What Insurance company will pay for Suboxone prescription
Hi, everyone, can anyone tell me what Insurance company will pay for Suboxone besides Welfare? I have been researching and cannot find one? I have been dropped by welfare and I am in need of help. I first was on a Methadone clinic for a few years, then switched to a sub. doctor and I am still clean from use of street drugs for almost 5 years now. Welfare has dropped me because they state that I need to belong in a rehab and that because my primary diagnoses is opiod dependency that I have no other option but to stay in a state run program or rehab(which does not make any sense to me). They are not giving me any chance to explain anything and are dropping my medical coverage. I do not know what to do now I cannot afford to pay for the suboxone through the pharmacy it would cost me $600 or more. Their has to be an Insurance company in pennsylvania that would cover or at least have a co-pay? Thank You.
Re: What Insurance company will pay for Suboxone prescription
Hello D,
If the social services office will not listen to you, then you need to request a fair hearing as soon as humanly possible.
If you have a legitimate reason for not attending a clinic, I am sure that they will be willing to listen at that time. Time is of the essence; requesting a fair hearing before your case is closed may prevent your local office from closing your case.
If it is closed, the State can compel the local office to re-open your case under "aid to continue" status. This depends on different factors and is at their discretion.
Please remember that opiod use is not restricted to just "street drugs" but also prescription medication(legally or illegally obtained).
If any toxicology reports are available that are positive for opiates, etc., it most likely will be used against you at the hearing.
Take care.
Phoenix
__________________
When in doubt, post it out.
Last edited by Phoenix; 08-26-2008 at 06:35 AM.
Reason: additional comments
Re: What Insurance company will pay for Suboxone prescription
Phoenix, Thank You for responding to the thread! Well the welfare office did not drop me yet, I am still waiting for an answer to see if my MA went through, I should know in a week or so! I really do not understand why they have not made a generic for Suboxone yet! It is to expensive! They make this drug to help people, but then they make it so expensive that people cannot afford it! I am trying so so hard, and then something else bad happens! Oh well, I will post again when I find out the outcome of my Medical Assistance and find an Insurance company that will help!
DTryingMB
Last edited by mod-anon; 09-03-2008 at 07:05 AM.
Reason: removed quote
Re: What Insurance company will pay for Suboxone prescription
There is no way of knowing what Insurance Company will pay for any medication. First, it often depends on the plan under which you are covered and every insurance company sells thousands of different plans. Second, often pharmacy use is covered by a PBM (pharmacy benefit manager - a company hired just for that purpose - to control costs and access to meds).
For example, an employer offering health insruance that really wants to cut costs may have the PBM or Insurance Company require patients use medications on a formulary (list of accpted meds). Recently my insurance company (pbm) said that a nasal spray I was using for allergies would no longer be covered. I'm sure it's a cost saving measure. The PBM is also sending me requests every 2-3 months to talk to my doctor about using a generic instead of Crestor for cholesterol.
Drugs eventually go generic - usually after about a 10 year period in which the manufacturer holds a patent on the medicaiton. For example, Zyrtec is an allergy drug that just went generic this year. You can ask your pharmacist when the expected date of a generic equivalent is....but keep in mind it can be years from now.
How would you be getting insurance - through work?
Re: What Insurance company will pay for Suboxone prescription
It's not as simple as which insurance company will cover the drug - there is more to it than that. Plenty will probably cover the medication if you were already a member before you needed it. But if you apply for individual coverage and have a history of drug abuse, most companies will say that you are ineligible for coverage with them altogether until you have been drug and treatment-free for a certain period of time (such as 10 years) -- or you could possibly be accepted for coverage with an exclusion rider, meaning that the insurance company will take you on as a member, but will not pay for any treatment of that particular pre-existing condition. If you were to obtain coverage on a group plan through an employer, they could not deny you based on your health history and could not impose an exclusion rider, but they could impose a waiting period before they will cover pre-existing conditions if you have not had creditable coverage within the past 63 days. So, no one can really tell you if a particular insurance company covers this medication because the real question is whether they would accept you as a member and offer coverage for your treatment of this particular condition -- in addition to whether there is any coverage for suboxone under whatever plan they might be able to offer you. Hope this helps.. good luck to you!
Re: What Insurance company will pay for Suboxone prescription
I have United Health Care and it is paid for. I get 90 8mg per month and it costs me $115.00 per month. It's about $430.00 without insurance. I hope this helps.
Re: What Insurance company will pay for Suboxone prescription
Quote:
Originally Posted by madera74
It's not as simple as which insurance company will cover the drug - there is more to it than that. Plenty will probably cover the medication if you were already a member before you needed it. But if you apply for individual coverage and have a history of drug abuse, most companies will say that you are ineligible for coverage with them altogether until you have been drug and treatment-free for a certain period of time (such as 10 years) -- or you could possibly be accepted for coverage with an exclusion rider, meaning that the insurance company will take you on as a member, but will not pay for any treatment of that particular pre-existing condition. If you were to obtain coverage on a group plan through an employer, they could not deny you based on your health history and could not impose an exclusion rider, but they could impose a waiting period before they will cover pre-existing conditions if you have not had creditable coverage within the past 63 days. So, no one can really tell you if a particular insurance company covers this medication because the real question is whether they would accept you as a member and offer coverage for your treatment of this particular condition -- in addition to whether there is any coverage for suboxone under whatever plan they might be able to offer you. Hope this helps.. good luck to you!
the best thing we addicts can hope for is for the obama health plan to pass and become law.then these preexisting conditions that the insurance cos are denying us on will have to cover us no matter what.i pray that the obama healthcare plan passes and becomes available to all us poor people.its the only way we will ever have any type of insurance.
Re: What Insurance company will pay for Suboxone prescription
We *just* got Insurance with United health Care and the formulary *says* Suboxone, and there are no stars by it and it's not red lettered like my husband's Lexapro, which for some insane reason has a $70 co-pay, but I'll believe it when I see it. I assume you have exhausted your 'free meds' help; the Dr. Can have up to 3 patients at any one time that get free meds for up to one year; I was able to do that and it saved my life. Plus I added in some creative math so that I had a pretty good stash for when my year was up. Good Luck to you, dear.
