Updated: Feb 15
One of the biggest obstacles that prevent patients from seeking help are the costs associated with treatment. They are often unaware of what it is going to take to be able to seen by a Suboxone doctor and furthermore what their medication is going to cost at the pharmacy which can often exceed $400-$800 depending on the quantity of medication prescribed. That is why we try to be as transparent as possible when it comes to pricing and have our costs posted on our website here for all to see. It is also why our flat monthly rate has not changed since opening and we try to be as all-inclusive as possible so that patients aren't having to seek out their own counseling and incurring additional costs to obtain that.
Besides the cost of the Suboxone clinic, your medication at the pharmacy is a separate expense that needs to be taken into account. Luckily, if you have insurance the majority of the time your Suboxone will be covered minus whatever co-pay you are responsible for which varies by plan and tier classification. However, your insurance may require what is known as a prior authorization (PA) before they will agree to pay for your medication which is an additional hurdle that you must jump through and can often delay treatment even further. If you have a good Suboxone provider then usually your PA can be completed the day of your visit and the turn around time is usually 24-48 hours and sometimes even immediate. If you are lucky, then your insurance does not require a PA and you can go straight to the pharmacy to pick up your medication. Also, if you have private insurance through your employer or the Marketplace then Indivior (the maker's of Suboxone) offer a co-pay assistance coupon that will decrease your co-pay down to just $5.
Another issue you may encounter is that your insurance may have a specific form of Buprenorphine on their formulary that you are essentially stuck with. It may not always be your preferred choice although I try to explain that all forms of Buprenorphine are technically the same and should work equally as well. For example, UnitedHealthcare plans preferred form of Buprenorphine is Zubsolv and will require you to "fail" that form before considering covering another. This can often be a lengthy process knows as the appeals process and even after submitting an appeal there is no guarantee that they will agree to your reasoning. Another example is that in Indiana, the Healthy Indiana Plans (HIP) which is our states Medicaid program will only cover the generic Buprenorphine-naloxone tablet which has caused many issues for those used to the Suboxone film. However, there has been FDA approval of a new generic Suboxone film although the availability seems to be lacking at this time.
What If I'm Self Paying for My Suboxone
Another category of patients are those without insurance or those who have insurance but either Buprenorphine is not covered or they have a high deductible plan and are essentially self paying for their meds. These patients are responsible for the full costs of their medication at the pharmacy which can easily exceed several hundred dollars. In these instances, we generally advise patients to use the generic Buprenorphine-naloxone tablet as opposed to the more expensive name brands such as Zubsolv or Suboxone film. In addition, there are several coupons available that can bring the costs down dramatically and are available for anyone to use regardless of if you have insurance or not. Some of the coupons available are:
In my experience, the Phoenix RxAdvantage card tends to provide the largest discount if you are willing to take the generic Buprenorphine-naloxone tablet and it seems that the more tablets you obtain at one time the larger discount your receive. If you plan to use the Zubsolv free voucher coupon then you are only allowed to use 2 of these in your lifetime and each one is good for up to 15 tablets for a total of 30. If you have private insurance and are on the Suboxone film then it is wise to use the Indivior Suboxone co-pay assistance coupon to bring your costs down to $5 a month. I will often give my patients multiple coupons and have the pharmacy run each one to see which offers the largest discount since the discount tends to vary from month to month.