Vivitrol is naltrexone. So is the $23 bottle of tablets on a mail-order pharmacy’s website. Same molecule, same manufacturer class of drug, approved for the same two conditions, and separated by more than $1,700 a month.
That gap is the whole story of this page, and it is not a scandal so much as a design choice. Vivitrol is an extended-release suspension that a clinician injects once every four weeks, and the delivery system is what you are paying for. Whether that is worth 50 to 77 times the pill price is a conversation for you and a prescriber. What follows is what each option actually costs, researched September 3, 2026.
What Does Vivitrol Cost Without Insurance?
Prices below are for the medication only. Vivitrol is administered by a clinician, so an office visit and an administration charge sit on top. Federal acquisition figures come from CMS’s NADAC dataset effective August 19, 2026. Medicare figures are the July 2026 Part B payment limits, in effect July 1 through September 30, 2026.
| Product and fill | Low | Average | High |
|---|---|---|---|
| Vivitrol 380 mg, one injection | $1,716.48 (NADAC acquisition) | $1,719.50 (Medicare Part B limit) | $1,758.09 (Drugs.com cash) |
| Vivitrol, 12 injections (one year) | $20,597.81 | $20,634.00 | $21,097.08 |
| Vivitrol cash price after the $500 savings card | $1,258.09 (Drugs.com less card) | $1,258.09 | $1,258.09 |
| Naltrexone 50 mg tablets, 30 | $22.94 (Cost Plus Drugs) | $32.24 (Drugs.com) | $34.18 (NADAC acquisition) |
| Naltrexone 50 mg tablets, 100 | $97.55 (Drugs.com) | $113.92 (NADAC acquisition) | $113.92 |
| Naltrexone 50 mg tablets, 12 months | $275.28 (Cost Plus Drugs) | $386.88 (Drugs.com) | $410.11 (NADAC acquisition) |
| OTP naltrexone bundle, CY2026 (G2073) | $1,760.73 (CMS) | $1,760.73 | $1,760.73 |
Note what happens in the tablet rows: the federal acquisition price sits at the top of the range rather than the bottom. Cost Plus Drugs sells 30 tablets for $22.94, which is below what the average American pharmacy pays to buy them ($34.18 at the August 19, 2026 NADAC price). That is not an error, it is what a direct-purchase pharmacy with a flat labor fee looks like when it competes with a conventional dispensing model.
The Vivitrol rows tell the opposite story. Acquisition, Medicare’s payment limit and the retail cash quote land within $42 of each other. There is essentially no shopping to be done on this drug. The price is the price.
What Drives the Price
The formulation, not the molecule
Naltrexone hydrochloride is an old, cheap generic. Vivitrol suspends it in polylactide-co-glycolide microspheres that release the drug over about four weeks, and it ships as a kit with its own diluent. That extended-release engineering, plus brand exclusivity with no generic competitor as of September 2026, is the entire $1,700 difference.
There is no generic to compete with it
Federal acquisition data carries the Vivitrol 380 mg vial-and-diluent kit with a brand classification and no corresponding generic price, and Drugs.com states outright that Vivitrol is brand-only. Generic naltrexone exists in exactly one form, the 50 mg oral tablet. Nothing puts downward pressure on the injection’s price.
It is a medical benefit, so a discount card behaves differently
Vivitrol is billed under J2315, the HCPCS code for depot naltrexone at 1 mg. Medicare’s July 2026 payment limit is $4.525 per mg, which for the standard 380 mg dose is $1,719.50. Because it is administered in a clinic rather than picked up at a counter, the coupon and pharmacy-shopping tactics that work on ordinary generics mostly do not apply.
Where you get it
At an opioid treatment program the drug is not billed on its own. CMS’s CY2026 naltrexone bundle (G2073) pays $1,760.73, of which $1,520.16 is the drug and $240.58 covers dispensing, counseling, individual and group therapy, and toxicology testing. That $240.58 buys the entire wraparound month, which is why bundled settings often work out cheaper overall than paying for the drug and then paying separately for everything around it.
The visit and the shot are extra
Neither Alkermes’ savings program nor Medicare’s drug payment limit covers the administration. The savings card terms say so explicitly: the program assists with the out-of-pocket cost for Vivitrol only, not the office visit or the medication administration. Our doctor visit cost guide covers what to expect for the appointment itself.
Cash Price vs. Insurance
Vivitrol is one of the few expensive brand drugs where being uninsured is not an automatic disqualification from manufacturer help. Most copay cards, including the one for Sublocade, require commercial insurance. Alkermes’ does not.
The Vivitrol Co-pay Savings Card lists eligibility as patients with commercial health insurance and patients with no insurance or who are cash-paying. The pharmacist instructions on the card even spell out how to run a cash claim as a primary claim. The benefit is up to $500 per prescription, up to 12 prescriptions per calendar year, capped at $6,000 a year.
For a cash payer that is a real but partial fix. Taking $500 off the $1,758.09 Drugs.com price leaves about $1,258 per injection and roughly $15,100 a year. Better than nothing, and nowhere near the pill price.
The exclusions matter too. Anyone whose Vivitrol is paid for in whole or in part by Medicare, Medicaid, Medigap, VA, DOD, TRICARE or a state or residential correctional program is ineligible. If you are Medicaid-eligible but not enrolled, enrolling almost certainly beats the card: Alkermes reports that 99 percent of people with any insurance including Medicaid have coverage for Vivitrol.
Alkermes also runs Vivitrol2gether patient support services, which Drugs.com lists as including a patient assistance program for people with no prescription coverage, based on federal poverty level. That is the route for someone who cannot cover $1,258 either.
How to Pay Less
Ask what the oral tablet would cost you. This is the single largest lever on this page and it costs nothing to ask. A month of generic naltrexone tablets runs $22.94 at Cost Plus Drugs and $32.24 at the Drugs.com quoted price, against $1,758.09 for the injection. Over a year that is $275 versus $21,097. The two are not clinically interchangeable, and only a prescriber can tell you whether the daily form fits your situation, but nobody should be paying the injection price without knowing the pill price. Our naltrexone cost guide covers the oral form in detail, and low-dose naltrexone covers the compounded version.
Get the savings card before your first injection, not after. The card covers cash payers and takes up to $500 off each of up to 12 fills. The terms also allow claims dated up to 90 days before your enrollment date, so if you have already paid for a shot it is still worth enrolling.
Price the opioid treatment program route. The CY2026 bundle at $1,760.73 includes counseling, therapy and toxicology testing that you would otherwise buy separately. Our rehab cost guide explains how bundled behavioral health rates are built and where they are negotiable.
Check Medicaid eligibility today. Coverage rates for Vivitrol under Medicaid are near universal per Alkermes’ own reporting, and Medicaid enrollment is retroactive in most states for up to three months of prior bills.
Use a sliding-scale clinic for the visit. Even if the drug is covered, the appointment may not be. Federally qualified health centers set fees by income. Our guide to free clinics and sliding-scale care explains how to find one and what documentation to bring.
If a bill has already landed, do not pay the sticker. Clinic-administered drugs generate bills with several separable lines. Our guide to negotiating medical bills walks through asking for the self-pay rate in writing, and our fair price checker shows typical cash figures so you know when a quote is out of line.
The Bottom Line
Vivitrol costs $1,716 to $1,758 per monthly injection in September 2026, or about $20,600 to $21,100 a year for the drug by itself. The savings card, which uniquely covers cash payers, knocks up to $500 off each dose and up to $6,000 off the year.
The same active molecule as a generic tablet costs $22.94 to $34.18 for a 30-day supply. That is not an argument for one over the other, because the products behave differently and only a prescriber can weigh that. It is an argument for asking the question out loud before agreeing to a $21,000 annual bill, and for checking whether Medicaid or a bundled opioid treatment program takes the number down first. Our guides to Sublocade and methadone cover what the other long-acting options cost.