Just a short request tonight. I need help gaining an understanding of how buprenorphine/Suboxone is covered, across geography, insurance carriers, and state Medicaid agencies.
Please write to me and share what you know. Does your state limit coverage for buprenorphine to a specific length of time? Have you appealed that limit? Did you win or lose? Does you insurer limit or deny coverage?
I am interested in responses with ‘just the facts’, or more lengthy descriptions of interesting or unique experiences. I will assume that anyone who writes wishes to remain anonymous; if you are willing to speak with an investigative reporter about your experience getting coverage, please specifically write that I can share your name/contact info.
Please send comments to drj (at) suboxonetalkzone.com , or if you prefer you can share them below.
Thanks!
{ 3 comments… read them below or add one }
Michigan Medicaid had previously limited Suboxone coverage to one year. Then Michigan Medicaid expanded coverage to more than a year but required an evaluation by an addiction medicine specialist or psychiatrist in order to be approved for more than one year. This restriction now seems to have been lifted as well. It does require that you are enrolled in a treatment program.
There is some confusion relating to insurance coverage rules because this drug (Buprenorphine or Subutex) for a number of reasons. Most often because it can be prescribed for both pain &\or substance abuse. When being prescribed for substance abuse some Insurance companies do put limits on the duration of coverage as they expect you to ween off the drug and no longer need it. When prescribed for chronic pain the need for long term coverage is justifiable.
WARNING:
A mistake I made when I switched from Morphine (MS Conton) was to allow my Doctor to prescribe Suboxone instead of Subutex. Suboxone is the brand name for Buprenorphine mixed with Naloxone and is most often prescribed for drug rehabilitation, not pain. Therefore Suboxone has the stigma of being the drug of (recovering) addicts, not chronic pain suffers. As soon as I started taking Suboxone I noticed a change in the way health professionals dealt with me. I did not realize that I was being looked at as a drug addict. I was also unaware that I had the option of Subutex. Subutex is the brand name for Buprenorphine and it does not contain the Naloxone that is mixed into Suboxone to stop people from abusing is most often by injection, as is the practice of some addicts.
The benefits of Buprenorphine over other Narcotic pain relief medications is that it provides a more consistent half life in your bloodstream. Most people are able to go 36+ hours without taking a dose and still not have any withdrawal symptoms. Many people experience relief from chronic pain at a Buprenorphine dose of 12 – 16 MG 2 X daily, where as for addiction management as little as 1/2 MG a day is all that is needed.
I’m here at the ASAM meet. The Patient Advocacy Task Force is working with TRI and another agency to collate all state info on coverage. This is a work in progress
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