Wellpoint (previously Amerigroup) provides Medicaid and Medicare coverage for millions of Americans. To clarify, the company used to be known as Amerigroup, but started changing its name to Wellpoint at the beginning of 2024. They offer Medicaid plans in Iowa, Maryland, New Jersey, Tennessee, Texas, and Washington. They also offer Medicare Advantage plans in Arizona, Iowa, New Jersey, Tennessee, Texas, and Washington.
Wellpoint (Amerigroup) Medicaid and Wellpoint (Amerigroup) Medicare Advantage plans cover treatment for opioid use disorder (OUD), Suboxone (buprenorphine/naloxone) or generic versions of it. If you have Medicare, the buprenorphine/naloxone itself (like most medications) requires a drug plan or Medicare Part D.
Finding a Suboxone doctor that takes Wellpoint
Locating a provider that takes your insurance plan can feel like searching for a needle in a haystack. Luckily, there are tools nowadays that make it easier.
- Use Wellpoint’s online provider locator: The Wellpoint website has a page just for finding a provider. Click here to start your search. You will need to log in or have your member ID in order to search.
- Log into your Sydney Health app: Wellpoint is part of the Anthem network, so they use the SydneySM Health app. Through this app you can find information about your plan and coverage, as well as locating a provider. You can click here to download the app.
- Give them a call: There is a phone number on the back of your insurance card. When you call it, Wellpoint will have agents who can help you understand your plan and locate resources and providers.
- Find a provider first: You can use a tool like SAMHSA’s Buprenorphine Practitioner Locator or FindTreatment.gov to locate a provider in your area. Then contact the provider to see if they accept your Wellpoint plan.
- Use a search engine: This one is less official, but it can be helpful. Use a search engine with a query like “Suboxone Wellpoint [my state].” Many treatment centers and providers will list the insurance plans they accept. For example, when I did a test search for “Suboxone Wellpoint Texas,” I got responses for Workit Health, because we have pages talking about the fact that we accept Wellpoint in Texas.
Will I need prior authorization from Wellpoint for my Suboxone prescription?
Yes, you may need prior authorization from Wellpoint (Amerigroup) 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?
Opioids work by affecting the brain. They bond to and stimulate the mu (μ) opioid receptors that everyone has in their brains, creating euphoria and relieving pain. Over time, this affects the way the brain produces and reacts to neurotransmitters, creating intense, obsessive cravings. Opioids also create dependence, so that there are physical withdrawal symptoms when use is stopped.
Buprenorphine is a partial opioid agonist. It binds tightly to the mu opioid receptors in the brain, but only partially activates them. The partial activation limits the pleasurable or euphoric effects to that most people with a tolerance for opioids (like people with opioid use disorder do) don’t feel a “high.” It activates them enough to relieve withdrawal symptoms and reduce cravings, though. Buprenorphine also has what we call a “ceiling effect.” Past a certain point, its effects don’t get more intense if you take larger doses (they hit a ceiling they can’t go past). This means people are unlikely to develop a tolerance to it or to seek out larger doses. Buprenorphine is metabolized in the body relatively slowly, so it doesn’t cause the highs and crashes that many other opioids do. The partial activation, the ceiling effect, and slow metabolization all combine to make buprenorphine an excellent option for treating opioid use disorder.
What about the naloxone in Suboxone? When taken as directed, it doesn’t do anything. It is poorly absorbed through the tissues of the mouth, and Suboxone is dissolved in the mouth. If Suboxone (or another buprenorphine/naloxone medication) is snorted or injected, the naloxone will block the effects of the buprenorphine.