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PostPosted: Tue Nov 25, 2014 1:20 pm 
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Joined: Wed Sep 10, 2014 4:52 pm
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I will try to make this short and simple. I was switched from suboxone to subutex when I became pregnant last year. After I had the baby, medicaid continued to pay for the subutex. Then after being on the subutex for a year, I needed prior authorization in order to get it filled. Medicaid denies it because I don't have any allergies to the subutex and they will only cover the suboxone. Okay, so I am thankful to have the medication in general to take but I would much rather take the subutex for many reasons. I am just wondering why Medicaid would rather pay for suboxone which is close to $1000 instead of paying for the subutex which is around $300. Does anyone know the answer?

Also, I forgot to mention to my doctor that when I was on the suboxone films, they made the bottom of my tongue peel and have open cuts/sores as well as it being sore. Is that an allergic reaction?

Thanks in advanced to everyone who can shed some light. I have an appointment with my doctor today so I can talk to him but Im not sure if he will know why medicaid would rather pay for a medication that is more expensive.


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PostPosted: Tue Nov 25, 2014 8:53 pm 
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Joined: Tue Nov 24, 2009 7:36 pm
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Location: Wisconsin
I'm not sure any officials will admit to this but I have a very strong feeling why only suboxone is covered and not subutex. I'm betting dr. j could add in a lot more. The real reason and actually this goes for most anything government does is its done by government. When is the last time government ever did anything right or well? The makers of Suboxone have done a very good marketing job in convincing people that any buprenorphine other than suboxone strips are dangerous. That's the bottom line. Many will dispute that but others believe it. Government officials who administer the Medicaid programs have bought into this. Cost is not an issue for them. Is cost or spending ever an issue for government? If course not. It's not their money. So in the name of safety and reducing diversion they only allow strips or Bup with naloxone. The makers of suboxone tried to get it taken off the market entirely - EXECPT for their strips. Thankfully they failed at that. They were, however, able to get many state programs to only pay for Bup with naloxone included.

Don


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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