Does Insurance Cover Suboxone?

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The opioid epidemic continues to devastate America. So much so that it is likely that you or someone you know has been affected by opioid addiction. As a response, addiction treatment has been much more sought after in recent years. One of the more popular treatment methods is the use of Suboxone. Even though it is in high demand, access to and affordability of Suboxone can be an issue for some.

What is Suboxone and How it Helps Treat Addiction?

Suboxone is a medication commonly used to treat opioid addiction. The medication consists of buprenorphine and naloxone, which work in tandem at curbing withdrawal symptoms and cravings as well as preventing patients from using it to get high. It typically is used under the supervision of a doctor as part of a treatment plan that consists of medically assisted treatment as well as behavioral therapy.

What Does Addiction do to the Brain and Body?

Drug addiction has a huge effect on the user’s brain. In the case of opioid addiction, it changes the way the receptors in your brain react to opioids. Over time, you build up a tolerance and a need for the opioids. The tolerance causes the user to take more drugs to recreate the original euphoric effects.

A physical need for the drugs causes the user to go into withdrawal if they do not use. Withdrawal symptoms resemble a terrible flu, symptoms include nausea, diarrhea, body aches, chills, and sweating. This fear of withdrawal is what motivates a person to keep using despite any negative effects it would have on their life.

How Can Suboxone Help?

Suboxone works to block the effects of opioids as well as stop withdrawal symptoms. Blocking the high created by opioids aids in one’s recovery by breaking the cycle the brain has of positive reinforcement. If the drugs will not have an effect, you are less likely to use them. Stopping withdrawal symptoms helps people stick to treatment plans because they are not in pain and desperate to alleviate the symptoms.

Peer support and therapy help deal with the emotional aspects of drug addiction and are strongly suggested as part of a maintenance treatment program. The habit of drug use can be very hard to break, therefore, the typical length of a Suboxone treatment plan is generally one year. This time can be very beneficial for a person to build the foundations to their sobriety.

Suboxone vs. Methadone

Medically assisted treatment is not a new invention. Suboxone was approved by the FDA in 2002, previously methadone had been the treatment medication of choice. Even though methadone has been around for a long time, Suboxone is quickly becoming a safer, more successful option.

One advantage Suboxone has over Methadone is that due to the low risk of abuse, patients are allowed to take home their doses and only have to go to the doctor monthly. Whereas methadone carries a higher risk of abuse and dependence as well as the risk of overdose causing it to only be administered in supervised clinics. Need for a daily dose requires patients to travel to the methadone clinic daily, while Suboxone being prescribed in a doctor’s office is not only more convenient, it also greatly increases accessibility. With a 40-60% success rate, it is easy to see why Suboxone is the superior choice for medically assisted treatment.

Even with great advancements in the medication available, there is still a decline in people who use medically assisted treatment. Some factors as to why are:

  • Negative opinions about trading one drug for another
  • Discrimination against MAT patients
  • A lack of training for physicians

Paying For Suboxone

Suboxone can be very costly, the typical cost is usually $1 per milligram. Doses of Suboxone range from 12-24 mg per day. Without insurance, they could quickly get extremely expensive. Cost of Suboxone is attributed to the following factors:

  • Pharmaceutical manufacturer
  • Insurance
  • Health plans or prescribing clinic
  • Retail pharmacies

The price of the medication isn’t the only thing to consider when receiving medically assisted treatment. Office visits, therapy, and other required tests should be accounted for in treatment costs. Thanks to recent changes in insurance coverage, most companies now cover Suboxone treatment.

While most insurance companies now offer policies that cover treatment, it is important to know just how much is covered. Any portion of the treatment not covered by your plan will be your responsibility to pay out of pocket. Other factors to consider are time limits for treatment if a referral is needed and if you must receive the prescription from an in-network provider. If help is needed to pay for Suboxone treatment, look for programs that offer payment assistance. Your income will be considered when determining how much treatment will cost. Medicaid also offers coverage for treatment.

Information About Doctors Prescribing Suboxone and Accepting Payment

Although coverage is available that does not always mean accessing treatment is easy. Any doctor interested in prescribing Suboxone has to meet many legal obligations. In order to prescribe Suboxone, a doctor must be certified. There are also strict regulations on how many patients a doctor can treat every year. Thirdly, the DEA requires strict monitoring of the prescriptions. Those three factors may limit the number of available physicians who are currently accepting patients for Suboxone treatment.

Doctors may also choose to not accept insurance and require cash payment, leaving you to cover the upfront cost of treatment. In these cases, you may submit a claim to your insurance company to be reimbursed. Another downside is that due to our free enterprise system, doctors can decide what they are going to charge. Change is coming; however, many states have passed laws requiring insurance companies to cover addiction treatment. That being said, thorough research is best to find the right doctor and insurance company.

Find What’s Right For You

Treatment is not one size fits all, doing adequate research is vital to finding the perfect plan for you. Knowing your options and what to consider is an integral step in your analysis. Once the conversation is started, many companies will work with you. Take the time to examine your financial situation and the cost of care. Most importantly reach out. There is someone out there to help you navigate the road to treatment.

 

Sources
[1] Does Insurance Cover The Cost Of Suboxone? (2019, January 29). Retrieved from https://www.rehabcenter.net/insurance-cover-suboxone/
[2] Suboxone Addiction and Abuse Treatments. (n.d.). Retrieved from https://americanaddictioncenters.org/suboxone
[3] S.A. Health. (n.d.). Buprenorphine/naloxone for opioid dependence. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/resources/buprenorphine+naloxone+for+opioid+dependence+important+points+to+know+about+buprenorphine+naloxone+suboxone

Does Insurance Cover Suboxone?

Does Insurance Cover Suboxone?

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When you or someone you love is contemplating treatment for addiction, a million and one things will go through your head. How will we ever get over this? How to manage the pain and sickness? How are we going to pay for this? If you're contemplating taking suboxone to overcome opioid addiction, then you might wonder whether insurance covers it. Here is where the costs of suboxone are explained for those interested, whether your insurance might cover all or part of the cost, and what else you can do if you're interested in Suboxone treatment.

Is Suboxone Covered By Insurance?

If you, or your loved one have an insurance policy, then check it, as there should be some coverage for addiction treatment. The more expensive your policy, the more will be covered. If you have a lower cost insurance policy, there may be some co-pay, where you will have to pay for a portion of it from your own pocket. One way or another, you should have some of the costs of Suboxone covered as a form of treatment.

Your insurance company will likely have a list of registered pharmacies where you can go to fill the Suboxone prescription, so check that carefully before you waste time going into any pharmacy. Not all pharmacies are licensed to dispense the drug.

If you don't have your policy on hand right now, here are some of the big insurance companies that do include cover for Suboxone treatment:

  • Blue Cross Blue Shield (BCBS)
  • UMR
  • Aetna
  • Beacon
  • Cigna
  • Multi Plan
  • United Health Care

If you don't see your insurance company on the list above, don't worry, it is not exhaustive. There are other companies that provide the cover required, simply check your policy or give your company a call to find out.

Why Would I Need Insurance For Suboxone?

On it's own, Suboxone isn't cheap. You will still need a prescription from a doctor, but you can buy the sub-lingual films from a pharmacist for cash. For Suboxone sublingual film (2 mg-0.5 mg) the price is roughly $158 for a supply of 30 film, depending on which pharmacy you go to. However, it is not likely to be much less. Don't try and buy Suboxone on the black market, as you don't know what you're getting.

If you'd like to check into a detox or rehab facility where Suboxone is used, there are some residential treatment facilities where it is part of the treatment that can charge around $8,000 per month. If this isn't an option for you, then there's no need to worry because there are other alternatives.

One of the good things about Suboxone is that you don't need constant surveillance to take it. Due to the fact that it's nearly impossible to get high from it, users can be trusted to take it responsibly. In this sense, it can be a cheaper way to pursue a life without addiction, especially if your insurance covers the cost of the medicine.

Why Should You Choose Suboxone?

If you are addicted to injecting opioids, then Suboxone can help you break that habit. Firstly, it will take away your cravings and you won't have to mess about with needles and doses anymore.

Your dosage is prepared and you take it in a daily dose or one every two days. Even if you take more, you won't get the same effects as you did with heroin, so there's little point in trying. Your habit with the needle goes away and you can return to some normal form of life, without having to spend every day chasing a high, or trying to get enough heroin so that you won't get sick.

If you've been addicted to prescription opioids, Suboxone means that you can come off the drugs you've been abusing and not have to endure a debilitating withdrawal. You can get back to a normal routine, without thinking about taking drugs. It's important that when you take Suboxone you realize this is only treating the physical side of the illness and you must figure out what lies beneath. Addiction is a psychological condition that can be very complex, and you may have some stuff to work through in order to really get better. Insurance packages now cover addiction as a chronic illness, so you will get some cover for medication, such as Suboxone, under your plan.

What's Different About Suboxone?

Suboxone is a medicine that has been specifically developed to treat opioid addiction. It is made with a combination of two drugs: buprenorphine and naloxone. Suboxone was approved for treatment of opioid addiction by the FDA in 2002. People who have tried other forms of treatment for their addiction often have more success with Suboxone, so it has been seen as somewhat of a wonder drug.

Some people argue that it's not real recovery when you are still taking an opioid to replace another opioid. It's true that when treating opioid addiction with another opioid, there is the potential for dependency. This has been seen with some people buying methadone on the black market.

However, when you have been abusing opioids for some length of time, the drugs have affected the receptors in your brain, so giving them up does not simply make you go back to normal. In fact, you will get very sick, which people who have tried to go cold turkey have quickly realized!

Suboxone is different to methadone, because it has a ceiling effect, thus users won't get high from it, no matter how much they take. The naloxone is an opioid antagonist that can reverse the effects of narcotics such as heroin and methadone.

This also means that the user cannot feel the euphoric effects of Suboxone, even if they try to use it in a way that's against doctor recommendations. Naloxone can cause a person to go into severe withdrawal if they abuse opioids. This helps prevent misuse of Suboxone.

Unlike methadone, which is frequently used in the treatment of opioid addiction, Suboxone is prescribed in a sublingual or tablet form and doctors can provide patients with a take-home dose of 30 days. It works on the nervous system to reduce cravings and users will not go into withdrawal as long as they adhere to their doctor's instructions.

Suboxone Offers Hope

Coming to terms with the fact that you or a loved one suffers from opioid addiction can be overwhelming. With deaths from overdoses at an all time high, it's vital to get someone in addiction into some sort of treatment, even if they have tried before.

You need to consider what treatment options might suit and the cost. If you have insurance, it will certainly cover some of the cost and it can be more successful than other ways that have been tried before. It's a long, hard road, and it can often seem like there's no good news. Suboxone offers people some hope, even if other treatment methods have failed.

If you have a loved one who has been suffering with opioid addiction, you can find out more about its benefits here. Your help and support while your friend or family member is trying to recover can be invaluable.