You have been wrestling with the seemingly ongoing cycle of opioid use for the last few years. Every time you’ve pulled away, the cravings for opioids have only grown stronger. You keep thinking this time will be the time you will stop using opioids, but you always leave treatment programs before you can get anywhere because the desire to use opioids feels impossible to break through. A friend suggests you try a Suboxone treatment as it can help manage cravings. However, you are now on Medicaid after losing your job due to skipping work to use substances. You wonder if Medicaid will pay for a Suboxone treatment or if that would be something you would have to pay out-of-pocket for. You know you would have a challenging time if Medicaid didn’t cover it.
Today, approximately 1.7 million people in Tennessee are on Medicaid. Every year, Medicaid allows many low-income individuals to receive life-saving medical care that includes treatment for opioid use disorders. Physicians often use Suboxone as a tool for treating opioid use disorders.
At ReVIDA® Recovery, we provide personalized assistance, including applying for aid, finding a job, and handling court letters. We want to ensure that you can access and understand the resources that allow you to reclaim your life from opioid use disorders. A common question people might ask who are entering opioid use disorder treatment and have Medicaid is, “Does Medicaid pay for Suboxone treatment?”
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A Closer Look at Suboxone
When treating opioid use disorders, Suboxone is a medication medical professionals might use during medication-assisted treatment (MAT) to help manage symptoms of withdrawal, including cravings. It is used as a tool alongside treatment plans, allowing people to focus on other services such as counseling. The medication is a 4 to 1 ratio of buprenorphine and naloxone, which has a “ceiling” effect that makes it difficult to overdose on. This “ceiling” effect makes it safer even at higher doses, as it levels off the effects of buprenorphine. Typically, people do not have to be on the medication forever, and they can taper off once they are ready. The time someone is on Suboxone can vary from person to person because everyone is different and requires different timelines for recovery.
Understanding the Appeal of Using Suboxone
People use Suboxone because it makes withdrawal from opioids easier to manage. Opioid withdrawal often comes with intense cravings that can present a strenuous challenge to focus on one’s recovery. Often, people who are undergoing opioid withdrawal feel like they can only focus on the need to use more opioids, which may lead to them deciding to leave treatment and return to use. However, when people use Suboxone, it allows them to focus on treatment programs instead of their desire to use opioids. This is a life-saving solution for many, as Suboxone allows them to move past their cravings and withdrawal symptoms so they can focus on their recovery.
Some common opioid withdrawal symptoms people might experience include
- Intense cravings
- Muscle aches
Explaining Medicaid Coverage for Suboxone Treatment in Tennessee
In Tennessee, Medicaid covers Suboxone under 2 specific circumstances. The first requirement is that the patient must have a diagnosis of an opioid use disorder. The second requirement is that a physician prescribes the medication. The physician must have completed a certification program and reviewed the Controlled Substances Database on the date of the prior authorization request, to ensure there is no overlap in prescriptions for the patient. They also must have submitted an anticipated treatment plan and obtained a TennCare/Medicaid ID number. Medicaid will also cover buprenorphine hydrochloride only if the person cannot take Suboxone due to pregnancy or an allergy to naloxone. In this case, your physician must fax the allergy documentation to TennCare’s pharmacy benefits manager.
Medicaid also requires the tapering of Suboxone when the patient has completed treatment. The dosage limit is 16 mg a day for a maximum of 6 months, after which there is a maximum dosage of 8 mg. Medicaid will not cover dosages more significant than 16 mg for Suboxone. They will also not cover prescriptions that are written by a mid-level practitioner or intended for treating pain or depression.
Anticipated Out-Of-Pocket Costs for Suboxone With and Without Medicaid or Other Insurances
In 2020, the average cost of Suboxone with Medicaid in the United States was around 10 cents a day. In the same year, people who did not have any form of insurance paid, on average, $8.44 a day for the medication. People with commercial or private insurance paid around $1.82 a day. These numbers mean, assuming a 30-day month of taking the medication, on average, people who had Medicaid spent around $3 a month for Suboxone. Those with commercial or private insurance paid around $54.60, and people without Medicaid or other forms of insurance spent around $253.20 a month.
Understanding the Procedure for Medicaid Registration in Tennessee
In Tennessee, Medicaid is called TennCare. It works to provide healthcare to low-income people in Tennessee, specifically the following groups of people:
- Pregnant women
- Parents or close relatives of a minor child who lives with you
- People who receive Supplemental Security Income (SSI) checks
- Children under 21
- People who have gotten an SSI check and a Social Security check in the same month at least once since April 1977 and still receive Social Security checks
- People who live in a medical institution and have a monthly income below $2,829
- People who receive long-term care services covered by TennCare
To receive Medicaid, you must meet one of the above groups and meet the income and resource limits for those groups. TennCare allows people to apply whenever they fall into one of these categories. People in Tennessee can register for TennCare online. They also have online paper options to print and mail in English and Spanish.
When applying for Medicaid, you will need to know information such as your home address, phone number, and email address. They will also want information about your income from jobs and other sources such as child support. You will also want to know the value of your assets, including cars and property. Information about your citizenship or immigration status is also necessary if you are an immigrant. If you are applying for people who are not yourself, you will want to know everyone’s social security numbers and dates of birth. If applicable, you may be requested to provide other health insurance information. The more you can provide, the faster they can decide if you qualify for Medicaid. However, if more information is required, they will send a letter asking what they need from you. The application takes, on average, 30-60 minutes to complete.
Embark on Your Opioid Recovery Journey With Suboxone Treatment at ReVIDA® Recovery Today
The journey of seeking Suboxone treatment for an opioid use disorder is a compassionate decision for yourself. With the medication, you will be able to focus on your treatment plan without having to worry about the potential cravings you might experience. Treatment allows you to create your personal story of inner resilience and strength that provides you with the steps it takes to recover from the potential cycle you have found yourself in when it comes to your opioid use. In your treatment plan, you will be able to learn skills and techniques and form relationships that will encourage you to reclaim your life as you form a healthier future.
With many locations throughout Eastern Tennessee, ReVIDA® Recovery is passionately committed to guiding you down the path of recovery as you reclaim your life. Our facilities have same-day appointments available so that you can start your opioid use recovery journey. If you have any questions or concerns or wish to begin treatment, please contact us at 423-631-0432 today.