The treatment of opioids is complex and often requires medications to help individuals re-train the brain to no longer crave and seek out these substances. One of the ways this may be done is through the use of Suboxone, which is a formulation of buprenorphine. The drug is typically highly effective at helping people stop using more powerful opioids. The question many have is, “Is suboxone covered by insurance?”
What Is Suboxone?
Suboxone is a type of medication-assisted treatment typically used for opioids and sometimes alcohol disorders. It is FDA approved. It combines buprenorphine, a type of partial opioid agonist, with naloxone, an opioid receptor antagonist. Often, it can be very helpful at binding to the opioid receptors in the body. The effect buprenorphine has is much less pronounced than the opioids themselves.
What Is Suboxone Treatment?
Suboxone is a common component in medication-assisted treatment. With this type of treatment, doctors use counseling and behavioral therapies, along with medication, to treat the substance use disorder. This method allows people to break their dependence on opioids because it works to trick the brain into believing those substances are present. Over time, the brain no longer craves opioids. This medication works to normalize brain chemistry. It also works to block euphoric effects from opioids and other drugs it’s used with, such as alcohol. As a result, suboxone is helpful in:
- Eliminating the high a person gets from these drugs
- Eliminating the cravings a person has for seeking out these drugs
- Normalizes the function of brain chemistry
- Works to normalize body functions without negative effects
This medication treatment may work for you for several months or longer. The long-term goal is to stop all medication use, and many people are able to do that after time without feeling the intense withdrawal side effects they may feel now.
This may be the ideal combination of benefits, but is suboxone covered by insurance? If this is the right treatment for you, chances are good your medications will be covered.
What Are Suboxone Treatment Costs?
The cost of suboxone treatment depends on many variables. Your doctor may be able to provide you with some insight into these drugs and what to expect from them. They will also communicate with you about your options in this and other treatments. Most often, they can tell you the cost of this plan.
Most of the time, health insurance companies cover suboxone treatment. This is dependent on the specific treatment plan you have, though. The best way to find out whether you have coverage is to reach out to your insurance provider directly to inquire about your policy’s specific features. This includes:
- If suboxone is covered
- When it is covered
- If there are deductibles and copays necessary
If you have Medicaid, you are likely to have coverage for suboxone. It may be completely covered in some states. Other times, there is a copay. If you have a prescription drug coverage policy through Medicare, it may also cover the cost of this type of treatment. With both of these options, it’s important to reach out to your plan provider to verify your coverage before seeking out care.
How to Know If You Have Coverage?
Know that your insurance company has to legally protect your privacy. Calling to ask questions about medication-assisted treatment and prescription medications that you may qualify for is your right. Here are some questions to ask.
When is suboxone covered?
In some situations, you may need a formal diagnosis of addiction and dependence. You may need to seek out care from a specialized provider before it is offered to you. A licensed provider must write a prescription for this medication most of the time.
What additional costs are there?
When contacting your insurance provider, be sure to ask how much of the prescription is covered. You may have a deductible to meet or a copayment you need to make prior to accessing the medication. Also note that your insurance provider may determine any special approvals you need prior to offering this protection.
Our Admissions Team Can Help You
One of the steps you can take to make verification of coverage easy is to contact our admissions team. We can help to gather your insurance information and determine if you have coverage. Fill out this form here to start your verification process or give us a call at (866) 971-5531.