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Does Insurance Cover The Cost Of Methadone Clinics?

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 17, 2019

All insurance providers are now required to cover addiction treatment, but not all plans cover the cost of methadone treatment. For those seeking medication-assisted treatment and are worried about their coverage, it is important to know what kinds of options are out there.

What Is Methadone?

Methadone is a manmade, or synthetic, narcotic. Typically, methadone is prescribed to treat opiate addiction and is administered in the detox process. Unfortunately, though, some people are affected by the illicit use of methadone. For this reason, in 2008, manufacturers of methadone hydrochloride tablets agreed of their own accord to limit the distribution of the medication strictly to detox facilities with authorization for treatment of addiction, according to the Drug Enforcement Administration (DEA). When administered properly, methadone can be used to effectively treat addiction to opioids– a monumental task.

Methadone Treatment: What You Need To Know

The National Alliance of Advocates for Buprenorphine Treatment (NAABT) cites an entire list of pros and cons associated with methadone treatment for persons affected by addiction. Some of the pros include the following:

  • Methadone treatments have been used to effectively treat addiction to opioids for more than 30 years
  • Daily visits in clinics give a stable structure to patients affected by addiction who so desperately need that structure
  • Cost of methadone treatment is usually less than that of other treatment options; cost may also be calculated on a “sliding scale” basis, according to income
  • In-clinic treatment presents the opportunity for those affected by addiction to meet others in recovery
  • Group counseling often accompanies the treatment
  • Methadone is an opioid, so it has the ability to stop withdrawal symptoms for those affected by addiction
  • The effects of methadone last for up to 24 hours

Conversely, some of the cons are as follows:

  • Persons seeking methadone treatment can continue use of opioids simultaneously
  • Methadone treatment adheres to a strict protocol– this may cause some persons seeking treatment to feel that they have no control of their own treatment
  • Methadone– since it is a narcotic– will show up in urine testing, such as for employment screens
  • Methadone treatment requires daily visits, which could be a difficult requirement for some people seeking treatment
  • Daily visits for treatment may make some parts of life difficult (i.e. overnight trips) for people seeking methadone treatment

In any case, methadone treatment came on the scene for treating persons affected by addiction over thirty years ago as a way to help those people not only overcome withdrawal symptoms, but also return to their lives as normal, and to focus on something other than drugs. After it was discovered that methadone could have this effect on persons affected by addiction, methadone has been used in treatment of addiction ever since, according to the National Alliance for Medication Assisted Recovery (NAMA).

Though it may seem obvious to some that the pros outweigh the cons, the important thing to note for anyone seeking treatment from addiction is that it is always best to find the right treatment plan for the person affected. If methadone seems like the right plan for you or someone you love, it is available, and there are way to get access to methadone treatment.

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Do Methadone Clinics Accept Insurance?

While the Affordable Care Act now requires all insurers to cover addiction treatment, not all insurance plans cover all forms of treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Some insurance plans may also set a restriction on the number of prescriptions a person receiving medication-assisted treatment may receive. Further, Medicaid may not cover methadone, and persons seeking methadone treatment should consult the Preferred Drug List for confirmation.

As for methadone treatment coverage through a commercial health plan, several factors are involved in the approval process for getting treatment coverage, including having a medical need for treatment, whether medications will be covered, and if there will be a required co-payment. The important thing to remember is that if methadone coverage is the right method of treatment for you or someone close to you who is affected by addiction, treatment is available, and you do have options.

Finding Help For Opioid Addiction

We live in a society largely affected by addiction. The great news for this sobering truth is that we have many types of treatment to aid persons affected by addiction on the road to recovery. If you are that person, and you are just beginning to start your journey, or if you know someone who needs help, you can find the help you seek. Contact us today so you can begin the journey to recovery.

Drug Enforcement Administration - Drug Fact Sheet: Methadone

National Alliance Of Advocates For Buprenorphine Treatment - What Are The Pros And Cons Of Treatment With Methadone?

National Alliance For Medication Assisted Recovery - Methadone 101

Substance Abuse And Mental Health Services Administration - Insurance And Payments

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