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Does Insurance Cover The Cost Of Suboxone?

Brenda Munnerlyn, RN, BSN

Medically reviewed by

Brenda Munnerlyn, RN, BSN

January 29, 2019

Opioid addiction is on the rise and many people struggle with finding the treatment that is right for them. Suboxone is a medication that is prescribed to individuals who are in treatment for opioid addiction. This medication helps to lessen the symptoms of withdrawal and increase the odds of a successful recovery.

What Is Suboxone?

Suboxone is a medication used to treat opioid addiction. It is made with a combination of the common forms of medication used to treat opiate drug abuse concerns, buprenorphine and naloxone. Suboxone may be used in patients who have already tried buprenorphine treatments.

The hard truth about some medications used to treat narcotic addiction is that they can cause habits and dependence to form—much like the habits and dependence associated with the substance which they are being used to treat. Thus, in some instances, it is better to use a combination of medications, such as in Suboxone, to avoid causing dependence and the severe side effects of physical withdrawal that may be associated with the other treatments.

Suboxone has a ceiling effect, after taking it for some time, the opiate effects level out. This and the addition of naloxone, an antagonist, helps to prevent misuse and abuse. Available in a sublingual film or tablet form, Suboxone works on the central nervous system (CNS) to prevent or significantly alleviate cravings and withdrawal side effects.

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How Suboxone Works To Treat Addiction

As persons affected by substance abuse build a tolerance to opioids, something happens in their brains; that is, their opioid receptors become increasingly less affected by opioids. That is how persons abusing these drugs end up using more of them, in their effort to obtain the same high or euphoria they fuel their addiction. Without sufficient opioid intake, a person affected by addiction may suffer from severe withdrawal effects, prompting the person to seek more of the harmful drugs in an attempt to stop the unpleasant or uncomfortable symptoms.

When an addicted individual takes opioids, they will feel relief as the drugs bind to the receptors in the brain, despite this, the damage is still occurring if you are using opioids illicitly. For these reasons, drugs such as Suboxone have been made available to become critical components of drug addiction treatment.

Buprenorphine is an opioid partial agonist, which means it works in a similar capacity to full opioids, enough to keep the person from feeling severe withdrawal effects. However, it does not produce the same intense, euphoric feeling as a full opioid, in turn offering you a greater amount of protection against creating another issue of dependence. It does this by occupying the opioid receptors in the brain.

In the instance of maintenance therapy, the buprenorphine again occupies the receptors in your brain, in a capacity that blocks the illicit drug from doing so, thus blocking the effects of the damaging drug.

Suboxone Coverage

Most insurance plans do cover Suboxone medication, though some doctors will accept cash only for prescriptions. However, many people seeking treatment prefer to pay for the medication personally, in order to keep their treatment measures private. Please remember, drug addiction is nothing to be ashamed about. It is important that you reach out so that the addiction professionals have a chance to help you.

In any case, the important thing to note about Suboxone is that it is indeed covered by most insurance policies as a form of medication treatment for addiction, and, therefore, insurance coverage should not be one of the factors holding back a person from seeking addiction treatment.

To prescribe Suboxone, a doctor must be certified. Individuals seeking Suboxone as a treatment option should consult with their insurance provider for a list of physicians or facilities close to them who are certified to prescribe this medication. Strict regulations regarding the amount of patients each doctor may treat, may at times make it difficult to find a physician.

Even worse, doctors may choose to refuse insurance for medications prescribed for treatment of addiction, despite the fact that many insurance companies now reimburse for such medications. Some reports warn that some doctors still participate in the illegal practice of discriminating against persons affected by addiction that are in search of treatment. It is also up to the discretion of specific practices to decide what private insurance they will accept.

For these reasons, it is important to do adequate research before selecting a physician, or treatment, to ensure that you receive the most thorough method of care. In addition, there are various scholarships or grants that may help pay for your treatment, that way you can get one step closer to being in a facility that offers Suboxone treatment.

Getting The Right Treatment

Addiction to opioids can cause severe withdrawal symptoms. Recovering from these symptoms can be a harsh process, and, as the U.S. National Library of Medicine states, one that can be difficult and dangerous if attempted alone.

Instead, those suffering from substance abuse and addiction and the subsequent withdrawal symptoms should attempt to recover in a safe space. In some circumstances, a person may choose to do this at home, if they have a strong support system, however, as opioid addictions are some of the most severe, we recommend in the very least a hospital, or if possible, an appropriate rehab center that can support you during a medically supervised detox.

Choosing the right treatment is key. The benefit to choosing inpatient drug rehab is that you will progress through detoxification in a safe and comfortable environment, and be on site and able to begin the other aspects of treatment that can be so crucial towards your recovery success. Taking the time to examine your financial situation, including any insurance concerns is key in enabling you to receive care at a treatment center that is best suited to your needs.

We Can Connect You To The Proper Treatment

Today, across the United States, countless individuals are affected by substance abuse and addiction, in fact, in 2014, 435,000 people used heroin alone. The silver lining to this daunting number is that if you or someone close to you is struggling, you are not alone in your hardships, and there is hope.

You can find treatment, whether in the form of a medication like Suboxone or in a variety of other successful treatment modalities. We can help you to navigate any insurance concerns or any other questions that you might have. Contact us today.

Mayo Clinic - Buprenorphine/Naloxone (Oromucosal Route, Sublingual Route)

U.S. National Library Of Medicine - Opiate And Opioid Withdrawal

Substance Abuse and Mental Health Services Administration - Buprenorphine

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