Is Amerigroup the same as Wellpoint?
Yes, Amerigroup is changing its name to Wellpoint around the country. The rebrand started on January 1, 2024. As I’m publishing this in the summer of 2024, the company has officially become Wellpoint in Arizona, Iowa, New Jersey, Tennessee, Texas, and Washington. If you’ve had Amerigroup insurance coverage for years, it makes sense that you may still think of it by the old name. But the official name is now Wellpoint in those states.
You may have received a new member ID card with the Wellpoint logo on it. If so, that’s the one you should be using. But your Member ID number should still be the same as it was under Amerigroup.
Does Wellpoint Medicaid cover treatment for opioid use disorder?
Yes, Wellpoint Medicaid does cover treatment for opioid use disorder (OUD), including Suboxone (buprenorphine/naloxone).
In general, Medicaid plans are either administered by the state or by managed care organizations. Wellpoint is a managed care organization. This can be an important distinction because Medicaid that is administered by the state has to include treatment for OUD. That’s because in 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), which required all state Medicaid programs to cover FDA-approved opioid use disorder treatment. Then the Consolidated Appropriations Act, 2024 made that support of treatment for OUD by state Medicaid programs a permanent requirement.
On the other hand, while managed care organizations are encouraged to offer OUD treatment, they are allowed to carve out certain exceptions to their coverage, including psychotropic drugs like the ones used in medication-assisted treatment. That means they’re not required by law to cover Suboxone treatment. However, Wellpoint does cover OUD treatment for its Medicaid members. Depending on your provider, they may require prior authorization for you to receive treatment.
Does Wellpoint Medicare cover treatment for opioid use disorder?
Yes, Wellpoint Medicare Advantage plans do cover treatment programs for opioid use disorder (OUD). The medication itself (like most medications) requires a drug plan or Medicare Part D. If you have Medicare Part D, it will cover buprenorphine/naloxone medications.
Will I need prior authorization from Wellpoint for my Suboxone prescription?
Yes, you probably will need prior authorization from Amerigroup/Wellpoint to pick up your Suboxone prescription. To find out for sure, check the formulary for your Wellpoint plan. The formulary is the drug list that shows which medications your plan covers, and any restrictions on that coverage. When I checked the formulary for Wellpoint in Texas, for example, I saw that buprenorphine/naloxone medications are all listed as “Yes” for requiring prior authorization. Your provider or pharmacist can help you request this prior authorization.
How does Suboxone (buprenorphine/naloxone) treat opioid addiction, anyway?
Buprenorphine is a partial opioid agonist. It binds tightly to the opioid receptors in the brain, but only partially activates them. This makes it a partial agonist instead of a full agonist. The partial activation limits the pleasurable or euphoric effects it can create; for most folks with opioid use disorder, it relieves withdrawal symptoms and reduces cravings but does not create a euphoric feeling of “high.” It also has a ceiling effect, meaning that its effects don’t get more intense if you take larger doses, and it is metabolized relatively slowly in the body, so it doesn’t create erratic ups and downs. The combination of the ceiling effect and slow metabolization causes buprenorphine to have a more stable effect, rather than the major ups and downs that many other opioids create.
When taken as directed, the naloxone in Suboxone has no effect, as it is poorly absorbed through the tissues of the mouth. If Suboxone (or another buprenorphine/naloxone medication) is snorted or injected, the naloxone will block the effects of the buprenorphine.
The most specific way to confirm that your Wellpoint plan covers OUD treatment is to call the phone number on the back of your insurance card or access your Sydney Health app.