It is currently Sun Aug 20, 2017 6:51 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 18 posts ] 
Author Message
PostPosted: Mon Jan 30, 2017 9:53 pm 
Offline
Average Poster
Average Poster

Joined: Mon May 11, 2015 11:37 pm
Posts: 20
I live in California. Tried applying for medi-cal, but got denied. Looking to pay out of pocket for health insurance that covers a buprenorphine medication. Dont care what form or brand. Zubsolv tablets or Suboxone brand strips, it doesn't matter to me.

Looking at health insurance formularies isn't necessarily the answer, and would take forever. I have had insurance cover a medication that I could not find on their formulary. Medical billing is often complicated and unexplained.

So that is why I am asking here. To hopefully hear from people that have insurance covering their buprenorphine, so I can possibly look into getting it, as I believe what I am paying now for the doctor visit and script is more than an out of pocket plan, and I need insurance anyways for other reasons.


Top
 Profile  
 
PostPosted: Mon Jan 30, 2017 10:58 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4133
My insurance company, United Healthcare, pays for my buprenorphine and the monthly doctor's visit. I know I am among the very lucky. On the other hand, I was yelling and crying at my insurance company last Friday because they were just dicking me around while I tried to get a prior authorization. :roll: :roll:

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 12:42 am 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1543
In Wisconsin, almost all insurers cover one of the buprenorphine products. Most cover Suboxone films; a few cover generic buprenorphine, and a few cover zubsolv or bupe/naloxone generic tabs.

The insurers include United Health, Molina (which is an ACA plan), Network Health, BC/BS, WPS, Dean, Humana... and others I can't think of at 10:30 PM. They almost all require a PA, but that usually goes through within a day.

A couple plans lately have been asking for more stuff. One asks for monthly drug tests. One asks the doc to attest that the patient is in counseling.

Medicaid in WI covers Suboxone film for a $5 copay, with no time limit (at least for now). It requires a PA, but that goes through in an hour or so. People on Suboxone in WI are allowed 180 days of medication every 180 days-- i.e. if they run out early, pharmacists cannot sell it for cash, even if the doc wants them to for some reason. Patients on medicaid cannot get Suboxone if they are taking Soma, trazodone, or other opioids.

The cash price for buprenorphine has come down each year, and now goes for about $2 at many pharmacies per 8 mg tablet.


Top
 Profile  
 
Our Sponsors
PostPosted: Tue Jan 31, 2017 10:50 am 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
I dreaded getting old enough to qualify for medicare, but in some ways it's the best insurance I've ever had.
It does cover my Suboxone, but with the copay I'm still out of pocket a couple hundred every month.
It's a lot I know, but compared to the money I was spewing (it's the best word I can think of at the moment),
it's not a big deal. I'm almost happy to pay it. Plus it's an incentive to continue tapering. My first few months I was well over $300.

The thing that bugs me is that we're forced to pay much more than we should, given that there are perfectly
fine generics out there. The added naloxone to the best of my understanding does nothing terribly useful.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 11:23 am 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
I lived in CA for most of my sub use. United Health Care covered 14 tabs every 24 days. I needed to get a prior-authorization every year for anything higher. That was for 8mg suboxone or subutex tabs though. Subzolv, and strips were not covered at all and cost $10 a pop.

Edit: If you are near L.A., let me know I have an excellent pharmacy where they deal mostly with sub patients and treat you well. Nothing not legit, mind.... They just tend to understand your issues. And its in a nice area.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 12:30 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 627
Keith,
A search shows Medi - Cal covers all bup products. But then we often read there are few Dr's that can afford to accept medicaid patients which means a patient has bup drug coverage but no Dr. to write the script. Dr J has a good article in Talkzone.
How many individual plans are listed in the Cali exchange? It might not be that many to call. Altho today is the last to enroll?
There's a member here knockoutmouse that describes low/free bup Dr visits and scripts in SF, if you're near there. Look up her posts and PM her if interested.
Sheesh. Is there any other maintenance med that is so difficult to get? Crazy the obstacles and hurdles Dr's and patients have to go thru. Best. P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 1:19 pm 
Offline
Long Time Member
Long Time Member

Joined: Thu Aug 08, 2013 5:40 pm
Posts: 419
Sheesh. Is there any other maintenance med that is so difficult to get? Crazy the obstacles and hurdles Dr's and patients have to go thru. Best. P

Short answer, yes, trying getting Humera or the new Hepatitis C treatments.
Getting imaging approved can be quite difficult as well.
Perhaps you can draw solace knowing they treat everyone (well, a lot) like crap.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 1:46 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 627
Ah, right, good points. Yes there is solace in others experiencing the same crapolla. Never fun to suffer alone!
docm2, I'll ask both you and Dr. J. this - I was surprised to read Dr J's comment that WI medicaid disallows bup if patient is on trazadone.
I'm curious - why would trazadone and buprenorphine be considered a no go? Thx. P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 2:01 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
"Perhaps you can draw solace knowing they treat everyone (well, a lot) like crap."

Not to get political (as I get political :D ), but how much of this is simply bureaucratic idiocy. (A lot.)

I saw in the WSJ today that Trump has issued a directive to the effect that every time some (mostly mindless) federal agency) comes up with some new (for the most part useless) regulation, they have to retire two (undoubtedly moronic) existing ones.

Smart.


Top
 Profile  
 
   
PostPosted: Tue Jan 31, 2017 2:05 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4133
That's a good question, P. I just googled trazodone and there are no harmful interactions listed with any opioids. The information does say to call a doctor if an erection lasts longer than 6 hours though???

It seems that it's just another tetracyclic antidepressant, so I have no idea why they can't be used together. Doctors?

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 2:30 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 627
Ya, I read the 6 hrs too! Whoa. Said its rare. Priapism for male and female too. P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 5:18 pm 
Offline
Long Time Member
Long Time Member

Joined: Thu Aug 08, 2013 5:40 pm
Posts: 419
With Minnesota plans I haven't had any trouble with Trazodone yet. Just benzo's and more recently the z drug sleepers.
to be technical Trazodone is a Quatracyclic (4 rings instead of 3) and due to its favorable profile on sleep architecture I consider it my go to medication if Melatonin isn't sufficient.
Guys laugh about the priapism, but extremely painful, and the treatment is nasty as well. Haven't seen it in years. Mainly because I haven't used Trazodone as an antidepressant 300-600 mg a day vs 50-100 mg as sleeper, although priapism is not supposed to be dose dependent.
Godfrey, prior authorizations is strictly on the insurance companies, not as a result of interfering government regulations. simple bureaucratic idiocy can be found anywhere you have layers of intervening responsibility.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 5:31 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
Quote:
simple bureaucratic idiocy can be found anywhere you have layers of intervening responsibility.

No question about it. And it's likely a disease without a cure. Though perhaps it can be minimized if we're watchful enough.

Quote:
The information does say to call a doctor if an erection lasts longer than 6 hours though???

My God. I don't know exactly at what point I'd start worrying but I gotta say, I wouldn't be sitting there with a stop watch waiting for the full 6 hours to pass before calling for help.


Top
 Profile  
 
   
PostPosted: Tue Jan 31, 2017 9:43 pm 
Offline
Super-Duper Poster
Super-Duper Poster
User avatar

Joined: Fri Dec 30, 2016 7:01 pm
Posts: 353
Location: Mid-Atlantic
BC/BS Covers mine. I have a $20 co-pay for suboxone. I think generic would only be $5, but the $15 difference wasn't enough to switch.
My visits aren't covered as of yet. I submitted them as a major medical claim twice and haven't heard back. They should be covered but the clinic i go to wasn't sure on the correct procedure code.

BC/BS has obamacare plans you can buy on the open marketplace. i lost my insurance for 6 months. i tried to buy a plan and i had a $5K deductible and a $500/mo payment. The month I got my insurance back I got on Subs!

_________________
Get your shit together and live your life." Black Snake Moan


Top
 Profile  
 
PostPosted: Thu Jun 22, 2017 6:26 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
Amy-Work In Progress wrote:
My insurance company, United Healthcare, pays for my buprenorphine and the monthly doctor's visit. I know I am among the very lucky. On the other hand, I was yelling and crying at my insurance company last Friday because they were just dicking me around while I tried to get a prior authorization. :roll: :roll:

Amy


A few years ago my insurance, (state Medicaid), would drive me to hair-ripping tears with all their hoops they had us go through including that god-awful prior authorization bull$h/+! So, I can totally sympathize with you, Amy! Every time your dosage was changed just a tiny bit, and the once a month prior authorization, they wanted the prior authorization crap! Which would often take days of frustrating phone tag with insurance and the clinic.

Now, however, things seem to have changed as I haven't ran into a prior authorization request in over a year and I am much happier. My doctor upped my dose three times since last year from 2mg to 4mg, and finally, to my stable dose of 8mg, and none of those times required a prior authorization. They also use to have a rule that they would only cover two years of Suboxone treatment and I've been on it and in outpatient treatment since 2009! I had to stop going for a while when they still had the two year rule going but as soon as I realized I was still eligible I found a clinic. I also realize that I am one of the lucky ones not having to pay a dime for the clinic visits, prescriptions or any Counseling I might need/want. They also pay for both the generic medicine and the brand-name strips and any and all medical testing like the urine tests we all usually have to do.

My advice would be to not give up! There's an insurance company out there somewhere that will be a perfect match for you. I know it's frustrating I've been through all the insurance annoyances. Even if you have to go with a private insurance company you might be able to find one with low out of pocket costs for doctor appointments and prescriptions. Or, if you have absolutely no other option you might be able to find a clinic who will work with you on a sliding scale depending on your income to pay in installments what you can, and, with the generic pill now on the market being a little cheaper than the brand-name one, and with the use of prescription cost-lowering cards, this might be a back-burner option.

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
PostPosted: Thu Jun 22, 2017 6:29 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
Pelican wrote:
Ah, right, good points. Yes there is solace in others experiencing the same crapolla. Never fun to suffer alone!
docm2, I'll ask both you and Dr. J. this - I was surprised to read Dr J's comment that WI medicaid disallows bup if patient is on trazadone.
I'm curious - why would trazadone and buprenorphine be considered a no go? Thx. P


That's so weird. My mother is also in the Suboxone program and she is also prescribed Trazadone and has been taking it for years. Her Suboxone doctor has no problem with her being on both at the same time.

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
PostPosted: Thu Jun 22, 2017 6:36 am 
Offline
Super Poster
Super Poster
User avatar

Joined: Mon Mar 30, 2009 6:45 pm
Posts: 157
Location: 1974 Scurry Lane, Squirrel Town, USA
Amy-Work In Progress wrote:
That's a good question, P. I just googled trazodone and there are no harmful interactions listed with any opioids. The information does say to call a doctor if an erection lasts longer than 6 hours though???

It seems that it's just another tetracyclic antidepressant, so I have no idea why they can't be used together. Doctors?

Amy


Not a doctor, but I can add that my mother is on both Suboxone and Trazadone with no problems at all. She takes her Trazadone at night before bed because it makes her sleepy and her Suboxone in the morning when she gets up. She is also prescribed Provigal for a sleep disorder that lingers from her years as a night-and-swing-shift nurse.

_________________
Image

My sweet girls; Hermione & Ginny. My little adopted fur-babies since summer 2013! ^__^


Top
 Profile  
 
PostPosted: Fri Jun 30, 2017 11:08 pm 
Offline
Average Poster
Average Poster

Joined: Sun May 01, 2016 10:37 pm
Posts: 4
My Suboxone is 100% covered. I am on generic form tablets, not the film. OHP (Oregon Health Plan) covers 100% of the cost and I've been on it for almost 5 years now. My health insurance is Medicare and I've been on it a long time. I qualify because I don't have a job and I am a mother, but not single. I am just not married and I'm a stay at home mom. Maybe you should think about going to Oregon lol. Or figure out what qualifies you for Medicare and decide if its worth the medication.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 18 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group