Does Medicaid Cover The Cost Of Suboxone Treatment?

When exploring treatment options for an opioid use disorder (OUD), finding out if Medicaid covers medications like Suboxone can be extremely important.

Does Medicaid Cover The Cost Of Suboxone Treatment?

Substance use disorders are common across the United States, and although a significant number of individuals who are covered by Medicaid struggle with substance abuse and addiction, not even five percent of Medicaid recipients attend substance abuse treatment yearly.

Medication-assisted treatment (MAT) programs are outlined as the standard method of treatment for opioid use disorders (OUD). When a person is seeking treatment for opioid addiction, it is important that whatever facility they choose offers MAT options that meet their needs.

The Opioid Epidemic In America

Pharmaceutical companies were adamant that patients would not become addicted to opioids, and this promise resulted in a significant increase of opioid painkillers being prescribed across the United States.

With the abundance of opioids that became available due to over-prescribing, it was apparent that prescription opioids were as addictive as other opioids, like heroin and morphine. The increased availability led to increased abuse of opioids.

The availability of opioids created a wave of addiction and overdose deaths across the country. The Centers for Disease Control and Prevention first declared opioid overdoses an epidemic in 2011.

In 2017, the U.S. Department of Health and Human Services announced that opioid addiction was a “public health emergency”, and revealed their strategy to overcome and manage the opioid epidemic.

Suboxone – What Is It?

Suboxone has two active ingredients – naloxone and buprenorphine. Buprenorphine is a partial opioid agonist. Its properties are long-lasting. When buprenorphine binds to the opioid receptors, it prevents other opioids from binding, rendering them ineffective, in other words, when buprenorphine is in the system, other opioids won’t work.

Naloxone, on the other hand, is an opioid antagonist. Naloxone is the active ingredient in Narcan, which is the medication given to reverse an opioid overdose.

Suboxone is unique in that the only time the naloxone becomes activated is if the person ingests Suboxone in a way that is not prescribed, like an injection. The naloxone in the Suboxone actually acts as a deterrent so people are less likely to abuse Suboxone.

Suboxone, when taken as prescribed, reduces cravings and uncomfortable opioid withdrawal symptoms. Suboxone also blocks the effects of other opioids, if a relapse happens to occur.

How Suboxone Is Used In OUD Treatment

More than two million people in America were addicted to opioids in 2018. Of those two million, just over seventy-five percent of those were addicted to painkillers, while the rest struggled with heroin addiction.

Suboxone is a medication-assisted treatment (MAT) during three different stages during treatment for an OUD.

When a person enters treatment for opioid addiction, they usually are in need of a medically supervised detox. After the first twelve to twenty-four hours, a person can start Suboxone treatment. Starting before that would likely cause intense withdrawal symptoms to emerge.

Once a person has adjusted to Suboxone, and no other opioids are present in the system, the person is considered stabilized. The medical professionals may adjust dosage and frequency, depending on individual needs.

The final stage is what is considered a maintenance stage. The purpose of this is to maintain sobriety and prevent a relapse. Doctors will discuss how long a person needs to continue this maintenance dose, and this time frame varies from person to person.

Suboxone Helps Prevent Opioid Withdrawal

While opioid withdrawal on its own is not necessarily fatal, it can cause significant complications that can end up being life-threatening. Complications such as imbalances, dehydration, or aspiration of vomit into the lungs.

Other side effects of opioid withdrawal include:

  • nausea
  • vomiting
  • sweating
  • chills
  • anxiety
  • insomnia
  • restless leg syndrome
  • abdominal cramping
  • muscle pain
  • high blood pressure

Side Effects Of Suboxone

If a person starts a Suboxone regimen while opioids are still in the system, it will throw a person into withdrawal as soon as Suboxone reaches the receptors in the brain.

So some of the side effects of taking Suboxone are comparable to opioid withdrawal, such as:

  • headache
  • constipation
  • muscle cramps
  • insomnia
  • nausea
  • increase in body temperature
  • profuse sweating
  • vomiting

How To Take Suboxone

Suboxone is available as a sublingual film, meaning it is to be dissolved under the tongue or between the cheek and gum. This medication has been known to cause irritation of the skin in the mouth.

Do not take Suboxone with any other medication, substance, prescription drugs, alcohol or illicit drugs, as severe adverse reactions can occur. Combining Suboxone with another CNS depressant can lead to respiratory failure, risk of overdose, or death.

Suboxone does carry a risk of physical dependence, so it is important to communicate with the prescribing doctor when decreasing doses, and do not go cold-turkey off of Suboxone.

Why Is Suboxone The Preferred MAT?

Suboxone has fewer restrictions than other MAT medications, like methadone. Suboxone can be prescribed outside of a clinic/hospital setting.

Individuals are also less likely to abuse Suboxone because it is not as potent as other opioids, it does not work if it is injected, and the naltrexone activates when injected, resulting in immediate withdrawal symptoms.

Risks associated with Suboxone are lower as well. Suboxone is four times less likely to result in overdose than methadone. In fact, any reported overdose involving Suboxone occurred when a person was mixing Suboxone with CNS depressants like benzos or alcohol.

Suboxone appears to be safer for women who are pregnant, and their babies. Buprenorphine research has shown positive outcomes when used in addiction treatment. Individuals are less likely to quit rehab, overdose, or relapse.

Affording A Suboxone Opioid Treatment Program

Finding a program that takes Medicaid insurance can seem confusing, but thankfully solutions aren’t actually as complicated.

Starting October 1, 2020, the SUPPORT act requires all states to cover opioid treatment programs (OTP) in their Medicaid programs. Additionally, for individuals who qualify for both Medicaid and Medicare, there will be coverage for OTP from both insurances.

While most people understand that Medicare is for individuals over the age of 65, many are not aware that younger people can qualify if they have a disability or end-stage renal disease. Addiction is considered a disability.

Without insurance coverage, Suboxone costs between $165-$500, and the generic is between $60-$200. Insurance coverage and discount prescription cards can make Suboxone and its generic significantly less expensive.

Opioid Treatment Programs And Suboxone

Finding a location that offers the treatment services you need and feel comfortable with are extremely important. Opioid addiction is complicated and it takes a village to guide a person through the stages of recovery. That’s what an OTP can do for you.

Reach out to us today. We are available to answer your questions about Suboxone, insurance coverage, costs, and how our programs are right for you.

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