In short
Act 140-2010 provides that every insurer, every health service organization organized under the Puerto Rico Insurance Code, insurance plans providing services in Puerto Rico, the Puerto Rico Health Insurance Administration and any entity contracted to offer health or health insurance services through the Puerto Rico Health Insurance Administration Act, must include within the “Medicaid Preferred Drug List,” or the health plan’s preferred drug list, for the treatment of opioid addiction, the medication known as buprenorphine. The law took effect January 1, 2011 and applies to each health plan when sold and/or renewed, subject to approval by the Rates and Health Plans Review Board. It is a short, concrete mandate: it places the medication on the preference list, with treatment of opioid addiction as the named use.
What is it?
It is the law that put buprenorphine, by name, on health plans’ preferred drug lists in Puerto Rico when the use is treatment of opioid addiction. Its usefulness is direct: if the plan answers that this medication is not on its formulary, the law says otherwise and names who is bound.
Who can do it?
People in treatment for opioid addiction covered by an insurer, a health service organization organized under the Puerto Rico Insurance Code, an insurance plan providing services in Puerto Rico, the Puerto Rico Health Insurance Administration, or any entity contracted to offer health or health insurance services through the ASES Act.
Requirements
- That the use be treatment of opioid addiction, which is the use the law names.Verified against the official source
- That the plan belong to one of the entities the law lists: insurers, health service organizations under the Insurance Code, insurance plans providing services in Puerto Rico, ASES, or entities contracted through the ASES Act.Verified against the official source
Documents you need
Information pending verification.
Cost
Step by step
Step 1: Ask for the preferred drug list in writing
The law is complied with or breached in that document. The mandate is to include buprenorphine within the “Medicaid Preferred Drug List” or the health plan’s preferred drug list. Asking for the list and looking for the molecule is the step that makes the law verifiable.
Step 2: Cite the use the law names
The mandate is written with a specific use: “for the treatment of opioid addiction, the medication known as buprenorphine.” When you write to the plan, frame the request in that use, which is the one the statute covers.
Step 3: The law names ASES expressly
This matters if you have the government plan: the duty reaches the Puerto Rico Health Insurance Administration and any entity contracted to offer health or health insurance services through the ASES Act, in addition to private insurers and Insurance Code health service organizations.
Step 4: If denied, use the denied-medication route
The law creates no procedure of its own: it creates the inclusion duty. The claim runs through the routes that already exist for a denied or excluded medication, which we cover in its own guide, and through complaints to the Office of the Insurance Commissioner and the Office of the Patient Advocate. Bring the copy of the list and the denial letter.
Where to do it
First the plan, in writing. Then the Office of the Insurance Commissioner and the Office of the Patient Advocate, which are the complaint doors we cover in the health insurance guides. For the treatment itself, ASSMCA is the mental health and anti-addiction services agency and has its own guide, as does the PAS line.
How long it takes
What to do if something goes wrong
How far this law goes, said plainly. The law orders including the medication on the preferred list. It sets no quantities, no treatment duration, no copay, does not bar prior authorization, and does not require a particular presentation or brand: it names the molecule, buprenorphine. Being on the preferred list and being approved in your specific case are not the same thing, and we will not say they are. What the law does resolve is the answer that “that medication is not on our formulary for opioid addiction”: that is precisely what the statute addresses. We did not read the Puerto Rico Insurance Code or the ASES Act, both cited by the law to define whom it binds, nor any plan formulary; so we publish no copays, formulary tiers or listings. And the law provides it applies to each plan when sold and/or renewed, subject to approval by the Rates and Health Plans Review Board.
Common mistakes
- Accepting “it is not on the formulary” at face value: the law requires including it on the preferred list.
- Requesting it without framing the use: the law names it for treatment of opioid addiction.
- Believing it binds only private plans: the law expressly names ASES.
- Expecting the law to set a copay or quantity: it does not.
- Assuming the law bars prior authorization: it does not mention it.
- Not keeping the denial letter: it is the basis of the claim.
Frequently asked questions
What exactly does Act 140-2010 require?
To include within the “Medicaid Preferred Drug List,” or the health plan’s preferred drug list, for the treatment of opioid addiction, the medication known as buprenorphine.
Does it apply to the government plan?
Yes. The law names the Puerto Rico Health Insurance Administration and any entity contracted to offer health or health insurance services through the ASES Act.
Does the law guarantee approval for me?
It does not say that. The law orders including it on the preferred list; it sets no quantities, duration or copay and does not bar prior authorization. What it does resolve is a refusal based on the medication not appearing on the list.
When did it take effect?
From January 1, 2011, and it applies to each health plan when sold and/or renewed, subject to approval by the Rates and Health Plans Review Board.
Official sources
These are the government pages this guide is based on.
- Oficina del Comisionado de Seguros (OCS)
OCS
bvirtualogp.pr.gov
- Office of the Insurance Commissioner
OCS
ocs.pr.gov
Last verified
August 24, 2026
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