Opioid Agonist Therapy Gap Coverage Program

Overview

Opioid agonist therapy (OAT) involves taking medications like buprenorphine, buprenorphine-naloxone, or methadone to treat opioid use disorder. These medications reduce cravings for opioids and help manage withdrawal symptoms.

OAT can help improve stability and day-to-day functioning. For some people, OAT can be a long-term treatment and for others it may be shorter term. For those without health benefits, cost of OAT can be a barrier to treatment.

Program details

The OAT Gap Coverage Program provides immediate, no-cost coverage for OAT medications – oral buprenorphine-naloxone, methadone liquid or injectable extended-release buprenorphine – for 120 days, while you enrol in a supplementary health benefit plan.

If you are not already enrolled in a benefit plan but have an Alberta Personal Health Number and a valid prescription, you can start treatment right away and have your medication costs covered temporarily.

The period between when you enrol in a health benefit plan and when those benefits become effective can be up to 120 days. You are expected to seek supplementary health coverage as soon as possible within this period.

If you have applied for benefits but they will not come into effect by the time 120 days is up, you may request an extension of gap coverage until your benefits come into effect. To be considered for an extension, you, or someone on your behalf, must submit a coverage extension request form. It is recommended you submit the extension request form as soon as possible. Your extension request may be denied if you do not submit it before your initial 120 gap coverage is up. Talk to your pharmacist for information and support.

Benefits enrolment

Once you have started receiving your medications through the OAT Gap Coverage Program, you need to enrol in a supplementary health benefit plan. The Alberta government offers several health benefit plans, including Non-Group Coverage, Coverage for Seniors and low-income health benefit programs. You can enrol in any health benefit plan that you qualify for.

If the health benefit plan you qualify for has premiums or co-payments, those will need to be paid to maintain the plan. Talk to your plan provider about whether co-payments are required by your plan.

If you have applied for coverage through a supplementary health benefit plan, you may continue to receive your OAT medications until your benefits come into effect, even if it takes longer than 120 days. To be considered for an extension, you, or someone on your behalf, must submit a coverage extension request form. Talk to your pharmacist for information and support.

Contact the Alberta Health Care Insurance Plan to find out more, or call Alberta Supports at 1-877-644-9992.

Provider information

Enrolment in the OAT Gap Coverage Program takes effect immediately once an eligible Albertan presents a valid OAT prescription at a pharmacy. Patients are required to be enrolled in the Alberta Health Care Insurance Plan, that is, they need to have a Personal Health Number to access the OAT gap coverage program.

For more information, including how to support your client if they need to enrol in health benefit plans, read the OAT Gap Coverage Program information for health care providers .

Pharmacists can also contact Alberta Blue Cross directly for information about the program.