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  • BDD Moderators: Keif’ Richards

Suboxone and Insurance question...

painenduser

painenduser

Bluelighter
Joined
Jul 13, 2011
Messages
404
Location
NJ
Hey guys,

Long time no chat! Listen I have a question... I know that this is not the place to ask any insurance questions, but this shoulds be a question I can ask here. I talked to my Pain MGT Dr, and I asked him about switching me to Suboxone, not for abuse reasons, but because after 4 years of being on Opiates, I am just tired of being on them. So at my last appt, I asked him if he could switch me over to Suboxone, and he said sure, so he wrote me a script for it. I did warn him that I would need at least 1 weeks worth of my meds because the pharmacy told me that they would have to order it. So with the script for one weeks of meds and the new script for Subs, I went to the pharmacy. Because the Subs script was post dated for the week, I asked them to put it on hold and I would come back the following week for the Subs. The pharmacy did not read the script until Yesterday and when I called them to collect, they told me that there was a problem with the script. Apparently my Dr, while he is a certified pain mgt Dr, he was not certified to prescribe Subs? I have never heard of this, do you guys know anything about this? Apparently my Pain MGT Dr has not, he had no clue what they were talking about.. As well, my insurance company told my pharmacist that they would not pay for the Subs, unless I was 7 full days with out any other opiates in my system?? Again, I have to ask, have you guys heard of this? I thought Subs were to be taken so that you did not go into withdrawal from yourI am completely confused as to the purpose of Subs? This makes no sense to me and I could not find any information on the Suboxone website regarding these things. Also just to be clear, my insurance company is New Jersey State Medicaid. Could this have something to do with it?

I am hoping someone can help clear this up, because there is no way I could go a full 7 days with no meds, I would be an absolute mess!

Any info would be gretly appreciated!

Thanks!

Pain
 
Yeah I actually believe that Methadone and Bupe connot be prescribed they are just given to you at clinics in daily doses or possibly "take home doses" But I don't understand why are you trying to get off opiates to basically be on just another type of opiate substitute? especially if its for legit pain?
 
The reason that I want off of the opiates is because I am tired of being tired, plus I spend a few days every month in withdraw because I can only see my Dr the first Tuesday of each month, so if he is on vacation, or away what have you, I can not see him again until the next month. This is because I am on Charity Care, and the hospital pays the bill so he is the only Dr I can see. He has no on call or coverage Dr. If I am not feeling well one day, and I don't read my script before I leave the Dr and they are wrong, I very little recourse especially now because of a new law in NJ where if you are under the care of a pain mgt Dr, you can not get help for anything that has to do with your meds from the ER, even if it is clear that there was a mistake on the scripts. It's like living in a prison with the meds. I have been told be many people that Subs are actually a really good pain suppressor with out all the tiredness of the opiates and are far easier to come off of in the long term. These are the reasons for wanting to switch. I have talked to many people that are on them and they all tell me that their pain was managed very well with the subs, and those who eventually did come off of them, I am told that its very easy to come off of. One friend of mine had a bunch of left overs and he gave them to me and I did try it out myself, and I can insure you that they were accurate. I found that they did handle the pain, and I pulled myself off of them 2 weeks later, and dummy me should have talked to my Dr then because I had no withdrawal coming off of them however, my pain came back really bad with in 4 days of no Subs, but I had no withdraw symptoms at all. The people that I have talked to are not seeing any pain clinics or anything, they are just seeing their regular pain mgt Dr. and in one case, he was seeing his primary Dr. of coarse I never asked about their insurance carrier because I had no clue about these issues. After 4 plus ears of being on opiates, I am finding that I am more of a slave to the drug then I am able to manage my life events and this is why I want out of them. Being on a medication that would handle the pain, and allow me to no longer live this subservient life is ideally what I would like. I could be wrong here, but from what I have heard and read in forums such as here, and what I experienced when I tried them, that subservient life style seemed to be gone, and this is ideally what I am looking for.
 
Get on sub not methadone.

Methadone requires more visits...

You won't really get very many doses to take home on methadone...

You can get a months worth of sub at a time...
 
Psychedelic Jay,

My point is to go on Subs, but like I was saying, NJ Medicaid, is telling me that I have to be off my Opiates for 7 days before they will pay for the subs. This is what I am looking to you guys for some advice on, because it just doesn't seem right that you should have to put yourself into 7 days of hell to get on the Subs. My understanding on the Subs was that you would transition right to the Subs so that you didn't have to endure the withdrawal of the opiates. It makes no sense, if you can be off the opiates for 7 days, then why go on Subs at all, since by then, you would either have committed suicide all ready or you would be through the worst of the withdrawals. I am not willing to sacrifice 7 days of being miserable beyond belief and total hell just to get on Sub. At that point it seems useless. I'm just trying to understand their thinking in having to be off the opiates for 7 days before they will pay for the Subs. :( Completely at a loss.
 
If suboxone is being prescribed for addiction, then the doctor needs to have been certified to treat addiction. When I was getting it prescribed the doctor had to use his other DEA ID number (or whatever that number is called that they all have to have on their prescriptions) which was specifically for sub scripts. I think he referred to it as his Z number since it started with a Z, or maybe it was X, don't remember.

Anyway, if they tell the pharmacy that it's not for addiction then they should be able to prescribe it for pain and not have to be certified to prescribe it, so call your doctor and see what's up. Maybe you should ask for subutex instead since it's generally cheaper (although suboxone may be cheaper now since I think there are some generics) and has less side effects.

Psychedelic Jay said:
Get on sub not methadone.

Methadone requires more visits...

You won't really get very many doses to take home on methadone...

You can get a months worth of sub at a time...
Click to expand...

If he gets it from the doctor then he won't have to go everyday.
 
Getting methadone from a primary care practitioner is just as impossible as it is to get suboxone from them.

Not too many doctors go through the training or are too scared to prescribe them.

So, those expensive ass trips to opiate recovery doctors are really monopolized in the areas they are.

This is in my town BTW.

I have to drive miles for opiate treatment...
 
^ By me it's not uncommon for people to be prescribed a few 10mg methadone pills a day for pain.
 
Hey Guys. All really good points and to be clear I was never inquiring about Methadone, as I don't see that there is any need for that, so I don't want this thread to be side tracked by that. My biggest concern what that medicaid had told my pharmacist that they would only cover the Subs if I was opiate free for 7 days which goes against everything I had understood what Subs was about. When I speak to my Dr tomorrow I hope I will bring this up to them and see what we can do. I do appreciate hearing both sides, but I never had Methadone in mind when I decided that I wanted to try to get out of this subservient life with my opiates. Let's not be mistaken, yes I have a physical dependence to opiates, and anyone who says after taking them daily for the last 4 years does not have a physical addiction to it is completely out of their mind and living with a false sense of thinking. I just do not see how that is possible, and as well, yes there is some psychological addiction as well. It kind of goes with out saying. The difference with me is that I have never taken my addiction to the point where I felt I had to abuse the drugs. I take them to live a life with no pain and having at one point been an abuser of alcohol, I don't ever want to live a life where my every though is about that next high. With opiates, that is not an issue for me, however, my fear of withdrawal is a huge concern. For this reason, I can not go 7 full days with out intervention and I know I can do it on my own with the proper transition from Dilaudid / Opana, to a regiment of Subs. I wanted to make this all clear as the conversation seems to have included Methadone which was something I did not introduce to my original post. So if anyone can advise specifically on this rule that Medicaid is telling me which is I must be off of all opiates and my Dr must be registered with (I'm not sure who) in order to be prescribed subs, these are what I am here trying to learn more about. I am hoping to see my Dr's partner tomorrow to straighten this out, but I am trying to learn and get all advise I can so that I can speak to them with some knowledge and not just sit there and just take their word for how things should work, since obviously they did not know their full responsibility towards this. Also, being that this is Medicaid I am sure that there are a lot more rules since this is a state program and they will try and make it harder for me to get the coverage since my understanding is that it is EXTREMELY expensive, and we all know how cheap any government sponsored plan can be. Again, I do appreciate the infor on Methadone, but this is not an option for me in my opinion for what I am trying to do.
 
^ Maybe if it's written for pain they will let it be filled right away. Your other option is to have your doctor double the dose for your next weeks dose so it will last you 2 weeks, allowing that week gap between when you really run out and when you can get the subs.
 
Tommyboy said:
^ Maybe if it's written for pain they will let it be filled right away. Your other option is to have your doctor double the dose for your next weeks dose so it will last you 2 weeks, allowing that week gap between when you really run out and when you can get the subs.
Click to expand...

Excellent suggestion! Tommyboy! I should be able to see his partner tomorrow and see if this is something they will go along with this. I will update this thread tomorrow after my appointment and let you guys know what we may come up with, Thanks!
 
Doctors need to be certified or some shit to prescribe Suboxone and are allowed to prescribe it to a limited amount of patients. Besides that you need to be in W/D before starting it or you're going to be in for precipitated W/Ds which is the absolute worst feeling in the world.
I never heard of insurance saying they wouldn't cover it if you were still on opiates so that's pretty bogus. Suboxone is extremely expensive without insurance. Lol actually I got my script for them yesterday and when I read the insert for them it said "Your insurance saved you $642.53" I can't imagine people without insurance taking Suboxone which is why I see why many people opt for Methadone.
Anyway I'm rambling, I hope everything works out!
 
^ yeah it was costin me half my paycheck a week and I work full time. When I told the clinic I couldn't afford it and more importantly I was done being chained to subs, they dropped me. Told me I'd relapse then asked if I really couldn't afford it. I told them I was done and walked out, now I'm at 0.5mg every 36-48 hours. Oh they also said anything under 2mg is placebo and they drop clients at that dose. I nearly fell out of my chair with inner laughter.

Anyway everyone is spot on unfortunately they don't allow anyone to prescribe it and sometimes you need prior authorization which can take a while. It took my girl 2 weeks to get them when she had insurance no other meds and was seeing a specialist. I friggin hate insurance companies.
 
Welcome to the bureaucratic incompetence that is modern drug laws.

The patient suffers, all in the name of (pseudo)science!
 
Well guys, it sounds like I may just be staying on my normal meds.... Dilaudid 2mg and Opana ER 30mg. Kinda sucks but I am not willing to go through a week of hell just to try and get something that I thought would be a far better alternative. I FINALLY was able to get an emergency appt with my Pain MGT Dr... Of coarse he wants to charge me $175 for the visit, when he knows I am on Welfair and Medicaid. If you ask me, he should have known about some of the Subs BS and the fact that he wants me to pay for this visit is such a scam in my book but sadly, he is the only pain MGT Dr who is covered under my Charity Care. Time to win the lottery and see any damn Dr I feel like, or just hit the streets.. You know it makes me wonder why the Fed's are on this "War on prescription drugs" when they are causing half the problems by not allowing you to get the help your asking for!

Thanks Guys.
 
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