CardinalCare Coverage for Suboxone Treatment in Virginia

If you're enrolled in CardinalCare — one of Virginia's Medicaid managed care plans — you might be wondering exactly what your coverage looks like for Suboxone (buprenorphine) treatment. The good news: CardinalCare covers medication-assisted treatment (MAT) for opioid use disorder, including all FDA-approved forms of buprenorphine.

But navigating managed care can feel confusing. Which pharmacies are in-network? Do you need prior authorization? What behavioral health services come with your plan? This guide walks you through everything CardinalCare members need to know about accessing Suboxone treatment in Virginia.

Whether you're just starting to explore treatment options or you're already established on buprenorphine and want to understand your benefits better, we'll break down the practical details that matter most.

What is CardinalCare?

CardinalCare is one of six Medicaid managed care organizations (MCOs) operating in Virginia. If you're enrolled in Virginia Medicaid and live in one of CardinalCare's service regions, your health coverage is administered through their network of providers and pharmacies.

Unlike traditional fee-for-service Medicaid, managed care plans coordinate your healthcare through a network. This means you'll typically choose a primary care provider (PCP) from CardinalCare's network and get referrals for specialty services when needed. However, addiction treatment services — including Suboxone — are generally accessible without PCP referrals.

CardinalCare serves members across multiple Virginia regions. Your specific benefits and provider network depend on where you live. All Virginia Medicaid MCOs, including CardinalCare, must cover the same essential health benefits, but how you access those benefits can vary by plan.

Does CardinalCare cover Suboxone and buprenorphine?

Yes. CardinalCare covers all FDA-approved buprenorphine formulations for treating opioid use disorder, including:

• Suboxone film (buprenorphine/naloxone sublingual film)
• Generic buprenorphine/naloxone film and tablets
• Zubsolv tablets (buprenorphine/naloxone)
• Sublocade monthly injection (long-acting buprenorphine)

Coverage extends to both brand-name and generic versions. In most cases, CardinalCare will cover generic buprenorphine/naloxone first, as it's clinically equivalent to brand-name Suboxone but costs less. If your provider determines that a specific brand is medically necessary, they can document that in your prescription.

This coverage applies whether you receive treatment through in-person visits or telehealth appointments. Virginia's telehealth parity laws require Medicaid plans to cover virtual addiction treatment the same way they cover in-person care.

Do you need prior authorization for Suboxone through CardinalCare?

This depends on the specific medication and dosage. CardinalCare's formulary (the list of covered medications) includes buprenorphine products, but some may require prior authorization (PA) before your prescription can be filled.

As of 2026, CardinalCare typically does not require prior authorization for:

• Generic buprenorphine/naloxone film or tablets at standard doses
• Initial prescriptions for opioid use disorder treatment

Prior authorization may be required for:

• Brand-name Suboxone when generic alternatives are available
• High-dose prescriptions above typical maintenance levels
• Sublocade injections (long-acting monthly buprenorphine)
• Switching between different buprenorphine formulations

If prior authorization is needed, the prescriber supplies the clinical information requested by the plan. Processing times and expedited-review criteria vary; confirm current timelines with CardinalCare.

Your provider will document your diagnosis, previous treatments (if any), and why the prescribed medication is medically appropriate. Most prior authorization requests for buprenorphine are approved when properly documented. For more details on this process, see our guide to prior authorization for Suboxone.

CardinalCare pharmacy network for filling Suboxone prescriptions

CardinalCare contracts with most major pharmacy chains in Virginia, including CVS, Walgreens, Kroger, and Walmart pharmacies. You can fill your buprenorphine prescription at any in-network pharmacy.

To find CardinalCare pharmacies near you:

• Call CardinalCare Member Services at 1-844-235-2387 (TTY: 711)
• Use the pharmacy locator on the CardinalCare member portal
• Ask your provider's office for a list of nearby network pharmacies

Not all pharmacies stock buprenorphine products, especially in smaller locations. It's smart to call ahead and confirm that your chosen pharmacy:

1. Is in CardinalCare's network
2. Has your prescribed medication in stock
3. Can fill controlled substance prescriptions (some locations have restrictions)

If you have trouble finding a pharmacy that stocks your medication, CardinalCare Member Services can help identify alternatives or arrange for special ordering.

Some CardinalCare members use telehealth providers like Grata Health. Confirm both the provider and pharmacy are in-network and that the prescribed product is covered before relying on benefits.

Behavioral health services included with CardinalCare

Medication is just one part of effective addiction treatment. CardinalCare covers comprehensive behavioral health services to support your recovery, including:

Individual counseling: One-on-one therapy sessions with licensed counselors or therapists. No limit on the number of sessions when medically necessary.

Group therapy: Peer support groups led by clinical professionals. These can include recovery skills groups, relapse prevention, and specialized populations (young adults, parents, etc.).

Care coordination: Help navigating your treatment plan, connecting to community resources, and coordinating between your medical and behavioral health providers.

Substance use disorder assessments: Comprehensive evaluations to determine the most appropriate level of care for your needs.

Intensive outpatient programs (IOP): Structured programs offering multiple therapy sessions per week, typically 9-12 hours total.

Family therapy: Sessions involving family members or significant others in your treatment and recovery process.

You don't need prior authorization for most outpatient behavioral health services. CardinalCare encourages integrated treatment that combines medication with counseling and support. For more on why this combination works, read about counseling alongside MAT.

How to verify your CardinalCare coverage before starting treatment

Before your first Suboxone appointment, take these steps to confirm your coverage:

Check your enrollment status: Make sure you're currently enrolled in CardinalCare and your coverage is active. You can verify this through the Virginia Department of Medical Assistance Services (DMAS) or by calling CardinalCare Member Services.

Confirm your provider is in-network: If you're seeing a specific addiction medicine provider or telehealth service, verify participation directly with CardinalCare and the provider.

Understand your pharmacy benefits: Confirm which pharmacies near you are in CardinalCare's network and can fill controlled substance prescriptions.

Ask about copays: While Virginia Medicaid generally has minimal or no copays for addiction treatment, it's worth confirming what (if anything) you'll pay out of pocket.

A benefits check can review reported eligibility, formulary information, and potential authorization requirements. It is not a guarantee of coverage or zero out-of-pocket cost.

CardinalCare member services and support

CardinalCare offers several resources to help members access addiction treatment:

Member Services phone line: 1-844-235-2387 (TTY: 711)
Available Monday-Friday, 8 AM - 8 PM ET

24/7 nurse advice line: Get health guidance any time, including questions about medication side effects or treatment concerns.

Care coordination: Request a care coordinator who can help you navigate treatment options, find providers, and connect to community resources like transportation assistance or housing support.

Member portal: Access your digital insurance card, find providers, view claims, and message your care team.

Language services: CardinalCare provides interpretation services in over 200 languages at no cost to members.

If you're having trouble accessing treatment or getting a prescription approved, don't give up. Contact Member Services and ask to speak with a care coordinator who specializes in behavioral health. They can help troubleshoot coverage issues and find solutions.

Getting started with treatment is often easier than people expect when you have someone helping you navigate the system.

Switching to CardinalCare or changing Medicaid MCOs in Virginia

Virginia Medicaid allows you to change managed care plans once per year during your enrollment anniversary month, or within 90 days of first enrolling in Medicaid. You can also request a change for cause (like moving, provider network issues, or quality of care concerns).

If you're currently receiving Suboxone treatment through a different Virginia Medicaid MCO and want to switch to CardinalCare:

Your current treatment continues: You have a 90-day continuity of care period when switching plans. CardinalCare must continue covering your current medications and providers during this transition.

Check provider networks: Before switching, verify that your current prescriber participates in CardinalCare's network. If they don't, you may need to transition to a new provider after the 90-day period.

No gap in medication: Your buprenorphine prescription should continue without interruption. If you encounter issues, contact both your old and new plan to ensure smooth coordination.

To change plans, call Virginia Medicaid Member Services at 1-800-643-2273 or visit the Medicaid Managed Care enrollment website.

If you're not currently in CardinalCare but are interested in their network and services, changing plans might make sense if it offers better access to providers or pharmacies in your area. However, all Virginia Medicaid MCOs must cover the same essential benefits, including Suboxone treatment. The main differences are provider networks and member support services.

Tips for navigating CardinalCare coverage effectively

Keep your member ID card accessible: You'll need your CardinalCare member ID number when filling prescriptions, scheduling appointments, and calling Member Services.

Build a relationship with your pharmacy: Once you find an in-network pharmacy that stocks buprenorphine, stick with them. Pharmacists can help smooth out billing issues and get to know your medication needs.

Communicate proactively with your provider: If you're having coverage issues, tell your prescriber right away. They can often help with prior authorization requests, appeals, or finding covered alternatives.

Use care coordination services: CardinalCare's care coordinators can help with non-medical barriers to treatment like transportation, childcare, or finding counseling providers.

Understand your appeal rights: If a medication or service is denied, you have the right to appeal. CardinalCare must provide written notice explaining denials and your appeal options. Don't assume a denial is final.

Ask about supplemental services: Some Medicaid MCOs offer extra benefits beyond standard coverage, like gym memberships, nutrition counseling, or peer support programs. Ask what's available.

Insurance questions should not prevent you from asking for help. If you have an immediate medical emergency or suspect an overdose, call 911; otherwise, contact the plan or a treatment provider about available care.

How Grata Health works with CardinalCare

Grata Health provides telehealth Suboxone treatment in Virginia. Network status and appointment availability should be confirmed for the member's specific coverage:

• Initial evaluation and prescription
• Ongoing medication management
• Behavioral health support and care coordination
• Prescription management and refills

Benefits can be checked before an appointment, and the clinical team can supply documentation requested for a prior authorization. Neither verification nor submission guarantees coverage, approval, or final cost.

Our clinical team includes physicians and nurse practitioners licensed in Virginia who specialize in addiction medicine. Appointments happen by phone or video call from wherever you're comfortable — your home, car during lunch break, or a private space that works for you.

Pharmacy inventory, dispensing decisions, network rules, and claim outcomes remain pharmacy- and plan-specific. Contact the pharmacy, plan, and care team early if a prescription problem arises.

Finding the right support for your recovery

Understanding your CardinalCare coverage is an important step, but it's just the beginning. Effective treatment for opioid use disorder combines medication with counseling, peer support, and addressing the underlying factors that contribute to addiction.

Available services and coverage vary by benefit and clinical need. Medication, counseling, and peer support can serve different roles in an individualized treatment plan.

You don't have to figure this out alone. CardinalCare's care coordination team, your treatment provider, and community resources in Virginia can all help you access the full spectrum of support you need.

Recovery looks different for everyone, but it starts with taking the first step. Whether that's calling CardinalCare Member Services to verify your benefits, scheduling an evaluation with a provider like Grata Health, or just reading articles like this to learn more — you're already moving in the right direction.

If you're ready to explore Suboxone treatment, request an appointment with Grata Health. Current availability, clinical eligibility, coverage, and cost are confirmed individually.

Your CardinalCare benefits exist to help you access the care you need. Don't let confusion about coverage stand between you and recovery.

Grata Health offers same-day telehealth appointments in Virginia, Ohio, and Pennsylvania and accepts most insurance plans. Specific benefits and eligibility vary by plan and individual circumstances.