Does Humana cover treatment for opioid addiction, and do they cover Suboxone?
If you’ve been struggling with opioid use disorder or if you’re concerned about your use of pain meds or other opioids, you may have heard that Suboxone is a possible treatment. So what is Suboxone?
Suboxone is one of the brand names of the medication buprenorphine/naloxone. Other brands of buprenorphine/naloxone include Zubsolv and Bunavail, and there are generic options, as well. Buprenorphine/naloxone comes as a film or a tablet that you dissolve under your tongue, rather than swallowing. (Suboxone and Bunavail are films, Zubsolv is a tablet, and generics may be either.) Buprenorphine is one of the three medications FDA-approved to treat opioid addiction and is the primary active ingredient in this medication. The small amount of naloxone, an opioid antagonist that blocks opioid receptors in the brain, isn’t absorbed by your body when the medication is taken correctly. It is included to prevent misuse.
Now that you know what Suboxone is, you probably have questions about whether your Humana plan will cover it and treatment for opioid use disorder, in general.
Does Humana cover treatment for opioid use disorder?
The basic answer to your question, “Does Humana cover opioid use disorder?” is yes. They do. Humana recognizes opioid use disorder as a medical condition, and they cover its treatment. As well, the Affordable Care Act (ACA) made it mandatory for insurance companies to provide coverage for treatment of alcohol and substance use disorders.
But which addiction treatment providers Humana will cover and the amount they will pay varies from plan to plan.
Finding evidence-based addiction care that is in-network with Humana or another health insurance provider can feel daunting, but there are resources to help you. Workit Health accepts Humana for opioid use disorder treatment in many states. You can click here to verify your coverage in our insurance checker. You and also call the number on the back of your insurance card to request help in finding providers who accept your Humana plan. And you can refer to your Summary of Benefits and Coverage to see how much is covered and what exactly your copay or deductible might be.
Does Humana cover Suboxone for opioid use disorder?
Humana insurance plans usually cover prescriptions based on a tiered system:
- Level 1 – Includes all generic medicines
- Level 2 – Includes lower-cost brand medicines
- Level 3 – Includes higher-cost brand medicines
If your Humana plan includes drug coverage, it will cover buprenorphine/naloxone (when prescribed as medically necessary by a licensed clinician). But depending on your plan, Humana may not cover the brand name medication Suboxone. It should be noted that the FDA requires that generic medications must be safe and work the same as name-brand medicines.
You can verify which versions of buprenorphine/naloxone are covered by your particular plan by checking the Humana formulary online here. A formulary is a drug list specifying which medications are included by an insurance company and which have restrictions. If your plan does not cover brand name Suboxone but you and your provider believe you need it rather than a generic version, your healthcare provider can request Humana to approve a coverage exception. This is called a prior authorization (also called pre-certification).
How does Suboxone (buprenorphine/naloxone) treat opioid addiction, anyway?
Buprenorphine is a partial opioid agonist. It has a strong ability to bind to the opioid receptors in the brain, but only partially activates them. This is why it is considered a partial agonist instead of a full agonist. This limits the pleasurable or euphoric effects; for many people, it relieves withdrawal symptoms and reduces cravings but does not create a feeling of “high” when administered for opioid use disorder. In addition, it has a ceiling effect, meaning that its effects don’t get more intense if you take larger doses beyond what is effective, and it is metabolized relatively slowly in the body, so it doesn’t create erratic ups and downs.
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.
In several states, Workit Health’s opioid addiction therapy program is covered for Humana members. This program includes clinician appointments, medication e-prescribed to a pharmacy, support from coaches and therapeutic courses, and online recovery groups to help you meet your recovery goals.