OBJECTIVES: Buprenorphine/naloxone (BUP/NAL) for the treatment of opioid dependence combination is available in film (since September 2010) and tablet formulation. Earlier studies showed that treatment with BUP/NAL film formulation leads to an improved treatment persistence and lower healthcare costs compared to BUP/NAL tablet formulation. A budget impact analysis was built to assess the health care expenditures related to new patients entering treatment in scenarios characterized by different market shares of the two BUP/NAL formulations. METHODS: A Markov model was structured tracking a cohort of patients initiating opioid dependence treatment with BUP/NAL film or BUP/NAL tablet formulation through successive phases of treatment: initiation, maintenance, discontinuation, off treatment and reinitiation. Transition probabilities and resource utilization were estimated from a Marketscan Multi-State Medicaid database. The total healthcare expenditure over five years was predicted for 65.6 million members for the following scenarios: 1)  100% market share BUP/NAL film formulation, 2) 100% market share BUP/NAL tablet formulation broken between all BUP/NAL tablet formulations currently available in the market. RESULTS:  In the first year, for Scenario 1 (100% on BUP/NAL Film) costs of medication acquisition were found to be %6.1 (-US$18.1 million) lower.  Costs of outpatient care were 31.65% (US$110.6 million) higher. Nevertheless, this difference was outweighed by lower costs of inpatient care (-36.09%) (-US$129.9 million), and emergency room (-7.96%) (-US$3.3 million). Scenario 1 total healthcare costs were 4.2% and 9.4% lower in the first year and cumulatively over five years, respectively. CONCLUSIONS: Treatment with buprenorphine/naloxone film results in less healthcare resource utilization and lower total cost burden for Medicaid plans when compared to treatment with buprenorphine/naloxone tablet