Insurance making it hard for people to stay on suboxone

[marsnd]

I was hoping for some advice on this subject. I have been on suboxone-2- 2 and a half 8mg films for over 9 years now. Every 28 days I see my Sub doctor, do counseling, and a drug test. Then pick up my scripts. Unfortunately this time I needed a prior authorization from my doctor, to insurance. So I waited, he sent them the required information. They requested more information, so he sent more paperwork and the treatment plan moving forward, with my signature. It got to day 30 and I called my insurance carrier anthem, and they declined me with no other option. No renewal or substitute. They told me the medication I was on was used for one year only, typically. I Explained my situation to them, and they said I can contact my doctor and he can appeal it. Why is it becoming harder to get medications to help with addiction/pain management then it would be to get oxy or percs again? Why are these insurance companies making this so difficult? At the 30 day mark, they would rather me go into withdraw, end up in the emergency room, and back in an inpatient Center. Then approve my Suboxone and maybe ask my doctor to wean me down, or an alternative medication? No warning either? Just you got denied, and good luck to you. Suboxone has helped me stay out of detox centers, hospitals, pain clinics, avoid alcohol or any other illicit drugs. I was able to put my life back together. Marry an amazing wife, rise to a management role at work. Have a savings account again. Before Suboxone it was treatment center after treatment center. Always relapsing, and back to some drug. Is anybody else out there experiencing these problems with insurance companies? If so what are you saying to them? I also have UnitedHealthcare now as a primary starting this month. In the past they've always denied at an Anthem has been the insurance carrier put that picked it up.

 

[marsnd]

I should also mention that I have had both knee scoped from tears. I now have bone on bone on both knees and have a very physical job. I've also had a rotator cuff and labrum surgery. At the end of last January I had pneumonia, that led to a collapsed lung, and 4 different surgeies. I was in a coma, and spent 6 weeks in the hospital. Followed by 3 months of extreme physical therapy. Not once did I ask for pain meds. I knew it would lead me down that road again. So I stayed of the subs, and muscled through it. So this has been a 20 year fight with addiction for me. I know Suboxone isn't substance free, and can be veey hard to come off of. At the same time, why stop, when it doesn't get me high, helps with pain, I have no cravings to use, or drink. This is a disease i'm going to have my whole life. Why is it that insurance companies are making it so hard for us that want to stay clean, be that way. The alternatives are them paying for an expensive rehab again. I thought now more then ever, we would have the help as addicts we need. Considering "The War On Drugs", and how abysmal it is for addicts. It's just becoming detrimental on my mental health here. Looking for anyone going through the same situation.

 

[Eryximachus]

This is the reality of modern day healthcare. You have your life together and a lot to lose. If insurance doesn't cover it, I would shop around to pay cash. You can consider foreign pharmacies as well. Even travelling to Canada could be worth it; they will take your script. I just checked a few DNMs, and the Suboxone black market price seems to be high, probably more than retail in Canada (About $10USD/pill).

All of that said, perhaps it is time to consider getting off the stuff. There are lots of options.

 

[mrsnowygrainius]

I was hoping for some advice on this subject. I have been on suboxone-2- 2 and a half 8mg films for over 9 years now. Every 28 days I see my Sub doctor, do counseling, and a drug test. Then pick up my scripts. Unfortunately this time I needed a prior authorization from my doctor, to insurance. So I waited, he sent them the required information. They requested more information, so he sent more paperwork and the treatment plan moving forward, with my signature. It got to day 30 and I called my insurance carrier anthem, and they declined me with no other option. No renewal or substitute. They told me the medication I was on was used for one year only, typically. I Explained my situation to them, and they said I can contact my doctor and he can appeal it. Why is it becoming harder to get medications to help with addiction/pain management then it would be to get oxy or percs again? Why are these insurance companies making this so difficult? At the 30 day mark, they would rather me go into withdraw, end up in the emergency room, and back in an inpatient Center. Then approve my Suboxone and maybe ask my doctor to wean me down, or an alternative medication? No warning either? Just you got denied, and good luck to you. Suboxone has helped me stay out of detox centers, hospitals, pain clinics, avoid alcohol or any other illicit drugs. I was able to put my life back together. Marry an amazing wife, rise to a management role at work. Have a savings account again. Before Suboxone it was treatment center after treatment center. Always relapsing, and back to some drug. Is anybody else out there experiencing these problems with insurance companies? If so what are you saying to them? I also have UnitedHealthcare now as a primary starting this month. In the past they've always denied at an Anthem has been the insurance carrier put that picked it up.

first off let me say I'm so sorry for your situation, i can empathize with you (sort of) see I'm on suboxone too, been on 8- 10mgs for over 4 years now. This medicine is literally a life saver, it is the sole reason why i am alive today. Suboxone saves lives and it needs to be made more accessible to addicts. I lost my best friend this week to an OD, it should have been me... he got bad with D once i got on subs... he couldn't afford suboxone.

see i am extremely lucky i found a DR that i can see 2- 3times month and i pay out of pocket its $250 for the usual 2 visits per month. Unfortunately These insurance companies are still ignorant when it comes to habit forming medications and addictions. They don't realize cutting someone off from their ORT can and most likely will lead directly to their death

if i were to get cut off from my subs for some reason the first thing i would do is call up my old dealer... see he is still around, i could have dope in my veins within an hour or 2 from calling him... then in all honestly id end up like my best friend Chris.. who just died at 24 years old

again I hurt for you OP i really do, i fear what you are going through right now every day of my life on the subs.. they don't get it, they just can't get it. If i were you id look into getting on methadone, I'm here if you want to talk.

 

[tacodude]

Just have your Dr appeal the denial

 

[Coolwhip]

Check and see if their policy for the tablets is any different, I had to switch insurance providers two years ago, and my new provider didn't cover the films, I actually paid cash for them for 2 months before I realized the covered the tablets. Using them SL is gross, but you could always filter and make a tincture, I filter them and make it into a nasal spray.

 

[Mr_Xan_Bar]

I feel your pain. I went through the same thing but luckily in the end they approved it.