Overview of Private Insurance Coverage

Health insurance plans classify buprenorphine as a "niche" medication. This is because Suboxone® and buprenorphine monotherapy tablets are prescribed solely for opioid dependence, a diagnosis that companies predict will affect a limited number of their covered individuals. However, private insurance companies are increasingly covering the cost of the appointments, and almost all major insurance providers now cover the cost of the prescription itself. Companies are also making it easier for physicians to obtain reimbursement for buprenorphine treatment.

Note that though insurers may cover more costs, there is often a high co-pay amount since buprenorphine is typically off-formulary. As such, the cost of co-pay can be exorbitant for patients and may require planning and foresight regarding dosing and medication refills. For instance, federal Blue Cross/Blue Shield co-pays are based on the number of pills prescribed.

Additionally, insurance coverages also vary by region; patients who plan to use insurance coverage for buprenorphine treatment should contact their provider to see what expenses are covered. This should be done prior to starting treatment so that there are no unexpected charges or fees later on.



Related Resources: 
Description: 
Displays the appropriate CPT and HCPCS billing codes for the different phases of buprenorphine treatment.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Description: 
This is an article written by CIGNA Behavioral Health's (CBH) Senior Medical Director. It describes how CIGNA addressed reimbursement, a major barrier to physician prescription of buprenorphine, by identifying an HCPCS code (H0033) that physicians can use to bill for the services provided during buprenorphine induction visits.
Source: 
Nemecek, Doug. Behavioral Healthcare: November 2007.
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Description: 
This study examines decision-making in the buprenorphine treatment distribution and payment systems. The study is based on interviews with health care leaders involved in the distribution and adoption of buprenorphine.
Source: 
The Center for Substance Abuse Treatment (CSAT)
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