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Unread 11-18-2010, 07:45 PM   #1
jcano6979
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Default Prescription coverage dropped suboxone, please help

Hello, I am new to this forum. I have been on suboxone for a while now, i have been doing great. I have a normal life and am happy i can live every day free of illegal drugs. With that said, I just encountered a HUGE problem with my prescription coverage. I currently have Amerihealth as my medical ins. I have Express-Scripts for my prescriptions, and i live and work in N.J. with these provided through my employer that i pay 520.00 bi-weekly for. The express-scripts took effect May 1, 2010. I have gotten my suboxone filled at my local pharmacy with a 35.00 co-pay until Nov 15th 2010. I went to the pharmacy with my new script and they told me that suboxone is no longer covered on my plan. I was NEVER notified of this change. I called express scripts and got lied to once, then i called back and they told me to contact my work as they made a change in the policy. I called my HR person and asked her to look into it. She called me back after 2 days and said effective Nov 1st, they had dropped a list of higher priced drugs from the plan, stating there are cheaper alternatives to all the drugs dropped?????? I was LIVID, What alternitive is there for suboxone? They told me Generic Subutex was covered for a 20.00 copay, But that is a different drug. I called my doctor and asked if he could change my script to subutex generic. He told me it was illegal for him to prescribe me that!!!!!! So how can the insurance say that there is an alternative? Please any help with this i would appreciate as i had to borrow money for this months script and cant afford to pay 360.00 a month on top of my 100.00 doctor visit and my 520.00 healthcare premium. THANK YOU ,
Joe
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Unread 11-18-2010, 08:24 PM   #2
tlg
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Joe~
Sorry to hear about all the issues with your insurance. Is there an appeal process? Can you have your doctor speak with ur ins. company to see if something can be done? I don't know why your doctor is saying it's illegal to script out Subutex, I have never heard of that. It is the same medication...Buprenorphine, without Naloxone. The Naloxone component is clinically insignificant when taken as directed (orally), but if injected can cause WD. So some doctors don't like scripting out the Subutex because it has a higher chance of being abused. There are also med programs that can help with the cost of it...and a lot of places like Walgreens and CVS offer discount programs. Needymeds.com has links to the assistant drug programs. There are a lot of options out there, and I would def. try and see if there's an appeal process or something. Also, you can always think about looking into another doctor if it comes to that! Good luck, and if you have more questions, feel free to ask!
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Unread 11-18-2010, 09:12 PM   #3
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Hi Joe, welcome. Sorry to hear of that being pulled on you without notice.

I will chime in with Trina, it is not illegal to prescribe generic Subutex. There are many people here who take it because of the lesser cost or if their insurance only covers that. Double check with your doctor and tell him that you found out it's not illegal to prescribe generic buprenorphine for opioid addiction and that's all that your insurance will cover. If he's still unsure, he can call the PCSS or SAMHSA or the FDA or the DEA for confirmation. Or you can print this out and show it to him:
From: http://buprenorphine.samhsa.gov/
Teva Announces Buprenorphine HCl Sublingual Tablets Approval

On Friday, May 7, 2010, Teva Pharmaceuticals USA announced that the U.S. Food and Drug Administration has granted final approval for the Company’s Abbreviated New Drug Application (“ANDA”) for Buprenorphine HCl Sublingual Tablets 2 & 8 mg. Teva’s Buprenorphine HCl Sublingual Tablets are the AB-rated generic equivalent of Reckitt Benckiser’s Subutex® and are indicated for the treatment of narcotic addiction.

Teva intends the commercial launch to occur later this month. To learn more about Buprenorphine HCl Sublingual Tablets prescribing information, please call 1-800-227-7522.


I hope this helps, please let us know. That's just not fair.

Nancy
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Unread 11-19-2010, 10:12 AM   #4
jcano6979
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Default Thanks for some info

Hello, thank u for ur replies, I don't see my doc till december now but I will definitely try to convince him to give me the generic subutex. Not sure if he will but it's the only shot I have at it. On another note , does anyone know if I can get the insurance to reconsider putting suboxone on a list of drugs they feel have a cheaper alternative? Also has anyone else had problems with dealing with Express-Scripts in this fashion? There is no contact info for them anywhere unless you call the customer service and they have no idea what they're talking about. They just look at a computer screen and tell u it's not covered anymore stating that's all they know. They can't even tell me what the alternative is they recommend!! I just assumed it was generic subutex
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Unread 11-19-2010, 10:56 AM   #5
MaJaBe
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My Dr. switched me to Generic Subutex after a few months. He had me go to the pharmacy and print out how much it would save me (Half the cost) and he said he had no problem whatsoever switching me to the 'tex.
It's certainly not illegal, that's ridiculous.
Good luck to you, sorry that happened.
I do know how expensive it is for Suboxone. One of the great things about tapering is you see your RX bill go down, down, down. $110 a month now, half that if I can sucessfully get down to 4mg.
Anyway, best to you, hope your doctor gets informed.
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Unread 11-20-2010, 12:54 PM   #6
AbbyNormal
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Joe,

I had a similar runaround with my insurance company when they changed to the film version of Sub. They will only pay half and not the co-pay like with the pills. I had my Dr. prescribe the pills instead.

My guess is that the insurance companies are seeing a lot more people being prescribed Suboxone and don't like the high cost of the drug so they are reigning in their policies on how much they pay before it gets really out of hand. Yes, it's far cheaper to pay for Norco, Vicodin, Oxy's, etc, than it is for a new costlier drug.

I feel bad for you because even with insurance you're still paying an awful lot of money for it. Plus, you don't need that kind of aggravation during the recovery process.

And check out what Trina suggested with organizations who help with medication costs. Search, search, search. Any little bit helps.

I wish the best for you as I too am new here and have found a wealth of information from all the good people here.

Keep Posting,

Tom
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Unread 11-20-2010, 01:54 PM   #7
jcano6979
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Default Update as of 11-20-2011

Hi all, I have a couple developments regarding my insurance plan. Well from fighting with my HR person at work I guess she got them to make a 1 time approval for my script that I just paid cash for. So I went and the pharmacist refunded my money and I paid the normal 35.00 co-pay. I was happy, but I'm still in the same boat for next month. I asked my HR person what the insurance says is a cheaper alternative and she told me they said METHADONE!!..... WHAT?? My doctor can't prescribe that, u have to go to a clinic for that, they cant mail order that either. So how can they tell me that this is an alternative?? For principles I went online to see if methadone is a covered drug and it doesn't even come up. Now what the he'll am I supposed to do, change my whole recovery plan? I don't think so. What do you guys and gals think??
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Unread 11-20-2010, 04:13 PM   #8
toms
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Getting some insurers to cover ORT can be a bitch. When I was on methadone, it was a non-stop struggle. I had to pre-pay the costs, then wait to be reimbursed. At times, I was owed over $1000, and I'd continually get form letters stating they needed a pharmacy receipt (even though I kept explaining there was none). I had the best luck using an advocate and/or getting the name of a specific person who knew wtf was going on. Even then, I still had occasional problems.

The big HMO's routinely deny claims hoping that you will accept it. Be persistant!
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Unread 11-20-2010, 04:44 PM   #9
tlg
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Joe~
You should be able to get the contact info from either your HR or if you have a prescription card or something...if not call the pharmacy and see if they can give you a number cuz I'm sure they have it! You can still contact your doctor even tho you don't have an appt until Dec, andthat'd be one of the first places I would start with. You need to find out for sure about ifk he will give you a script for the Subutex, and print out all the stuff Nancy provided about. The last thing you want to do is wait until your next appt and run out of meds and be stuck not knowing how/what your gonna do next! Lpts of ppl have had to deal with their insirance drug coverage flipping things around on them, and sometimes you can have the company get an approval in certain cases, other times, they wont. So start the process now b/c I'd hate to see you have to go without meds if byou wait until Devember!
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Unread 11-20-2010, 05:34 PM   #10
NancyB
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Hi Joe, I think it's time to talk with your doctor. Either show the doctor the information that proves prescribing generic -tex is not illegal, or have the doctor write to the insurance company and explain why they need to provide a waiver and that they need to cover the medication for you. The doctor will probably just choose to prescribe the generic -tex.
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Important disclaimer: Any information in this post is not and does not constitute medical advice under any circumstances. Addiction Survivors, Inc. does not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. NEVER take any online advice over that of a qualified healthcare provider. Any information contained on AddictionSurvivors.org should only serve to inspire further investigation with credible, verifiable references sources such as your physician or therapist.
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Unread 11-21-2010, 11:33 AM   #11
jcano6979
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Im very nervous that my doctor isn't gonna see that subutex is the alternative. He is very old school and probabaly only knows what the suboxone rep tells him. That it's gonna take a lot to convince him otherwise. He is the type that I am not his regular patient as a Pcp , so he feels I'm there for suboxone treatment and if I can't afford it , that's my problem that I must figure out for myself. Otherwise I must find another doc. I have called around every doc on the suboxone finder and either they aren't taking patintes or they are rediculous with thier pricing. One guy I called wanted 1500.00 up front and 100.00 an hour!!!! Stating the first visit usually takes 2 hours!! There should be legislation against these doctors, it is really out of hand. I don't know if he will even look at paperwork stating it is fine to give me subutex. Thinking I'm undermining his education as a doctor. We all know doctors think they are gods.
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Unread 11-21-2010, 06:45 PM   #12
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Joe~
First of all, you wont know how he's going to respond until you try. We often tend to jump ahead of things because we think we know someone so well, but until you take that jump and actually try it, then you don't know what you may be missing!

Have you considered calling the here to help people, and seeing if there is some info or something, someone, anything that you can get to your doctor to better educate him? If your doctor isn't willing to open up and learn new things, and become more educated, then maybe it's time to think of a new one anyway! I don't mean that he has to take just your word for it, but there are a number of places he can look into himself to find the facts!

Also, while calling around to other doctors, be sure they know that youo're already a patient who is on Suboxone, and just need to find a new doctor (say you are lookin for someone closer or something a long those lines) b/c often the prices they are gonna give you are induction prices, which are much more expensive then regular follow up visits ect. They may still charge more b/c you are a new patient to the doctor, but hopefully it wont be as high as someone just starting out on treatment! Have you looked into all the other patient assistant programs for help on the medication?

Also, have you tried contacting HR and your insurance yet? That may be the eaiest fix you can find, because they may very well be able to do an appeal or something to make it so you are able to get the Suboxone after all!

I think you need to take a deep breath, take a few steps back, and look at all your options! You are not at the end of the road here, you have a lot of different routes you can take, but until you act upon one of them, then nothing is going to change! Last question is, if you have insurance, will they not help you cover these other doctors you're looking into and the price they are charging? I would think with the insurance, you shouldn't be having to pay 1500.00 out of pocket! Maybe call the insurance company about that as well, see if they can help you find a new doctor taking new patients!

Good luck, and try not to get overwhelmed about everything until you take all those steps and suggestions people are giving you!
Trina
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Unread 11-22-2010, 06:33 PM   #13
jcano6979
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I don't plan on waiting till next appt, but it's so hard to talk to my dr. But Unless I'm at my appt. It's almost impossible to talk to him because the receptionists take all the calls and then talk to him and get back to me. I am in the process of trying to get my HR person at work to talk to my RX plan to see what I can do. Can they really say methadone is the alternative to suboxone when they can't even provide that without going to a clinic everyday? In my opinion that is NOT a alternative to my medication.
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Unread 11-22-2010, 06:52 PM   #14
tlg
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I am not sure if they can, but I don't think they can do that. Besides the suggestions that you've been given tho, I am not sure what else you can do. I know the receptionist's take the calls, and I have had to deal with that many of times, but you have to tell them what you have to tell them to get the doctor to call you back. Or, go up to the office or ask to speak with an office manager. You have to let them know it's about your medication you're taking and it's really important that you speak with the doctor in person. But you know your doctor and his office better. All you can do is try and see where you get...
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