Insurance Companies Reluctant to Cover Suboxone

By Mary Patterson Broome, September 09, 2016.

Insurance companies reluctant to cover suboxone

We weigh the pros and cons of Medication-Assisted Treatment (MAT) quite a bit in this publication. But whether we like it or not, it seems to be here to stay—especially if Hillary Clinton is elected.

Methadone is its own separate controversy—most Americans don't want a clinic in their 'hood because the stuff is often sold near the entrance as people come and go for their daily dosage. Suboxone, a buprenorphine-based maintenance drug, has a slightly less adverse reaction from the general public. While suboxone can be prescribed for month-long periods, it can also just as easily be abused and sold on the streets (it is, after all, a drug—with the same components of the opioids it safely replaces). However, a lot of evidence-based recovery enthusiasts are starting to agree: Suboxone in combination with therapy might be the best thing we're going to get next to total abstinence. But a recent NPR story highlighting an Indiana couple currently struggling to get the cost of their Suboxone covered begs the question: Are insurance companies ever going to adopt that sentiment?

The Reddest of Tape

The couple, Angela and Nate Turner of Greenwood, Indiana, both fell prey to painkiller addiction after being given perscriptions to treat injuries "several years ago." (It's not made clear in the article exactly when the drug use officially started.) Angela cites her Suboxone strips, albeit foul-tasting, as a "miracle drug" because she's able to function without being high or craving something to make her high. The trouble seems to be getting her insurance provider to readily collaborate with the doctor when he or she prescribes it, like they would myriad other long-term maintenance medication whether prescribed for hypertension or diabetes.

With Suboxone, apparently the doctor writes the script, but the patient still has to wait a number of days to fill it due to red tape the insurance companies call "prior authorization." They apparently pull this card a lot with addiction and mental illness related medication because (shocker) they want to do everything they can to avoid paying for it.

So technically, per the Healthy Indiana Plan, the insurance company is supposed to readily cover the Turners' Suboxone medication—but they won't do it without dragging their feet. Often, the prior authorizations will expire after a few months, at which point the doctors are forced to jump through the hoops all over again. Meanwhile, with every cycle of re-filling the scripts, the couple and others like them suffer the unfortunate side effects of opiate withdrawal—nausea, irritable bowels and muscle cramps; you get the picture, it's not pleasant.

NPR interviewed Sam Muszynski from the American Psychiatric Association about the issue of prior authorizations which he point blank describes as discriminatory and unfair. He said, "There's a continuing pattern of discrimination, which results in reduced access to [Suboxone for] people who need opioid addiction treatment."

Suboxone Now and Forever?

Okay, I get it, that sounds terrible—the side effects, not being able to get the medicine you need and the skewed lenses through which mental illness and addiction issues are viewed by healthcare providers. But my question is: what did this couple do before they got hooked on the painkillers? It doesn't mention any of their prior history with alcohol or drugs so I won't assume they were born with the gene for addiction (although perhaps that might be the case). For the sake of this argument though, let's say they functioned just fine and drank or used drugs recreationally at a moderate level like the average "normal" American. If that's the case, they survived without opiates up until the time when they were prescribed pain meds so...shouldn't the goal be to get back to that state? When someone goes to a treatment facility for addiction, the idea is that they get the treatment, then they go on with their lives after they're done with treatment. Formalized treatment isn't meant to last forever.

Does taking painkillers permanently reset one's brain and physiology to the extent that they will never again survive without them? I get why someone diagnosed as bi-polar will need to be on psych meds for the rest of their life, but are the brains of people who functioned without opiates up until they were prescribed opiates just totally rewired? Is a Suboxone prescription a new addiction merely replacing the opiate addiction? It's also worth noting that while Suboxone might block the euphoric feeling rendered from opiate consumption, it isn't without its own set of risks.

The Endless, Ironic Cycle

Doctors basically keep asking the insurance companies for continued authorization rather than planning a taper-off plan because apparently the withdrawal from Suboxone is a real shit show in itself. They also just don't want to risk their patients relapsing on a "worse" drug, which makes sense. It just appears to be a vicious cycle. But as the woman in Indiana seems to prove when she describes Suboxone as the reason she is able to care for her own child again, it might ultimately be the lesser of two evils. What's truly ironic is what Nate Turner, the husband in the NPR report, points out: he didn't have to deal with prior authorizations with the drugs he got hooked on in the first place, the one he was initially prescribed for his pain. Something is very wrong with this picture.

So if Suboxone is here to stay, insurance companies better buckle up. I think we'd all rather these folks keep putting strips under their tongues and lead relatively responsible lives than desperately resorting to mainlining cheap heroin in a ditch somewhere. Perhaps a group therapy type setting like Narcotics Anonymous should be a requirement for people hooked on opiates while trying to reestablish their lives through Suboxone treatment. If they can't ever cure the physical craving, they can at least try to heal their emotional, mental or spiritual issues that might have taken a role in their addiction before it ever took over.