The Vivitrol Program: Cost, Refrigeration, and Practical Details

Key Takeaways

• Vivitrol requires monthly office visits where a healthcare provider administers the intramuscular injection — it cannot be self-administered
• Without insurance, a single Vivitrol injection costs approximately $1,000 to $1,800; manufacturer assistance programs can significantly reduce or eliminate costs
• Vivitrol must be stored under refrigeration (2-8 degrees Celsius) and can only remain at room temperature for up to 7 days before administration
• Treatment duration is individualized; SAMHSA recommends continuing MAT as long as the patient benefits, with no arbitrary time limits
• Missing a monthly dose leaves the patient without opioid receptor blockade and at increased risk for relapse and overdose

Vivitrol Program: A structured treatment regimen involving monthly intramuscular injections of extended-release naltrexone (380 mg), administered by a healthcare provider as part of a comprehensive plan that includes counseling and behavioral support.

Vivitrol’s effectiveness depends not just on the medication itself but on the practical logistics that surround it — scheduling appointments, managing costs, maintaining the cold chain, and sustaining treatment over time. Many patients and families have questions about these everyday details that go beyond the pharmacology. This page addresses the practical side of Vivitrol treatment.

How the Vivitrol Program Works

Monthly Injection Schedule

Vivitrol injections are administered every four weeks (approximately 28 days) at a healthcare provider’s office. The schedule is straightforward but requires consistency:

• Week 1: Initial evaluation, opioid detox confirmation, baseline lab work, first injection
• Week 4: Second injection appointment
• Ongoing: Monthly injection appointments continue at four-week intervals

Some treatment programs schedule Vivitrol appointments on the same day of each month to simplify planning. Others align injections with counseling sessions so that both can happen during a single visit.

What Happens at Each Appointment

A typical Vivitrol appointment involves several steps:

1. Brief clinical assessment — the provider checks in on the patient’s recovery progress, mental health, any side effects, and substance use since the last visit
2. Urine drug screening — many providers conduct a urine test to confirm the patient has not used opioids, though this practice varies
3. Medication preparation — the Vivitrol kit includes naltrexone microspheres and a diluent that must be mixed immediately before injection. The provider prepares the suspension.
4. Injection — the medication is injected into the gluteal (buttock) muscle using a specialized needle provided in the kit. The injection alternates between left and right sides each month.
5. Observation period — some providers observe patients for 15 to 30 minutes after injection to monitor for allergic reactions, particularly with the first dose
6. Scheduling — the next monthly appointment is scheduled before the patient leaves

The entire visit typically takes 30 to 60 minutes. The injection itself takes only a few seconds, though patients commonly report soreness at the injection site for several days afterward.

Vivitrol Cost and Financial Assistance

Cost With and Without Insurance

Vivitrol is one of the more expensive MAT medications due to its extended-release formulation and brand-only status (no generic is available as of early 2026):

• Without insurance: approximately $1,000 to $1,800 per injection, varying by pharmacy and region
• With private insurance: co-pays typically range from $0 to $150 per injection, depending on the plan’s formulary and tier placement
• NJ Medicaid (NJ FamilyCare): covers Vivitrol, though prior authorization may be required
• Medicare Part B: covers Vivitrol as a provider-administered injection

The annual cost without insurance can exceed $15,000, which places it out of reach for many uninsured patients without assistance.

Manufacturer Co-Pay Programs

Alkermes (Vivitrol’s manufacturer) operates several financial assistance programs:

• VIVITROL Co-Pay Savings Program — for commercially insured patients, this program can reduce co-pays to as low as $5 per injection. Eligibility requirements apply, and the program does not cover patients on government insurance (Medicaid, Medicare, TRICARE).
• VIVITROL Patient Assistance Program — for uninsured or underinsured patients who meet income eligibility criteria, Alkermes may provide Vivitrol at no cost. Applications are processed through the prescribing provider.
• INSUPPORT Program — Alkermes’ support program helps patients and providers navigate insurance coverage, prior authorization, and appeals

Additionally, some New Jersey treatment programs receive state or federal grant funding that covers the cost of Vivitrol for patients who cannot afford it. SAMHSA’s State Opioid Response (SOR) grants have funded Vivitrol access in several NJ counties.

Refrigeration and Storage Requirements

Why Refrigeration Matters

Cold Chain: The unbroken series of refrigerated storage and transportation steps required to maintain a medication’s stability and effectiveness from manufacture through administration. Vivitrol’s microsphere formulation is temperature-sensitive.

Vivitrol must be stored in a refrigerator at 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit). The extended-release microspheres that gradually deliver naltrexone over 30 days are engineered to break down at a specific rate. Temperature excursions — exposure to heat above the recommended range — can alter the structural integrity of these microspheres, potentially affecting how the medication is released.

Providers who stock Vivitrol must maintain dedicated pharmaceutical refrigeration with temperature monitoring. Specialty pharmacies that ship Vivitrol to providers use insulated packaging with cold packs to maintain temperature during transit.

What Happens if Vivitrol Is Not Refrigerated

According to the prescribing information, Vivitrol may be stored at room temperature (up to 25 degrees Celsius / 77 degrees Fahrenheit) for no more than 7 days prior to administration. After 7 days at room temperature, the medication should not be used.

If Vivitrol has been exposed to temperatures above 25 degrees Celsius, or if the duration of room-temperature storage is uncertain, the medication should be discarded. The risks of administering improperly stored Vivitrol include:

• Altered release characteristics — the medication may release naltrexone too quickly or too slowly
• Reduced effectiveness — degraded microspheres may not provide the full 30 days of receptor blockade
• Potential increase in injection site reactions

Patients do not need to worry about storage themselves, as Vivitrol is administered in a clinical setting. However, patients who notice that their provider’s medication was not stored in a refrigerator, or who have concerns about storage, should ask their provider before receiving the injection.

Common Questions About the Vivitrol Program

How Long Should You Stay on Vivitrol

Maintenance Treatment: The phase of addiction treatment focused on sustaining recovery gains over an extended period, using medication, therapy, and support services. There is no universally recommended duration — treatment length should be individualized.

There is no standard duration for Vivitrol treatment. SAMHSA’s treatment guidelines state that medication for opioid use disorder should be continued for as long as the patient continues to benefit, and that discontinuation should be a collaborative decision between patient and provider based on sustained recovery stability.

Some considerations that influence treatment duration:

• Early recovery — the first 12 months carry the highest relapse risk, and most providers recommend at least a full year of MAT
• Individual stability — patients with strong recovery support, stable housing, employment, and mental health treatment may discuss tapering sooner
• Prior relapse history — patients with multiple prior relapses may benefit from longer treatment duration
• Patient preference — some patients prefer the security of continued receptor blockade; others are motivated to eventually discontinue

Abruptly stopping Vivitrol is not medically dangerous in itself (unlike stopping methadone or buprenorphine, which can cause withdrawal). However, the loss of opioid receptor blockade means the patient’s tolerance is reduced, and any opioid use carries a significantly elevated overdose risk.

Missing a Monthly Dose

If a patient misses their scheduled Vivitrol injection, the opioid receptor blockade gradually diminishes as naltrexone levels fall below therapeutic range. Practically, this means:

• Within 1-2 weeks past due — some residual blockade may remain, but it is unreliable. The patient should schedule the injection as soon as possible.
• Beyond 2 weeks past due — receptor blockade is likely insufficient. If the patient has used opioids in the interim, the provider will need to confirm opioid-free status before re-administering Vivitrol.

Patients who anticipate scheduling conflicts — travel, work obligations, family emergencies — should discuss with their provider in advance. Some flexibility in scheduling is possible within a few days of the target date.

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This glossary entry is part of our Addiction Treatment Glossary. For a clinical overview of the medication, see What Is Vivitrol?. To compare Vivitrol with other MAT options, read Vivitrol vs. Suboxone vs. Sublocade. For information on insurance coverage for addiction treatment, visit our guide on insurance coverage for rehab.