Is Suboxone Treatment Covered By Insurance?

Suboxone may or may not be covered by insurance. Medication-assisted treatment options (MAT) like Suboxone are an evidence-based solution for opioid use disorders that can reduce cravings and withdrawal symptoms and improve treatment outcomes overall.

Suboxone and other forms of MAT are covered by national health insurance providers and are available through certain healthcare providers and addiction treatment specialists.

Several medications are currently available for the treatment of opioid use disorders and opioid dependence in combination with counseling and behavioral therapy.

These FDA-approved medications, which include Suboxone (buprenorphine/naloxone), have been demonstrated to help patients who are struggling with opioid addiction better maintain long-term recovery following professional rehabilitation treatment.

Does Insurance Cover Suboxone Treatment?

Under the Affordable Care Act (ACA), the Mental Health Parity and Addiction Equity Act, and other laws, medication-assisted treatment options are considered essential healthcare services.

This means that most major private and public insurance plans will at least partially cover Suboxone treatment when prescribed by a licensed medical professional in conjunction with counseling and/or behavioral therapy.

How To Determine Coverage

The best way to determine if Suboxone or some other prescription drug will be included under your current insurance coverage (along with what your out-of-pocket cost, copay, and deductible will be) is to call your insurance company directly and ask.

Health Insurance Plans That May Cover Suboxone

Examples of insurance policies that may cover the cost of Suboxone prescriptions include:

  • Aetna
  • Anthem/Elevance Health
  • Blue Cross Blue Shield
  • TRICARE Insurance
  • Humana
  • Kaiser
  • UnitedHealth Group
  • Medicaid
  • Medicare Part D

You should note that prior authorization may be required before your healthcare provider can provide you with your medication, and this extra step can take from one day to one month to process.

What Is Suboxone?

Suboxone is a brand-name medication prescribed to treat various forms of opioid addiction and dependence. It is also available as equivalent generic versions, and under other brand names including Zubsolv and Bunavail.

Buprenorphine & Naltrexone

The medication combines two drugs:

  • buprenorphine, a partial opioid agonist that binds to the same opioid receptors in the brain targeted by opioid drugs, but with a weaker effect
  • naloxone, an opioid antagonist that blocks the effects of opioid drugs for a limited period of time

This combination of medications acts on the central nervous system to reduce the cravings and withdrawal symptoms a person may experience while in recovery, while also being very hard to abuse with euphoric effects due to the naloxone portion of the medication.

While Suboxone is not a cure for opioid addiction, it can help people manage their symptoms and find greater success in recovery. It is also not addictive or habit-forming and can be used long-term and discontinued as needed.

Side Effects

Like other medications, Suboxone films and tablets are known to sometimes cause mild side effects, including:

  • constipation
  • muscle weakness
  • headaches
  • stomach pain
  • sleep problems
  • diarrhea
  • back pain
  • nausea
  • sneezing, runny, or stuffy nose
  • unusual mouth or tongue sensations
  • changes in libido
  • mood swings
  • concentration problems

These side effects will generally improve as the body adjusts to the medication. However, if you experience any severe side effects or adverse reactions to your medication, let your prescribing healthcare provider know immediately or seek emergency medical care.

How Effective Is Suboxone?

While each patient is different, figures provided by one study suggest that patients who used at least 16 mg of buprenorphine/naloxone medications daily were 82% less likely to drop out of treatment due to relapse.

A large volume of other studies confirm that those who use Suboxone or similar medications experience fewer cravings and other symptoms of OUD, relapse less frequently, are at less risk of criminal behavior, and are more likely to complete substance use disorder treatment programs.

Other MAT Options For Opioid Use Disorder

Two other medications are commonly provided by substance abuse treatment professionals for opioid use disorders:

  • naltrexone, a longer-acting opioid antagonist that neutralizes the effects of opioid drugs while it is active in the body, discouraging relapse
  • methadone, a long-acting synthetic opioid that, like Suboxone, weakly activates a person’s opioid receptors to reduce cravings and withdrawal symptoms, while also blunting the effects of other opioids while active in the body

Of all three options, methadone has the highest potential for abuse and is typically distributed in limited doses in a controlled outpatient setting like a methadone clinic.

In contrast, naltrexone injections and Suboxone are both available from certain approved healthcare provider offices under the Drug Addiction Treatment Act.

In terms of cost, estimates place methadone and buprenorphine as the most cost-effective long-term MAT options, while naltrexone injections are considerably pricier.

If you are interested in learning more about MAT and how Suboxone can fit into your personal treatment plan, please contact Northeast Addictions Treatment Center today.

Written by
Northeast Addition Editorial Team

Published on

©2024 Northeast Addition Center | All Rights Reserved

This page does not provide medical advice.

Ready to make a change? Talk to a specialist now.