Not all health insurance plans cover naltrexone or include it in their list of approved medications. In these cases, individuals must pay for naltrexone out of pocket, which can be expensive. When naltrexone is covered, many health insurance plans require prior authorization, which can be burdensome for both the individual and the clinic administering naltrexone. Insurance plans may also require that individuals first try and fail at a less expensive treatment before being approved for naltrexone. It can also be challenging to find an in-network physician.

Insurance plans have varying coverage of the medically supervised withdrawal process that is often required before initiating naltrexone. This can include whether the process is covered at all and/or the number of days that inpatient detoxification is covered.

Naltrexone for opioid use disorder is provided by certified specialty pharmacies, which require a more complex coordination process for medication ordering and receipt. Pharmacies must first contact the covered individual to confirm that naltrexone is desired and authorize the pharmacy to bill their health insurance. The medication is then shipped to that individual’s physician, where it must be set aside for that specific individual to receive.