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PostPosted: Wed Sep 05, 2012 1:53 pm 
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So i was originally on 8mg a day and my insurance wouldnt cover it.. so... i got myself down to 2mg a day so i could afford with a flex card or w/ my own cash... so i went in expecting to pay full price.. and all of a sudden my insurance would cover it...

so my insurance would cover suboxone at a 2mg a day dose.. but nothing above that.. has anyone else experienced this?

i had even spoken to the insurance company and they had told me they didnt cover suboxone but once i got my dosage down all of a sudden it was covered.. strange huh? i cant seem to find anyone else with a similar experience from searching forums/google.

Now my problem is that my insurance expired and so i got a new policy with the same insurance company.. now i am worried that when i go to pick up my 2mg script for the month all of a sudden it wont be covered.. since i had originally been told they didnt cover it all.. but obviously they did.. just at a lower dose..? so strange.. cant find anyone else with a similar story.. i have been sorta preparing for the worst.. and lowered my dose to 1mg a day so if i have to.. which i dont want to.. and not ready to.. i can get off suboxone if i cant afford.. since i no longer have a flexcard.. which succckks.. hoping the insurance company will still cover it.. if not............ ugh..

update:
So i went to fill the script figured i would pay only a weeks worth and wait until new policy kicks in to see if they still cover it or not.... told the pharmacist i think my insurance is expired and my new policy hasnt started yet.. so if it doesnt go through let me know so i can pay for just a week until new policy starts... and guess what?! it went through..??javascript:emoticon(':shock:')

i just spoke to the insurance company yesterday and i am not enrolled yet.. and my other policy with them expired august 31st.... maybe because i will be on the same insurance it went through? since it should have started sept 1st. but my college never sent my info through to the insurance company even though i paid the premium.. either way. i dont get it.. but as long as i am not unwillingly committing fraud.... since i mean the pharmacist has to run it through the computer right? not me.. so weird.. so i am figuring that my insurance will keep paying for suboxone.. considering some how it went through even though i dont have insurance? i really dont get this.... but i guess i should be happy i only had to spend $30..


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PostPosted: Thu Sep 06, 2012 1:12 pm 
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Maybee you have a deductable on non generic prescriptions, that happened to me, at the beginning of the year I had to pay full price then in march it was covered.... then I found out I had a 500.00 deductable


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PostPosted: Fri Sep 07, 2012 8:25 am 
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[font=Comic Sans MS]That is exactly what I was thinking the whole time i was reading this. Deductable. What happens is if you have say, a $500 dedutible, the insurance company waits until you have paid $500 out of pocket for your meds. Once you have paid that amount out of pocket, you only have to pay the copay from that point forward. If you have a statement, ieither a hard copy or online, look under the deductible, and every month it should slowly be going down, by the amount you paid for the scripts. Once that number hits zero, they take over payment for your meds.

If this isn't the case, then I have no clue....it truly would be flat out bizarre....

So, you said that you aren't ready to come off of sub, are comfortable at the 1mg or 2mg dose? If not, I would go back up if the insurance is paying it. They cannot just cover a certain "dose" of medication. They either cover it or they don't. I hate to see you suffer on a dose that isn't completely helping you, just because of price. Anyway, I hope it all works out in your favor for sure....

Let us know....[/font]

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PostPosted: Fri Oct 05, 2012 5:13 am 
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Well, it is more important to have every type of insurance. Any type of problem occurs any time.


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PostPosted: Tue Oct 09, 2012 10:58 pm 
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I do happen to be familiar with stuff like this. My Insurance has quantity limits on certain drugs, suboxone is one of them, I can have 3/day of either the 2's or the 8's, any more and they won't pay for any of it(say you get perscribed 4/day, they won't cover any of it, not even the 3/day they would if you were scripted 3/day). Perhaps find out who handles the perscription side of your insurance and call them, find out if there's quantity limits.


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PostPosted: Sun Dec 07, 2014 12:04 am 
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I hate to bump an old thread but this might be really useful to anyone who got healthcare through the healthcare exchange (Obama Care) My insurance would not cover 8mg of Suboxone either & I called multiple times and always got the same answer & then out of crying and frustration because I went through so much to get insurance ($240 a month out of pocket for insurance just to ge ton subs to save my life) I randomly punched in 2mg Subxone & magically it was covered. I was using caremarks website since my insurance company used them.

Now here is the crazy part... It wasn't that they wouldn't cover 8mg a day or that they would only cover 2mg a day. It was that they only covered 2mg pills! for whatever dumb reason!!! They would gladly prescribe me 360 2mg Suboxone a month for a $10 co-pay but would not cover 8mg Suboxone which I would only need 90 of. I checked the cash price on both as well out of curiosity and they were spending a little less then double the cost of 8's paying for 360 2mg Suboxone. It made no sense at all.

After all the drama I was having with my insurance, liver problems that my Dr though could be from Naloxone as well as vomiting plus the fact he didn't like writing RX's for 360 pills! (not to mention hunting down 360 2mg subs without needing them ordered in was impossible) He decided to just put me on 8mg Subutex because of course my insurance gladly covered those for a $10 Co-pay

I never would have bumped this if I didn't see that other people had a similar problem and many more will with the healthcare exchange Obama Care and who you speak to on the phone doesn't always know anything more then what they are reading off the screen using the same website you are given to check whats covered and whats not. I only figured out that I could get as many 2's as I wanted covered but they wouldn't cover a single 8. For kicks I typed in 480 2mg Suboxone (4 8s a day) and it still said covered!

It makes me wonder if the OP's insurance actually meant they would cover 2mg Subs just not 8mg subs, but they made it sound like they meant they only cover 2mg a day because that is exactly how they made it sound to me until I did my own research and detective work. Sorry if I bumped way too old of a thread but I feel it's relative to this day still because of Obama Care insurance and other private insurance companies.


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PostPosted: Sun Dec 07, 2014 11:23 pm 
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That's great info Jon.

Thanks for bumping!

Q

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PostPosted: Tue Dec 09, 2014 2:22 pm 
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qhorsegal2 wrote:
That's great info Jon.

Thanks for bumping!

Q


Thank you! I normally don't bump really old threads but I guarantee with the current state of health insurance in the US that the OP and me are not going to be the only teo people to run into this problem. Especially since over half insurance carriers use Caremark (CVS Caremark) for there prescription coverage. If anyone ever needs help feel to PM me and I can break down the different routes I went to get mine covered. Insurance companies love using the most complicated words and phrases to explain something simple.


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PostPosted: Sun Jan 24, 2016 5:50 pm 
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now since you had already bumped this twice i can put in my thought, I am not sure what state you guys are in, but I live in Indiana, and I to am also the obama care plan, or what ever it is called the Hip plan (Indiana health insurence policy) i really dont kno what it is called but anyways, when i decided to go to my subboxone, i got a few pills from my doc and then he gave me a script. now when i went for my visit my insurence coverd everything but 20 bucks...co pay of course....BUT when i went to go pick up my script they said that my perscription was 649 dollars....i started freaking out....prolly cried because i know without my meds i would relapse, now thankfully for a great mother we went home and started calling our insurence, and after a few hours of getting emotional. we found out that our ensurence needed to do two things before allowing us have suboxone.
One. the insurence company had to call my doctor personally and verify with him that i need this medacine and for what condition. then also we found out that my insurence dosnt no cover suboxone pills nor subtex, but they only cover strips..

now after being on suboxon for 6 months im thanful that
I do not pay a dime for any co pay to see any doctor
thats a regular doc, eye doc, therapist, dentis, and also when i go to get a script. i pay absolutly nothing for 60 suboxone strips that at one time would have cost me 700 dollars.... and i am thankful


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