.
The PA questions are often insulting. Has the patient tried alternatives? There are no alternatives. Has the patient performed two drug tests on consecutive monthly visits?
The patient just walked in the door after kicking heroin! How would we have two months of urine testing?
Whenever I thought I had the system figured out, an insurance company would come up with a new requirement or reject my claim without any proper explanation.
I do not doubt that there are people who have worked at health insurance companies who are personally responsible for opioid overdoses of people whom they rejected a claim. For this reason, some states have outlawed the prior authorization process for addiction treatment medications.
With the introduction of the Suboxone generic tablet, insurance companies were less likely to cause trouble. Patients could get buprenorphine and naloxone sublingual medication. If they didn’t mind getting a slow dissolving tablet, the insurance would cover it.
I have always found it offensive when insurance companies act as if they are concerned about medical issues. When it comes to prior authorizations, it is about the money more than anything else.
Just over a year ago, we finally got generic Suboxone film on the market.
Finally, last March, just over a year ago, something new happened. Generic Suboxone strips became available. The FDA approved a generic version of the Suboxone film. Generic strips are fast dissolving, just like the branded sublingual film.
There had been a legal battle going on in the courts for some time: Indivior, the company that makes Suboxone, and a small generic drug manufacturer, Dr. Reddy, were fighting over the release of generic buprenorphine-naloxone films.
Indivior had fought for years to maintain a protected status in which no one could make a generic of their current product. It had something to do with Suboxone getting “orphan drug status” early on.
Last March, a judge overturned previous rulings. They ruled that Dr. Reddy, and other generic companies, could manufacture buprenorphine and naloxone strips.
Shortly after, other companies also made generic Suboxone strips. One brand that I often see patients filling at their pharmacies is the Mylan generic Suboxone.
Now, patients no longer have to make the decision anymore. The choice between a high priced brand or an inferior generic tablet was no longer an issue.
The new generic films dissolved fast under the tongue. Patients reported back that they were as good as the Indivior Suboxone brand film.
I was excited to share the news with patients during the months after the release of these new generics. Some patients were taking generic tablets to save money or because that was all their insurance would cover. Now, they could make the switch.
Other patients found that suddenly their buprenorphine-naloxone films were a lot cheaper. Or, the insurance copays were less. It was suddenly a lot easier to treat opioid addiction.
Whatever the motivation of the executives and lawyers at the Dr. Reddy corporation, their efforts have saved lives. By making Suboxone more available, more patients can benefit from this life-saving medical treatment for opioid addiction.
With the introduction of generic Suboxone, Indivior immediately pulls the Here To Help program.
How did Indivior respond to the release of generic Suboxone strips? Before March of 2019, Indivior had a program called the Here To Help program.
Here To Help offered free Suboxone films to patients who could not afford the medication. It was a life-saving program that allowed doctors to have up to three patients at a time getting their Suboxone for free.
Within days of the ruling to allow Dr. Reddy to sell generic Suboxone, Indivior pulled the program. Patients approved for Here To Help got cut off abruptly.
Did Indivior notify doctors that they were canceling the program? I received only one fax with no letterhead and no name, stating that the program cancelation was active immediately.
Patients on the program had no warning. Did this decision lead to patients losing access to treatment and relapsing? We may never know, but I suspect some patients may not have fared well, having Here To Help cut off overnight.
Fortunately, the company that manufactures ZubSolv, Orexo, has not pulled its patient assistance program. Patients can still get free ZubSolv if they cannot afford medication. And, Orexo has a free tablet offer that requires no application or proof of income.
Over a year later, patients are still happy to learn that Suboxone strips are now generic and affordable.
Now that it has been over a year since Suboxone strips went generic, doctors, pharmacists, and patients have gotten used to the new world where patients can get the best form of buprenorphine-naloxone films without compromise.
Occasionally, I get to share the good news with a patient who is just coming back to start treatment again. Recently, a patient asked me about the price of the medication.
They were concerned based on their previous experience that it might cost many hundreds of dollars per month, just for the medicine. It was nice to let that patient know that things had changed.
There was no longer an issue with overpriced brand-name Suboxone films. It was now possible for this patient to get the best and pay far less.
When it comes to affordable generic Suboxone strips, we can do better.
Have we solved the problem of making medication affordable for all patients? I think we still have further to go.
There are still issues that make the medication more expensive than it needs to be. As I have stated before, most drugs cost very little to manufacture at scale. These drugs are cheaper than water. Yet, patients pay several dollars per dose for a drug that costs pennies to make.
Many generic drugs cost only $4 to $10 for a full month’s supply. Some pharmacies give away 30 days of medicine for free to get patients to shop in the store. Why are buprenorphine and naloxone not in that price range? I have heard that there are still patent issues that keep prices high.
I don’t fully understand this and why the government cannot override such an obstacle. Our country is in the midst of an opioid crisis, and we need to make treatment accessible.
Additionally, the government must provide funding for medical care, as well. Patients who cannot afford treatment should be able to get doctor visits and therapy.
There are currently various pilot programs around the country that provide full medication-assisted treatment at little to no cost. We need more of these programs in more areas. And, we need to have a way for patients to find these programs more efficiently.
For the time being, patients will welcome the significant savings that we have enjoyed now for just over a year since the winning of the battle in court with Indivior and Dr. Reddy. Generic Suboxone strips are here to stay.