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PostPosted: Tue Jun 23, 2009 1:57 pm 
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I have a serious question. I have been on suboxone since august of 2007, I have been at a dose of 32mg since that date also. I have been sober thanks to this medication for 19 months today (you do the math). My question is this up until recently I have had no problems with my "insurance" covering the med, my doc would send in a prior authorization and it would get approved with my managed care plan through caresource a sub-division of medicaid. Well for the past 6 months they have been denying my authorization and their reasoning is " need more information: copy of last random urine screen, proof of patient not being rxed any opiate meds, documentation of counseling," and a few other things. this is of course a major pain in the a**, and I don't understand why all of the sudden they need this extra info. From what I have read randoms, and counseling are only reccomended so what is the deal are they just tired of shelling out the cash. ANY HELP concerning this would be greatly appreciated.


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PostPosted: Tue Jun 23, 2009 2:19 pm 
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I get my Suboxone through medicaid and those things have always been a condition of my coverage.

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PostPosted: Wed Jun 24, 2009 1:25 am 
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The only thing is that when I was on regular medicaid they covered the sub no questions asked, and now with this managed care they are giving me a hard time. I have absolutely no problem giving them the random urine screen because I am clean, but I think that the counseling should be my choice. My doc only wants me to go to some meetings as a stipulation of his treatment, but he says when it comes to random urine tests he figures if the person wants to be clean they will be and if they test positive for another sudstance what is he going to do kick the person out for doing what they are being treated for. I just don't understand why all of the sudden the past couple of months they are doing this to me shouldn't I have heard of these conditions of coverage 2 years ago. Please enlighten me I don't know what to do and since I am on medicaid I obviously don't have over 700.00 a month for this Rx, and I don't want to find another doc b/c this one is good and he doesn't charge me hardly anything to see him he is prescribing subox for the right reasons.


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PostPosted: Wed Jun 24, 2009 2:08 am 
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The HMO/managed care group that your medicaid is going thru now probably just has different policies. Either that or they just figured out that you were supposed to be doing those things and now they want proof that you're doing them.

With these big state agencies it's better just to jump thru their hoops than to make a stink about it. The can change shit at any time - it's happened to me with other meds that I take. Like in my state medicaid only pays for 12 months of Suboxone, but when my 12 months were up they sent me paperwork and I filled it out and the reapproved me for another 6 months. My doctor was like - whatever, probably just a blip but let's not call attention to it.

If you don't want to go to counseling, have your doctor ask them if meetings count toward that requirment. Or call them up and ask them yourself if you don't want to bug your doctor. The worst thing they can do is say no. Then just do the minimum amount of counseling required. It's a pain in the ass, but it's not going to hurt you and it might even help. In any case, it's still a better deal than having to pay for it out of your pocket.

My doctor said the UA/counseling requirments are because doctors were just presribing Suboxone without any kind of rehab plan - no meetings, no therapy, no drug test - just get your pills and go. So in my state you can only get 2 weeks worth of your meds at a time, have to go to therapy 2 times a month, do random UA's and I think there's some other shit. What can you do though? It's free and that's what I can afford.

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PostPosted: Wed Jun 24, 2009 7:24 pm 
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This does happen sometimes. My old insurance would let you get up to five scripts of Suboxone, then they wanted some special form from my psychiatrist.
Part of it is money, but another reason is diversion. There are more and more people selling Suboxone to cover their DOC habit- so wanting proof of specifics with your treatment may become permanently incorporated at some point.
Attending some type of counseling or support is a very important part of the process!

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