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You searched for Sublocade Solution,Extended Release Subcutaneous Syringe.

Sublocade At a Glance
Covered:	Yes
Your Cost*:	$$$$
Notices?:	Yes
* Your cost reflects copayment amount for drug. Individuals with high deductible plans may pay full cost of drug until deductible is met.

Strength:

Sublocade 300 mg/1.5 mL solution,extended release subcutaneous syringe

Sublocade is a covered medication with a Tier SP copayment. ($$$$)
Notice: Sublocade requires prior authorization. (PA)
Notice: Sublocade has a quantity limit. (QL)

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Buprenorphine-Naloxone	Buprenorphine-Naloxone Sublingual Tablet	Yes	Generic	$$$$	Yes
Buprenorphine Hcl	Buprenorphine Hcl Sublingual Tablet	Yes	Generic	$$$$	Yes
Buprenorphine-Naloxone	Buprenorphine-Naloxone Sublingual Film	Yes	Generic	$$$$	Yes
Bunavail	Bunavail Buccal Film	Yes	Brand	$$$$	Yes
Zubsolv	Zubsolv Sublingual Tablet	Yes	Brand	$$$$	Yes
Brixadi	Brixadi Solution,Extend.Rel. Subcut.Syringe	Yes	Brand	$$$$	Yes
Sublocade	Sublocade Solution,Extended Release Subcutaneous Syringe	Yes	Brand	$$$$	Yes

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Probuphine	Probuphine Subdermal Implant	No	Brand	$$$$	No
Suboxone	Suboxone Sublingual Film	No	Brand	$$$$	No

Alternative Drug Information

The value of choosing UPMC Health Plan

At UPMC Health Plan, we support our members in focusing on their total well-being. We want to make sure our members have everything you need to be as healthy and happy as possible. We do this by:

Providing access to care to help keep you healthy.

	$0 preventive care that covers many health services for adults and children at 100 percent.¹
	Coverage for high-value generic and no-cost preventive medications.²
	Access to top-ranked doctors and hospitals and an extended network.³

Taking care of your mental and physical health.

	Six free counseling sessions through LifeSolutions®.⁴
	Free health coaching to help you make healthy changes in your life.
	The RxWell® app provides virtual support for your total well-being.

Supporting you when you need it.

	24/7 virtual urgent care and connections to pharmacists, health coaches, and behavioral health concierges. Designed to fit your schedule, it's covered at 100 percent by most plans.⁵
	The UPMC Health Plan app for easy access to your health insurance information.
	Our exceptional Health Care Concierge team for help navigating your benefits with a quick online chat or phone call.

¹Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

²Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

³Go to www.upmchealthplan.com/BEST for award information.

⁴Only the virtual visit with the provider will be covered at 100 percent. Prescription drug and other costs related to the visit or recommended by the provider will not be included in the virtual visit coverage and will be your responsibility. If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan, UPMC AnywhereCare virtual visits will be covered at 100 percent after you meet your deductible. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

⁵UPMC Health Plan members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service or those who select Talk Therapy or Psychiatry services will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Limitations may apply for members of ASO plans that have opted out of coverage. Providers are not available to treat members who are in Puerto Rico.

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You searched for Sublocade Solution,Extended Release Subcutaneous Syringe.

Alternative drugs to Sublocade may be available. Review this list with your doctor.

These alternative drugs are not covered.