Does Humana Cover Suboxone?

Yes, Humana typically covers suboxone, but this coverage varies according to your insurance plans. The law mandates that insurance companies provide coverage for the treatment of alcohol and substance use disorders to an extent. However, before proceeding with the treatment or using suboxone, you should check your plan’s formulary or contact Humana to confirm.

You can get an insurance-covered online Suboxone prescription under medication-assisted treatment at our clinic. All you need to do is verify your insurance coverage on our website and book an appointment.

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An Overview of Suboxone

Suboxone is a brand name for buprenorphine/naloxone combo that is used to treat opioid use disorder (OUD). It is a crucial part of medication-assisted treatment (MAT). It helps control cravings and withdrawal symptoms.

Does Humana Cover Treatment For Opioid Use Disorder?

Yes, Humana typically covers treatment for opioid use disorder (OUD), including medications like Suboxone or its generic equivalent, buprenorphine-naloxone. Prescription coverage is often organized through a tiered system. They offer 3-tier, 4-tier, and 5-tier plans. The 5-tier plan may include the following levels:

Tier 1 – Preferred Generics: Preferred, low-cost generic drugs

Tier 2 – Non-Preferred Generics: Nonpreferred and low-cost generic drugs

Tier 3 – Preferred Brand-Name Drugs: Preferred brand-name and some higher-cost generic drugs

Tier 4 – Non-Preferred Brand-Name Drugs: Nonpreferred brand-name drugs and some nonpreferred, highest-cost generic drugs

Tier 5 – Specialty Drugs: Highest-cost drugs, including most specialty medications

Bonus Tip

Suboxone is often a Tier 3 or Tier 4 drug, depending on the plan. However, the generic buprenorphine/naloxone is usually in Tier 1. Always check with Humana to confirm your exact cost and coverage details. Plus, there may be other nuances to your plan’s coverage that you should discuss with the healthcare provider. 

Were you wondering, “Does Humana Cover Suboxone?” and looking for a sign to initiate recovery, it is here! Call us at 844.445.2565 or fill out this form.

Humana Medicare Advantage Plan Options

Humana Medicare Advantage plans offer various treatment options, including coverage for opioid use disorder. Below are the main Medicare Advantage plans offered by Humana:

1. HMO Plans

With this plan, you can choose a doctor from Humana’s network of providers. It covers unlimited visits to the doctor. HMO plans normally have lower premiums and out-of-pocket costs.

2. PPO Plans

PPO plans will allow you to choose any Medicare-approved doctor, even if the doctor is not within Humana’s network of doctors. The costs may be lower if you choose a doctor from their network.

3. PFFS Plans

Most private fee-for-service (PFFS) plans offer prescription drug and emergency coverage. It includes all the benefits of Medicare Parts A and B.

4. Special Needs Plans

Special Needs Plans (SNP) are available for those having an additional qualifying condition or are eligible for both Medicare and Medicaid. These plans often include all the benefits of Parts A and B, along with Part C.

Verify Your Humana Coverage!

What Restrictions Might Apply to Suboxone Insurance Coverage?

Even if your Humana plan covers Suboxone, there may be specific requirements you need to meet before your prescription is approved. Below are some of the key coverage limits you should be aware of in advance:

1. Prior Authorization (PA): It is usually required when you need a complex treatment or prescription. The doctor or pharmacist has to get approval from the insurance company before providing healthcare services or giving out a prescription.
2. Quantity Limits (QL): It limits the quantity of a drug obtained during a specific timeframe. 
3. Step Therapy (ST): It requires you to first use certain drugs, and if the treatment doesn’t work, you can go for another set of drugs.
4. Part B versus  Part D (BvsD): In this plan, Humana follows the Centers for Medicare & Medicaid Services (CMS) guidelines to determine if a drug is covered under Medicare Part B or Part D.

Addiction Treatment Insurance Coverage Beyond MAT

Many of Humana’s plans cover more than just medication-assisted treatment (MAT) for opioid use disorder. In addition to prescriptions like Suboxone, coverage may include counseling, behavioral therapy, inpatient rehab, outpatient programs, and mental health services that support aftercare and long-term recovery. However, you should review your benefits, ask your doctor or pharmacist, or contact Humana directly to find out what services are included.

Does ChoicePoint Have Online Suboxone Doctors That Accept Humana Coverage?

Absolutely! ChoicePoint accepts most insurance plans, including Humana, not just for Suboxone but for other addiction treatment services as well. These flexible programs are designed to fit in:

• Unique issues
• Convenient prescription
• Flexible timings

From detox to MAT, ChoicePoint’s services are covered by insurance. However, it is your plan that decides the extent to which it is covered.

Free Addiction Assessment

Please note this assessment is an initial self-screening, and it is not meant to be a medical assessment or clinical diagnosis of addiction. For proper diagnosis and treatment, schedule an appointment with ChoicePoint.

FAQs

Does Anyone Know if There’s an Online Suboxone or Sublocade Doctor That Accepts Humana Insurance?

Yes! Our online doctors accept most insurance. Whether you are from BCBS, Aetna, or Humana, the clinic will cover the costs. However, it may vary by plan, which is why it’s recommended to first verify your insurance coverage. 

Does Humana Medicare Advantage Cover Suboxone?

Humana offers various Medicare Advantage plans that may cover suboxone or its generic version, buprenorphine-naloxone, which is more affordable than the brand-name. You should always check with Humana to confirm your exact cost and coverage details.

How Can I Verify if My Humana Plan Covers Suboxone?

You can verify coverage by logging into your My Humana account and searching the drug list (formulary) for Suboxone or its generic version. You can also contact Humana’s customer service for details about the plan’s coverage.

What Should I Do if My Humana Plan Doesn’t Cover Suboxone?

If your Humana plan doesn’t cover Suboxone, your healthcare provider can submit an exception request on your behalf. The request should explain that Suboxone is medically necessary for your treatment and that no suitable alternatives are available.

What Is the Difference Between Suboxone and Its Generic Version?

Both suboxone and its generic version, buprenorphine-naloxone, consist of the same components and work the same for treatment. The difference lies in its brand name and generic alternative. Both are used to prevent cravings and withdrawal symptoms during opioid addiction treatment.