Does Insurance Cover Suboxone?

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 and affordability 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.

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. 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.

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.

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.

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] Persistent and Abusive Use of Opioids: Short- and Long-Term Effects on the Brain. (n.d.). Retrieved from https://www.biausa.org/public-affairs/media/persistent-and-abusive-use-of-opioids

[2] Velander J. R. (2018). Suboxone: Rationale, Science, Misconceptions. The Ochsner journal, 18(1), 23–29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/

[3] Government of South Australia. (2019, February). 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

[4] Does Medicaid or Insurance Cover The Cost of Suboxone? (n.d.). Retrieved from https://americanaddictioncenters.org/insurance-coverage/suboxone

[5] The National Alliance of Advocates for Buprenorphine Treatment. (2018, December). Does insurance cover it? Retrieved from https://www.naabt.org/faq_answers.cfm?ID=37