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Addiction: Substance Abuse Community
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233181 tn?1235186752

CHOOSING GOOD INSURANCE

What people need to do before they join an insurance plan is to ask to see their drug formulary. A formulary is a list of approved drugs under their plan. The insurance companies are all beginning to follow the medicare part-D system where as they will list drugs-by category and tier level.  Then you turn to the part of the drug formulary that will explain the tier process to you, here are a some, QL for quantity limits, PA for prior authorization, which means your Doctor must take the time out to call the insurance co. and see if they can get the prescribed drug authorized. And there is ST, which stands for Step Therapy, which means they would like the physician to try a cheaper drug first if one is available. (example Lyrica very expensive, insurance would prefer you get Neurontin much cheaper but is written by physician as off label drug, which is perfectly legal.

One mistake I think patients are making from the beginning is by not selecting the correct physician from the beginning. Just because a M.D. is allowed to prescribed suboxone (because he completed the eight hours required by the state) doesn't mean the insurance co. is going to approve the claim and pay for your visit, That's why so many Suboxone claims are denied because the provider was not an approved provider with the plan or the PCP referral had not yet been received.

Now, for all people with medicaid I have heard stories that their Medicaid HMO Plan has in fact denied coverage on suboxone. I an very surprised and shocked in these situations as medicaid is a program run by the state and Federal Government. Medicaid by law is suppose to follow Medicare guidelines. In fact Suboxone is listed on my medicare part-D, formulary drug list as a tier 3 drug with no Quantity Limits or prior authorization. In fact it is listed among the pain reliever category for 2007.

Remember starting 11/15/07 is open enrollment time for Medicare Part -D. Shop around and make sure you review their PDF (prescription drug formulary) to make sure that suboxone is on the PDF for 2008. If its not then keep shopping around. You have until 12/31/2007. And always see if you qualify for a low income subsidy. Which means the state will pay your part B and D premium. The part D plans can help you. And let you know if you qualify. Part B assistance will be processed by the DCFS you can apply on line in most states.

People receiving an SSI check have medicaid. Those that do will be receiving an Open Enrollment Letter in the mail. Make sure your address is current! This is the only time of the year that you will be allowed to change plans so do your homework and read those PDF manuals.

Finally everyone I believe you should seek out a pain management physician that has his /her DEA waiver to prescribe suboxone, As in my case after 1+yr on Oxycontin and Norco. After surgery eventually I was switched to suboxone and lyrics for pain caused by nerve damage, The point I am trying to make is go with a PM Doctor that already has their suboxone waiver. By doing this I was able to keep the same Doctor when I made the switch from opiates to sub/nx. My Doctor told me that they are instructed not use subutex for maintenance due to the potential for IV abuse, not so with sub/nx, I was also amazed that methadone in pill form is approved by medicare when prescribed by a pain management Dr.

GOOD NEWS FOR MEDICARE RECIPIENTS FOR 2008. SUBOXONE APPROVED WITH NO, QL or PA (no prior authorization) necessary.

Those with private insurance at work, HMO,PPO, and fee for service plans. If they dont cover suboxone now find out if it is going to be covered in 2008. Remember most employers offer more than one one plan, Now with the HIPPA laws they cannot ask you questions regarding substance abuse.

Finally new for 2008 medicare will not cover the very potent opiates such as duragesic patches and fentura along with fentanyl lollipops without a diagnosis of cancer.
I HOPE YOU ALL FIND THIS POST HELPFUL, BUT IF YOUR SICK OF YOUR INSURACE YOU DO HAVE CHOICES.    BEST OF LUCK TO ALL ------NOAH
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