Is Sublocade Covered By Medicaid

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Note On The Regulation Respecting The List Of Medications

Regulation respecting the List of medications covered by the basic prescription drug insurance plan

The List of medications constitutes a regulatory list of the medications covered by Québecs basic prescription drug insurance plan. See list update schedule.

For previous versions of the list, see the register below. The “Related legal document” links point to the ministers orders and RAMQ notices pertaining to the list.

Please note that under the seventh paragraph of section 60 and section 60.1 of the Act respecting prescription drug insurance , publication on this website of a regulation respecting the List of medications and of the Related legal documents imparts authentic value to them.

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. Thats 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.

Written by the Addiction Resource Editorial Staff

Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.

These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.

  • American Society of Addiction Medicine – Medicaid Coverage OTP Florida

Sublocade: A Monthly Dose Helps Maintain Abstinence

Sublocade is a brand name for a buprenorphine injection to help maintain abstinence after much of the opioid addiction treatment process has been completed. This medication is injected once per month by a trained health care provider in a treatment setting.

Usually, patients begin by taking sublingual suboxone strips or tablets for a period of time until they have achieved their goals for abstinence. For some people who have been on Suboxone stably, they may prefer to switch to a long acting injection like Sublocade so that they do not have to take Suboxone strips on a daily basis. Sublocade is usually for people who have been stably abstinent from opioids on Suboxone for a period of at least months to years.

The passage of the Affordable Care Act expanded requirements for health insurance companies to cover at least part of mental health and substance abuse treatment, and this includes lifesaving medications used to manage opioid use disorder . Although Sublocade is a new medication, it is covered by many insurance plans.

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Sorry You Are Not Eligible For The Insupport Copay Assistance Program For Sublocade Because One Or More Of The Program’s Eligibility Requirements Has Not Been Met

  • You must be at least 18 and less than 65 years of age.
  • You must have private health insurance.
  • You may not be enrolled in, or covered by, any local, state, federal or other government program that pays for any portion of medication costs, including, but not limited to Medicare, Medicaid, Medigap, VA, DOD, TriCare, CHAMPVA or any other federally or state-funded government-assisted program.
  • You must be a resident of the United States or U.S. territories.
  • You must have been prescribed SUBLOCADE by your treatment provider.

Other restrictions apply. Please see the program Terms and Conditions for the INSUPPORT® Copay Assistance Program for SUBLOCADE.

How To Take Suboxone

Does Insurance or Medicaid Cover the Cost of Suboxone Treatment ...

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.

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How Is Sublocade Given

Sublocade is a subcutaneous injection that is injected under the skin once per month. A healthcare provider will give you this injection. You should not give yourself this medicine.

Sublocade should never be injected into a vein or a muscle. This medicine is for injection only under the skin. Sublocade forms a solid mass when it comes into contact with a bodily fluid such as blood. Injecting this medicine into a vein or muscle could result in damage to the skin or underlying tissues, as well as a blood clot that could travel to the lungs and cause death.

After each injection, you may see or feel a small lump under your skin where the medicine was injected. This could last for several weeks but the lump should eventually get smaller. Avoid rubbing or massaging the lump, or wearing tight clothing over the area.

At least 26 days should pass between each injection of Sublocade.

Sublocade is only part of a complete treatment program that may also include counseling and other types of addiction support. Tell your doctor if you feel that this medicine is not helping to improve your symptoms of addiction.

You will need frequent blood tests to check your liver function.

Tell your doctor if you have a planned surgery.

Any medical care provider who treats you should know that you are being treated for opioid addiction and that you are receiving Sublocade. Make sure your family members know how to provide this information in case they need to speak for you during an emergency.

Use In Specific Populations

Pregnancy: Opioid-dependent women on buprenorphine maintenance therapy may require additional analgesia during labor.

Lactation: Buprenorphine passes into the mother’s milk. Advise breastfeeding women to monitor the infant for increased drowsiness and breathing difficulties.

Fertility: Chronic use of opioids may cause reduced fertility. It is not known whether these effects on fertility are reversible.

Geriatric Patients: Monitor geriatric patients receiving SUBLOCADE for sedation or respiratory depression.

To report pregnancy or side effects associated with taking SUBLOCADE, please call .

See the full Prescribing Information including BOXED WARNING, and Medication Guide. For REMS information visit www.sublocadeREMS.com.

References:

  • 1. SUBLOCADE . North Chesterfield, VA: Indivior Inc. 2020.
  • P-BAG-US-01139

    Intended for US audience.

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    How Can I Get Sublocade Treatment

    âIf your treatment program recommends monthly injections of Sublocade to help you maintain abstinence from opioids, you will need to find, or get are referral for, a Sublocade Risk Evaluation and Mitigation Strategy program. This program ensures your medication provider has the training needed to safely inject this subdermal medicine, evaluate any side effects, and support you if any issues arise.

    Sublocade is an injection medication that releases buprenorphine into the bloodstream at a measurable, regular rate over 28 days. You should not receive these injections more frequently than every 26 days. If you feel cravings or withdrawal symptoms before that time has passed, you should report these to your physician.

    Sublocade cannot be administered by you, the individual, or by a general practitioner. Only a doctor who has received training through the REMS program can administer this medicine.

    Prior Authorization Requirements For Sublocade

    Dec 1, 2018State & Federal / Medicaid

    Effective February 1, 2019, prior authorization requirements will change for the infusible/injectable drug Sublocade to be covered by Anthem Blue Cross and Blue Shield Medicaid. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

    PA requirements will be added to the following:

    • Sublocade implant
    • Phone:1-855-661-2028

    Not all PA requirements are listed here. PA requirements are available to contracted providers through the Availity Portal . Providers who are unable to access Availity may call us at 1-855-661-2028 for PA requirements.

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    Important Safety Information And Indication

    See More

    What is the most important information I should know about SUBLOCADE?

    Because of the serious risk of potential harm or death from self-injecting SUBLOCADE into a vein , it is only available through a restricted program called the SUBLOCADE REMS Program.

    • SUBLOCADE is not available in retail pharmacies.
    • Your SUBLOCADE injection will only be given to you by a certified healthcare provider.

    P-BAG-US-01130

    Affording A Suboxone Opioid Treatment Program

    Finding a program that takes Medicaid insurance can seem confusing, but thankfully solutions arent actually as complicated.

    Starting October 1, 2020, the SUPPORT act requires all states to cover opioid treatment programs 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.

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    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.

    Why Is Suboxone The Preferred Mat

    Does Insurance or Medicaid Cover the Cost of Suboxone Treatment ...

    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.

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    Does Medicaid Cover The Cost Of Suboxone Treatment

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

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

    Read Also: What Are The Eligibility Requirements For Medicaid In Texas

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    Will My Insurance Cover Sublocade Treatment How Much Does It Cost

    âSublocade is not available in retail pharmacies or regular physiciansâ offices, so finding a provider who accepts your insurance is an important first step. Most insurance plans cover at least part of your Sublocade costs, but the pharmaceutical company that manufactures Sublocade also offers copay assistance since individual injections can become expensive.

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    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 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.

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