OBJECTIVES: Buprenorphine/naloxone combination (BUP/NAL) has been available in a film formulation since 2010 for the treatment of opioid dependence. A clinical trial showed that patients preferred the film to tablet formulation. Insurance claims data extracted from MarketScan Medicaid database were analyzed to compare patient persistence and healthcare costs between the two formulations. METHODS: Patients initiating treatment with BUP/NAL after the launch of film (September 2010) were classified in two groups according to formulation of initial prescription: film or tablet. Time to treatment discontinuation and monthly healthcare costs by treatment phase (before treatment, initiation period, during treatment, discontinuation period, after discontinuation and reinitiation period) were compared between the two groups, adjusting on baseline characteristics (demographics, comorbidities, treatment, and resource utilization before treatment). RESULTS: Analysis included 450 patients initially treated with film and 1127 with tablet, followed over 6.3 and 8.0 months on average respectively. Of those treated with tablet, 17.8% of patients switched to film. The average dose at initiation was 16 mg in both groups. Kaplan-Meier estimates of the probability of persistence 200 days were 59.11% and 51.46% in the film and tablet groups respectively. The hazard ratio for treatment discontinuation with film vs. tablet, adjusted on baseline characteristics, was 0.72 (p=0.02). Monthly costs were highest around the time of treatment initiation, switch and discontinuation. Monthly costs during treatment were $418.76 for patients treated with film and $477.66 with tablet (p=0.1561). Monthly costs after treatment discontinuation were 40% lower among patients treated with film (p=0.0354). CONCLUSIONS: Patients treated with BUP/NAL film appear to have a lower probability of early treatment discontinuation. Treatment with the film formulation may generate cost savings since costs around discontinuation are relatively high, and costs after treatment discontinuation were found to be lower among patient previously treated with film.