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PostPosted: Wed Apr 05, 2017 12:05 pm 
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Here's what I have to deal with on a monthly basis. And I'm sure some of you have it worse, and if you do i apologize. But my sub doctor requires monthly visits. I started 6 years ago when the monthly rate was $100 so as long as I don't quit the program and start over my doctor can't charge me more than $100. I say that because a year or so after I started at this particular doctor she went up to $200 per visit. My insurance doesn't cover the visit so I have to scrounge up the money every month plus the money for my script.(another $40) My doctor also requires each patient to be drug tested every month. My insurance no longer covers that so I'm constantly getting bills from the lab company asking me to pay. (Which I can't and won't be paying)

My 1st question is this.....Is there a law that says doctors can only prescribe Suboxone "monthly" with "no refills"? Or is it up to the doctor?

2nd question... Does the law say sub doctors must drug test every month?

I'm at the point where I'm seriously considering trying to taper off simply because it's so aggravating to get my meds every month. Along with worrying that the lab company is gonna turn my bills over to collections and ruin my credit. If it were easier, like once every 3 months, I would likely stay on Suboxone forever. And I do worry that once I taper off completely, after a short time of being completely clean, I'll screw up and get back on pain meds. That's why I'd rather stay on the subs.


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PostPosted: Wed Apr 05, 2017 1:16 pm 
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Quote:
My 1st question is this.....Is there a law that says doctors can only prescribe Suboxone "monthly" with "no refills"? Or is it up to the doctor?

2nd question... Does the law say sub doctors must drug test every month?


Buprenorphine is a schedule III drug. 30 day supply with 5 refills is allowed. Not many prescribers will go that long however. There is no law regarding frequency of visits. After a successful induction and stable I will see patients monthly for 6 months, every two months during the rest of the first year. After that we decide whether to continue every two months or three months. Every clinic or practitioner has to come up with a schedule that they are comfortable with, but there is no 'law'.
Regarding drug testing, again there is no law, but it is recommended that 'periodic' testing be done. More and more insurances are demanding drug testing as part of the prior approval process so I routinely screen at every visit rather than try and keep track who needs what when. None have required monthly however.
Coming soon to many states will be mandatory review of the state's drug data base, not a big deal for me as I do it anyway.
If Suboxone is important to your continued recovery I would highly recommend you use the doctor search function and start looking for a clinic that is more compatible with your needs.


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PostPosted: Wed Apr 05, 2017 2:27 pm 
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Excellent advice from one of our members that happens to be a physician who prescribes Suboxone. Can't get much better feedback than that.

I don't know what kind of insurance you have but you should be able to submit a claim for the visit, as long as your doctor will give you the code numbers. If he is out of network and just not covered then you're on the hook for the money due.

Just like our good docm2 said, use the search feature and find someone more compatible with your needs. It does not sound like a good match. You and your doctor should be able to talk freely about your progress and what the future holds regarding dosage, etc. It is a two way street. Yes, it is hard to find one nowadays. Most of us were just plain lucky to be able to find a doctor we like who treats us like people, instead of drooling addicts. (like we used to be!)

By doing some research here and online you should be able to find out about the laws both Federal and then State regarding prescribing Suboxone. Plus, you can always ask here and we'll do our best to help. Some states are 100 years behind the times and I hope you don't live in one of those.

Good luck finding a suitable match. Everyone deserves a spot to stay clean. Unfortunately, our government doesn't think like we do. We continue to try to educate the masses but it seems stupidity is spreading like a contagious flu. The addicts seem to know more about Suboxone then the majority of our elected officials. The more laws they pass the more people turn to heroin and die. No, they don't seem to learn. Sorry for using your thread to rant. The subject gets me seeing red every time.

rule

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PostPosted: Wed Apr 05, 2017 2:41 pm 
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I understand your frustration. After six years of compliance it is difficult to be treated like you were on day one.

You are actually on the very low end of costs, especially for your doctor not accepting insurance. $140 is not bad at all for the doctor visit and the cost of the medication.

As docm2 has said, you may need to look for another doctor for your medication. Depending on your recovery, you could consider tapering off. Have you done work on your recovery? Have you been to an addiction therapist? Gone to meetings like AA or SMART Recovery? Have you figured out what in your life might trigger you to pick up your drug of choice again? If you've done this kind of work and if your life is unrecognizable from when you were actively using, it may be that you can taper off and stay in recovery. For example, do you have all new non-using friends, improved family relationships, a stable job/income? These are signs that you may be able to handle recovery without the buprenorphine. Unfortunately, the stakes are super high for us opioid addicts. Relapse can equal devastation and death.

This is what I would do in your position. I would calmly lay out the situation to your doctor including the lab costs. Say that you understand why drug testing is important. Would she consider doing one of two things? Since you have never had a failed UA or other compliance problems, would she consider drug testing you once a quarter instead of every month? Or would she consider starting to use the in-house UA cup tests that are much less expensive for you? If there were a problem with the in-house test then it could be sent to the lab for the more expensive testing. (You can follow this link to see what kind of test I'm talking about: http://usadrugscreening.com/clia-waived ... fgod4jgPfw

Perhaps she will be willing to work with you. I certainly hope it works out for you. If you decide to taper, I really suggest that you go slowly and taper down to micro doses before you step off. AND make sure that your recovery plan is solid.

Good luck!

Amy

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PostPosted: Wed Apr 05, 2017 3:25 pm 
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I should have been more specific. The rules I am familiar with are from the Federal side and the state of Minnesota. There are states that are becoming more draconian in their rules.
Amy brings up a good point about the UA's. I use the in house point of care. 12 panels, cost about 8 dollars a cup. Like a pregnancy test, just gives present or not present for each substance. I send it to a reference lab if someone disputes a result.
Roughly I think I avoid about 300,000 dollars a year in lab expenses this way. Quest and Mellenium charge $500 and more, sometimes a lot more for their testing.


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PostPosted: Wed Apr 05, 2017 4:33 pm 
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WOW!!
you do actually have it pretty good. I have been going to my sub doctor since 2009. They charge $180 every month which requires a drug screen every month that is included in the $180 price. I also have to go every month. It is just their policy. I live in Texas but I don't think that matters because the doctor's office makes that rule of coming in every month. Plus...they make you see a counselor every month. So that costs too.

After that, i pay for my medication. Luckily I have insurance that covers it.

I also got tired of the RED TAPE and I tapered off for about a year in 2011 -2012. During that time, I ended up relapsing on my Drug of choice and going right back to the Same sub doctor in 2012 and at that point I joined this forum and decided to just stay committed to the sub program and work on my recovery.

I know it seems like a pain in the Butt to have to go every month. But PLEASE think of the alternative of having to chase down opiates every day. So I will sacrifice the $180 and the once of month from the $2000 I was spending while on opiates every month and having to drive all over the place all the time just to "feel Normal"

My advice would be to look around at other clinics to see what they do. you may find that the $100 a month is a real sweet deal and just stay put. Or, you can try and taper off but don't do it for the wrong reasons. Meaning, if subs were free , and you were given an unlimited supply, would you stay on them still?. If the answer is yes, I would remain on them. It is not worth a relapse, plus if you do decide to jump off and then change your mind, your price goes up to $200!.

Call around to other clinics in your area and see if there is a better deal. But you may or may not find one. I wish you good luck!!


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PostPosted: Wed Apr 05, 2017 5:04 pm 
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Hey Woodzson, happy join day. One year ago today you logged into the forum for the first time.
Cool beans...


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PostPosted: Thu Apr 06, 2017 9:44 am 
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Docm2-- I'm gratified to see that you and I do things in a very similar way. I schedule visits at the same frequency as you do; I also do drug testing with point of care kits, and don't charge patients for them.

There are no laws that challenge those things, at least not in Wisconsin. But insurers are becoming more and more problematic. One insurer-- Magellan-- will not cover Suboxone unless I send them 3 monthly drug tests-- that include quantitative measures of breakdown products of buprenorphine. They also demand a treatment plan that includes a taper schedule. I have a patient who has the displeasure of being on their insurance; she has been stable for about 3 years, but she is still very young, and so I recommend she stay on buprenorphine. The insurer will not cover it without the tests, and since she has a high deductible the tests would cost her about $1000 each-- and they won't guarantee that they would even cover it WITH the tests.

I've appealed, but they denied the appeal. ASAM is worthless for these issues, so she is paying cash for now. If anyone has dealt with this successfully, let me know.

I've written about the testing business; I know people who own labs, and they boast that for 8 bucks of reagents they can run 10 tests and charge $1200. Even medicaid pays over $600. Pain clinics in my area now make more money from drug testing than they do from injections.

I used to use Ameritox; they promised they would only accept insurance. But then patients started getting huge bills. The rep from the company said 'just ignore the bills; nothing will happen'-- then they started trying to collect from patients. The testing industry is such a scam-- yet some doctors have pushed for those tests to be the 'standard of care'. It is frustrating..... I'm trying to reduce unnecessary healthcare costs, and even the insurers make that very difficult.


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PostPosted: Thu Apr 06, 2017 1:52 pm 
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U actually do have it pretty good imo with that price! I pay $350 a month plus medication... no financial help at all. I've been going to the same place for 5 years and there's no price reductions just because u have been there awhile. I get a drug screen every month and sometimes twice a month on my meeting days. The drug screen is included in the monthly price. So imo, I would absolutely love to be in ur position on ur doctors monthly price!

I do understand though that not everyone can afford to pay an expensive price. I don't know what I would have done if I couldn't have afforded it because it's saved my life. I truly try to look at it in a positive way in thinking I'd rather pay than be bk out there in active addiction. If ur doctor just is not working for u and ur not ready to stop ur treatment, definitely try to find another doctor. I've saw so many ppl stop my clinic only to be bk 6 months later.

I hope everything works out for u. I also hope u maybe realize that what ur paying each month, someone like me would love love to only have to pay what u pay. It could always be worse.

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