Does insurance cover suboxone treatment?

Are you one of the many people who are seeking help for opioid addiction? If so, suboxone may be a viable treatment option. However, the question always arises: does insurance cover suboxone treatment?

Substance abuse is never a joking matter but let’s have some fun and explore this topic together.

Let’s go!

First things first – What is Suboxone?

Before we dive into whether or not insurance will cover your suboxone treatment, let’s discuss what it even is. Suboxone is a combination drug that contains both buprenorphine (a medication used to treat pain and opioid addiction) and naloxone (an emergency overdose medication most commonly marketed under the name Narcan). When taken as prescribed by licensed professionals such as doctors or psychiatric nurse practitioners (they know their stuff) after proper medical assessment, these medications can be safe and effective.

Benefits of Suboxone Treatment

Why should someone consider taking subxane? Here are just a few possible benefits:

  • It can reduce withdrawal symptoms associated with opioids
  • Decrease cravings for drugs
  • Help prevent relapse (we don’t want that!)
  • Increase overall functioning while in recovery

Sounds good right… except it might come at a price. Let us find out if our friendly insurance companies can hook us up so we do not have to pay out-of-pocket.

Insurances Plans That Cover Subxane Treatment

When it comes to insurances plans (think Blue Cross/Blue Shield, Aetna, etc.), policies vary from state-to-state and plan-to-plan about whether or not they will provide coverage for specific treatments like an outpatient program involving clinic-based buprenorphine therapy (wowza, say that five times fast!). The good news however, lies with healthcare reforms made through the Affordable Care Act. These reforms stipulate that insurance policies offered under the ACA must cover medications used to treat substance use disorders, including suboxone.

But we all know nothing is ever straightforward with insurances. Here are a few things to keep in mind:

  • Co-pays and cost-sharing still may be involved
  • Some individualized policies might have yet another level of scrutiny before agreeing to pay for your treatment (competitive much?)

Can Uninsured Individuals receive Subxone Treatment?

If you don’t have health insurance coverage through an employer or on a private plan yourself or family member with Medicaid, it doesn’t mean you can’t get the help you need to overcome opioid addiction. Many states offer publicly-funded programs that offer accessible medication-assisted therapies (MATs) like those involving buprenorphine (ahem aka suboxane).

Additionally, many healthcare providers set up their own approved financial assistance programs enabling uninsured people who satisfy income criteria access subsidized care too.

Tiers of Health Insurance Coverage

Insurance companies specify levels of tiered payment when physicians bill them (aka reimbursement rates) known as Levels I – III (now we’re getting fancy). The availability and rates by insurers differ geographically on which tier they would categorize the treatments covered by a physician (phew check out us simplifying everything now).

Different medications emerge from varying tiers, and different costs (& reimbursements) according to what state customers claim from these pharmaceutical interventions.

So ultimately while every policy considers guidelines at model functionality/effectiveness along with comments provided by providers such as social workers/counselors/psychiatrists about drug-misuse history – which could make the difference whether they put patients down for Tier II-level payments/co-insurance over cheaper/more costly coverage options.

Still following?

Before signing where your pen hovers over though – one more thing: concerning buprenorphine, plans’ median reimbursement has increased to approximately $117 per prescription from 2011 going forward despite coverage gaps in both private/public plans that may exist.

Conclusion

Suboxone treatment can be life-changing for those struggling with opioid addiction. Thankfully, progress has been made in recent years ensuring insurance companies under the Affordable Care Act have some responsibility to offer coverage for Suboxone medications used to treat substance use disorders to their customers.

Now put on your slick sunglasses and relax because you don’t have sand stuck between your toes…oh wait let’s return back from daydreaming ‘look‘ at that subxane might not necessarily not be covered-. There’s hope yet! Speak with a provider or check out state-run programs if you’re an uninsured individual and make sure bartering is your middle name when dealing through tiers of health insurance policies even when buprenorphine reimbursements average $117 (SCORE!).

Hope this finding was useful (if not entertaining) as well as extra perks also free (but whose counting besides broke college students?) such as adding one more acronyms (ACA) under our belts + mental notes about non-exclusionary healthcare policies across America.

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