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PostPosted: Fri Oct 22, 2010 12:51 pm 
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Joined: Sat Jul 10, 2010 2:37 pm
Posts: 53
Hi All,

Got Some bad news yesterday that may pertain to many of you on Medicare receiving Part D drug coverage.

I Just received my new formulary in the mail for 2011 and made the observation that Subutex has been entirely excluded from the formulary for next year. In 2010 Suboxone was a non-covered drug, so my doc switched me to the now covered (generic) Subutex. I'll be covered until the end of the year.

Not only will the Subutex/generic, or any bup not be covered in 2011, but monies spent on it will not count in reaching phase III (catastrophic) if you are in the "gap" or "donut.... it's all out of pocket.

As part of closing the gap in 2011, the government has said they will offer 50% discount on tier III,IV meds, but I do not believe they will offer this benefit on a non-formulary drug.?

I'm aware that a physician can write a request for "formulary exclusion" exception, citing a specific reason why the patient must receive this drug. In my case I might ask him to say that it's the only medication that can be used to treat my pain. The letter is reviewed by a committee of MDs and Pharm Ds and they make a decision.

In passing, I'd like to to know what it considered to be a good or competetive price for Generic Bup 2mg tablets, quantity 60, but any quantity would be helpful....

I'm sure many of you are coming up on the big decision of what drug co. to choose for next Year. I'm with Humana- $7 copays,
gaps are the same with every co, premium is 95.00/ mo. I'll be looking for some comparison sites, but if anyomne has any suggestions, that's be great. My Mom has Aetna, and has $2 copays and lower premium....big decision!

Best wishes, sorry to be the bearer of bad news, any thoughts?


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PostPosted: Wed Nov 03, 2010 11:35 am 
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Joined: Mon Jun 21, 2010 5:47 pm
Posts: 28
runner wrote:
Hi All,

Got Some bad news yesterday that may pertain to many of you on Medicare receiving Part D drug coverage.

I Just received my new formulary in the mail for 2011 and made the observation that Subutex has been entirely excluded from the formulary for next year. In 2010 Suboxone was a non-covered drug, so my doc switched me to the now covered (generic) Subutex. I'll be covered until the end of the year.

Not only will the Subutex/generic, or any bup not be covered in 2011, but monies spent on it will not count in reaching phase III (catastrophic) if you are in the "gap" or "donut.... it's all out of pocket.

As part of closing the gap in 2011, the government has said they will offer 50% discount on tier III,IV meds, but I do not believe they will offer this benefit on a non-formulary drug.?

I'm aware that a physician can write a request for "formulary exclusion" exception, citing a specific reason why the patient must receive this drug. In my case I might ask him to say that it's the only medication that can be used to treat my pain. The letter is reviewed by a committee of MDs and Pharm Ds and they make a decision.

In passing, I'd like to to know what it considered to be a good or competetive price for Generic Bup 2mg tablets, quantity 60, but any quantity would be helpful....

I'm sure many of you are coming up on the big decision of what drug co. to choose for next Year. I'm with Humana- $7 copays,
gaps are the same with every co, premium is 95.00/ mo. I'll be looking for some comparison sites, but if anyomne has any suggestions, that's be great. My Mom has Aetna, and has $2 copays and lower premium....big decision!

Best wishes, sorry to be the bearer of bad news, any thoughts?



I am also on medicare and have received my formulary from aarp and suboxone is covered. I don't know if this pertains to you but open enrollment is nov 15 till dec 31. Have you thought about changing insurance companies? I just searced through the social security website till I found one that covered suboxone.

I changed to aarp last year when my prior ins company wanted prior authorization. I didn't want to have to go through that hassle. So I switched to an ins company that covered sub. I believe you're also allowed to switch insurance companies any time if you haven't changed companies before. You're only allowed to do it once but you're allowed to switch during open enrollment every year.


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