Opioid addiction is still a significant problem in the U.S, and many people struggle with finding the right treatment for their addiction. Suboxone is one of the most commonly utilized parts of medication-assisted treatment (MAT) used to treat opioid addiction in many parts of the country.
In addition to behavioral therapy interventions, Suboxone treatment can help reduce the severity of opioid withdrawal symptoms and eliminate opioid dependence in the long run.
Today, MAT is a standard of care for managing opioid use disorder, and your primary healthcare provider may recommend it for long-term recovery.
So, does insurance cover Suboxone treatment? Keep reading to learn more about Suboxone treatment and insurance coverage. We shall also let you know how to find a Suboxone provider near you so you can start your path to successful recovery from opioid addiction.
What Is Suboxone?
Suboxone refers to a brand name for a combination of two drugs, namely Naloxone and Buprenorphine. It is usually available as a dissolvable film for sublingual administration. The primary purpose of the medication is to treat opioid addiction for victims who have already started the recovery journey and plan to continue with treatment until the end.
Buprenorphine is an opioid agonist that binds to the opioid receptors in the brain. The primary purpose of Buprenorphine is to reverse and block severe effects of opioids and alleviate withdrawal symptoms and cravings.
Naloxone is added to the composition to help reverse the effects of opioid overdose. Although Naloxone can be administered on its own, it is usually included in Suboxone to discourage misuse of Buprenorphine.
Dissolving Buprenorphine to inhale or inject it into the body can lead to a rapid onset of severe opioid addiction withdrawal symptoms.
How Does Suboxone Treatment Work?
A person affected by opioid use disorder usually develops tolerance to these painkillers. Tolerance is a gradual process that takes place in the brain.
It means that the opioid receptors of the victim become increasingly less affected by opioids with time. As the opioid receptors become less affected by these drugs, the victim is forced to use more of them to obtain the same feeling/euphoria that they are used to getting whenever they inhale or inject opioids.
Without sufficient intake, the affected person may develop severe withdrawal symptoms, prompting them to seek more of the substance in an attempt to alleviate the unpleasant symptoms.
When the victim takes opioids, they feel relieved as the drugs bind to the opioid receptors in the brain. Despite the “sweet” feeling achieved, extensive damage to the brain is also taking place at the same time.
For this reason, drugs such as Suboxone have become a critical component of opioid addiction treatment.
Since Buprenorphine is an opioid partial agonist, it works relatively similarly to full opioids. The feeling generated when it binds to the opioid receptors in the brain is enough to keep the person feeling good without damaging the brain.
Remember that Buprenorphine doesn’t produce the same intense, euphoric feeling as full opioids because it is designed to protect the victim from developing another issue of dependence.
During maintenance therapy, Buprenorphine will again occupy the opioid receptors in the brain to block the full opioids from doing so, thus blocking the effects of the illicit drug.
How Much Does Suboxone Cost Without Insurance?
The exact cost of Suboxone without insurance depends on a wide range of factors. Generally, prices differ depending on the healthcare provider you obtain your prescription from and whether you receive the original or generic version.
Suboxone treatment drugs are priced from $59 for 14 sublingual films of the 2mg/0.5mg formulation to $225 for the 12mg/3mg formulation of the film strips. These figures may be slightly higher or lower depending on the pharmacy where you purchase the drugs.
On average, Suboxone costs around $6 per dose for the lower generic doses of buprenorphine/naloxone. However, these costs can add up quite significantly since you need several doses every day to manage the cravings and withdrawal symptoms.
Does Insurance Cover Suboxone Treatment?
Most insurance plans cover Suboxone treatment in compliance with the Mental Health Parity, and Addiction Equity Act passed in 2008 under the Affordable Care Act (ACA).
The Act requires that all healthcare insurance providers cover some level of benefits for behavioral conditions such as addiction as they do for basic surgical and medical care.
Under the Affordable Care Act, all marketplace healthcare plans must cover basic mental health and substance abuse services like any other essential healthcare services. ACA also stipulates that substance abuse and mental health conditions are like any other pre-existing conditions and no one deserves denied coverage for these conditions.
Therefore, insurance companies no longer have strong grounds to deny coverage for these services. But like any other condition, you must start by getting a comprehensive diagnosis from a qualified medical professional.
The medical professional then submits an approval request to your health insurance provider. The initial submission is known as prior authorization. When the insurer approves the submission, your doctor can proceed to prescribe medications such as Suboxone to help you begin your opioid addiction treatment.
You need to keep in mind that prior authorization can take some time. So, it is important to stay focused and motivated. Feel free to ask your doctor for any help or join a support group near you to get the social support you need to stay on course with your recovery.
Does Medicaid Cover Suboxone Treatment?
If you cannot afford a healthcare plan through the ACA marketplace, you may qualify for Medicaid. The primary purpose of Medicaid is to give you access to some types of treatment, including MAT for opioid addiction.
Almost all the states have Suboxone listed on their preferred drug list (PDLs), but most of them still require prior authorization. You also need to keep in mind that there are other medications that combine with Suboxone to aid recovery. So, sometimes, you may receive something that is not specifically Suboxone.
Documentation of behavioral therapy is also required for you to continue receiving Suboxone or similar medications. Medicaid programs in at least 21 states require evidence of prescribed behavioral therapy alongside MAT to approve coverage.
Some states have established prescription limits for people receiving Suboxone as part of their opioid use disorder recovery program.
The states of Washington, Michigan, Illinois, and the District of Columbia limit Suboxone treatment to one year, while Arkansas, Virginia, Mississippi, Wyoming, Montana, and Maine limit it to two years. Utah has a three-year limit.
How Do I Find Suboxone Clinic Near Me?
The truth is that millions of people across the country have been affected by the opioid epidemic. The silver lining to the daunting statistics is that if you or your loved one is struggling with the addiction, you are not alone in your hardship, and there is hope.
At CCIWA, we understand the pain and agony you are experiencing and your desire to take control of your life again. That is why we have assembled a team of highly experienced Suboxone doctors ready to help you with your recovery.
Finding a Suboxone clinic near you is now easier than you ever thought. Contact us today to learn more about our treatment options and how you can get started!