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PostPosted: Thu Dec 22, 2011 5:03 am 
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Hello!

I know i havent posted here in quite some time. I started subs back in june of this year because of this forum and i am happy to say i am still going strong on them and haven't had any relapses or even any issues since i started the suboxone!! I swear for the last 3 years i had been just taking pills to make me feel 'normal' and the sub does that for me perfectly and my life has improved so much since the first part of the year.

Anyway to my question.

I purchased a health insurance policy from my employer this year and i just had some questions because i have not used insurance with my subs yet.

So its Anthem BCBS of Colorado and we are on a formulary tired drug plan (they break different meds into tiers from 1 being generics to 3 being high priced brand names) I spoke to my benefits lady and she said Suboxone is covered under the tier 2 which would mean a $40 co pay. So i told her to go ahead and process my enrollment. She also said that buprenorphine was covered under tier 1 which confused me a little because i didn't think there was a generic version?? The straight buprenorphine would be $10 she said. Anyone know about getting just buprenorphine as a generic?

Sorry i know this is a long and im jumping around a bit.

Ok after i spoke to my benefits lady i did some surfing on the web and found Anthem's list of tiered drugs Tiered Drug List
now on this list it says Suboxone film and tabs require Pre autorization and it had Quantity Limits! The benefits lady didn't tell me any of this and it is to late to change my enrollment information so i am kind of scared at this point. I tried to call Anthem but they didn't have me on file yet so they said they couldn't talk to me yet and give me detailed information on my plan?? Also after reading some posts online i am concerned about this being considered a Pre existing condition.

If anyone has any stories related to this or information that would be awesome i go to the doctor next week to get a new prescription and Anthem said they should have my information ready at that point and said i should call them then with my doctor but i would kind of like to know what to look forward to if possible.

One more thing lol (Sorry)

My doctor only takes cash but he said something when i first went to him about if i had insurance he could give me something to give them and they may cover the visits (didnt have insurance then so didn't really pay much attention to it). Anyway i know my plan has a Substance Abuse/Behavioral health clause and was curious if anyone had any experience in submitting their own claims for a Sub doctor?

I really dont know anything about insurance i'm 25 and this is first time ive really carried it and i really only got it to help pay for the Subs. If i do file my own claims what would they reimburse me? Do i have to meet my $5000 deductible before they cover anything or what? Sorry i know i sound like an idiot lol but i would hate to be paying $150 a month for this insurance and it not cover any of this stuff and the preauthorization and quantity limits on the subs really is scaring me.

Sorry this was so long and if anyone has any help for me i would much appreciate it thanks!

-Nabbic


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PostPosted: Thu Dec 22, 2011 10:11 am 
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It is hard to give you any specific info because all insurance policies are different. It is quite common that drugs in the highest tier require a pre authorization. It is a fairly simple process and your insurance company will get whatever info they need from you Dr. Make sure you continue to check in with your insurance company so if there is something they need from your Dr you can stay on top of them to get it submitted.

There is no generic for suboxone but there is for subutex. Suboxone is bup and naloxone and subutex is just bup. Essentially they are they same med as the naloxone is an inactive ingredient, but some Drs will not prescribe Subutex. You will have to talk to your Dr to see if he is open to the idea.

You will have to look at your policy to see if you must meet your deductible before it will cover your Dr visits. Typically you are allowed a certain number of visits and do not have to meet your deductible but again it is something that varies. My Dr also accepts only cash but gives you everything you need to submit a claim to your insurance. It is basically a reciept with the correct insurance codes, and once submitted your insurance company will reimburse you.

The best advice I can give you is to stay on top of your insurance company and Drs office. Things like this can easily get lost in the shuffle so you must make sure everything is going correctly. I hope this new plan covers everything you need it to and let us know if we can answer any other questions.


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 Post subject: BCBS
PostPosted: Thu Dec 22, 2011 2:14 pm 
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Hi Nabbic,

I too have Blue Cross/Blue Shield but not Anthem. It is one of the largest health insurance companies in America and from what I've found, the coverage seems to be the same no matter what version a person has.

Breezy explained it fairly well but let me add some tips. For one, they are fairly easy to talk to. Call up your local office if you have trouble understanding the policy coverage.

My insurance is the same. $40 for name brand Suboxone and $10.00 for generics. I seriously doubt your doctor will give you Subutex so it'll most likely be Suboxone. But, there is a coupon from them for $45 off your script so it'll be free. I haven't paid a dime yet for Sub since I started it last May of '10. If you can't find the coupon I'll post the link on a later post. You can try NAABT for starters and see if that site has it.

I don't know about a cap so that question will be for a representative. Give them a call. I had to call when the film came out. They wouldn't cover it for about a month but now all is fine.

Hopefully that cleared up your questions. Either call them or read the coverage online.

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PostPosted: Fri Dec 23, 2011 1:16 am 
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Thanks for the replies. I guess the pre authorization thing just sounds scary but if it is a somewhat common thing then that settles me down a bit. I would just hate if they decided not to cover it for some reason. Anyone had any issues about this being considered a preexisting condition (starting insurance in the middle of my treatment)? The prescription plan is calked Express Scripts and i just found out today actually i wont be able to fill at walgreens anymore because this plan is leaving walgreens network. So hopefully they are not so cheap that they only cover like ten strips a month or something like that because i have seen posts from other insurers where that was the case. Anyone on here had experience with Express Scripts prescription plan before?

Thanks,
Nabbic


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PostPosted: Fri Dec 23, 2011 12:08 pm 
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Like Rule said, the best thing you can do is call your insurance and ask them. They should be helpful and can give you the specifics of your questions. I would make the call asap so you dont end up with a surprise when picking up your script.


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