Does Aetna Cover Suboxone?
Finding Suboxone treatment that is covered by your insurance company can be time-consuming and frustrating. But we have good news! Suboxone treatment is covered for fully-insured Aetna members in Michigan and California.
What is Suboxone film and what is it used for?
The medication buprenorphine/naloxone is often referred to by its most popular brand name, Suboxone. Suboxone comes as a film that dissolves under your tongue. Buprenorphine is one of the three medications FDA-approved to treat opioid addiction. The combination of buprenorphine and naloxone is what is commonly known as Suboxone. The small amount of naloxone, an opioid antagonist best known for its ability to save lives in the event of an overdose, isn’t absorbed by your body when the medication is taken correctly but prevents misuse.
For those with addictions to opioids, finding treatment can be difficult, with relapse waiting just around the corner. About 2.1 million Americans struggle with opioid use disorder and 5% of those people will try heroin. Many of the people struggling with opioid addiction are addicted to painkillers. Many people begin taking pain medications prescribed by a doctor and over time, the body gets used to the drug and higher and more frequent amounts are needed to obtain the same feeling.
But Suboxone is an opioid medication with unique properties that allow it to actually help people with opioid addiction and leads to successful, long term recovery for many.
How does Suboxone help treat opioid addiction?
Buprenorphine is an opioid that attaches to opioid receptors. It has strong binding ability, replacing and blocking other opioids so that they become ineffective. It is a partial agonist instead of a full agonist, meaning that it causes limited pleasurable effects, just enough to stop withdrawal symptoms. People report feeling “normal” rather than high when on a regimen of buprenorphine. In addition, there is a lower propensity for tolerance because buprenorphine takes longer to dissipate, creating a steadier effect on the receptors.
Does Aetna cover Suboxone?
So to answer your question, does Aetna cover Suboxone? Yes, they do. The amount they contribute to paying for Suboxone will vary according to your specific insurance policy or plan. There are commonly co-payments for each prescription. Some health plans may cover different types of Suboxone, like the generic instead of the brand name.
To find out how much your Aetna plan will cover you can contact the number on the back of your insurance card. You can also refer to your Summary of Benefits and Coverage to see how much is covered and what exactly you’ll owe. The Summary of Benefits should be available to you when you choose a health plan and once you’re enrolled in coverage.
Does Aetna cover opioid addiction treatment as well as the medication?
The answer to this is trickier, as finding quality addiction care that is in-network with Aetna or another health insurance provider can feel daunting. The cost of the medication at the pharmacy is just one cost — what about going to the doctor, receiving counseling, and your prescription? This is a separate cost and coverage will vary based on provider. The good news is that Aetna is now covering Suboxone treatment for fully-insured members in Michigan and California through Workit Health. If you aren’t in Michigan or California, call the number on the back of your insurance card to find an in-network provider, or use your insurance navigation portal.
There are limits on the number of patients a Suboxone provider can prescribe to at a certain time due to DEA regulations. This means that some clinics or providers may not be accepting new patients when you reach out to them. Don’t get discouraged and keep calling. Remember you deserve the gold standard of treatment and the best chance at recovery.
How can you make Suboxone more affordable?
If you’re concerned about having to pay out of pocket for medication, there are ways to make medications like Suboxone more affordable at the pharmacy. Remember that drug prices can vary from pharmacy to pharmacy and from brand name to generic. Your insurance can also cover one type of medication and not to the other, or ask for a pre-authorization to ensure that the medication is really needed. Following the instructions set out by Aetna or any health insurance plan can ensure you get the most coverage for treatment.
To compare the prices of medications from pharmacy to pharmacy, you can also use a service like Good Rx, which tracks prescription drug prices and offers coupons for medication.
In Michigan and California, Workit Health’s opioid addiction therapy program is covered for Aetna’s fully-insured members. This program includes medication, video visits with your clinician and online recovery groups helping you meet your recovery goals, and live your best life!