NEW HERE...INSURANCE WONT COVER SUBOXONE ANYMORE??

Number of posts : 4 Registration date : 2012-10-06

I am new here but have been on Suboxone therapy for several years. I spent a really substantial part of my life on pills and finally after my umpteenth time in rehab was put on Suboxone and it changed my life. I tried endlessly to stop using and like many others was unsuccessful before Suboxone. I am a single mom, I work, and I am on state insurance, or Medicaid. Medicaid has been covering my Subs for about the past two years, and I am truly grateful. There are a few times here and there where I have had to pay out of pocket before and even after I got on Medicaid for different reasons, and I'm not complaining, but something happened this last time I went to fill my script which has my puzzled, scared, upset, and a little angry. Well ok, ALOT angry. I see a Dr who does not take Medicaid, so I pay him cash for my visits every three months, and the Subs are covered, yet require a Prior Auth every 6mos, I think. I normally call in my script a day or two early around that time knowing it would take that long to get it approved. I have never had a problem as my Dr is very good at explaining the reason I take the medication and dose etc...to the insurance, but now, they DENIED my PA and no one will tell me WHY!? I know there are some new rules here lately and I get all that but when my Dr called to ask if my approval had gone through they told him they wont even talk to him about it because he is not a medicaid provider. WHAT? Since when? They have been allowing him to write me these scripts all this time and suddenly this month he cant do that anymore? This is a refill I was trying to get approval for by the way, NOT a new script. It just happened to be time for a PA. When I called the PA line I got a run around that they cant tell me anything due to HIPA laws etc etc and said to have my pharmacy call to see whats going on. Problem is my normal pharmacist is MIA and there is some new guy there who tells me "Nope they still wont let it go through. You know your not supposed to be on this medicine long term anyway." Im sorry, Mr Pharmacist, when did you become my Dr? He also said he got a fax stating that Medicaid will only cover 6mos of Suboxone therapy in a lifetime, and that its a new rule. Ok, fine, then give a person who has been on it for years 6mos to taper off, dont just cut them off with no notice or warning! So now what? I did not get any notice of these changes, about my Dr not being a Medicaid provider or the new 6mo rule. When I asked the PA line why they wouldnt give me time to get off the medication since I was on it LONG before these new rules went into effect she said they WOULD. Ok, so why arent they? I just cant get straight answers about who to contact to find out the exact reason I was denied after being approved all this time and dont know what to do at this point. My script should have been filled many days ago I cant afford to buy it and I still take the pills not the strips. Also my Dr already had 3 patients on the assisitance program. Has anyone been through this or heard of these new rules? Any help would be greatly appreciated.

Hi alynn,
I hate hearing what you are going through in trying to get your much needed medication. I hate it that non medical personal are playing doctor in so many instances. How can someone without a medical license practice medicine. That problem is going on everywhere. Someone somewhere determines that a certain length of time is long enough for people to receive medication and once they hit that date, they are cut off.
The length of your treatment should be decided between you and your provider. All treatment should be determined on an individual basis.
When you were told that the PA line could not talk to you due to HIPPA, why couldn't they take the information to determine who you were and then discuss your case with you?

And as for the new pharmacist, who is he? Is he your doctor? NO, he is not. He is a pharmacist. It is not up to him to tell you that you should not be on your medication long term. Some people do require longer time than others. Period.

Is there a phone number on the back of your medicaid card for members that you can call to find out information?
There should be a number for providers and one for members.
In order to qualify for the patient assistance program you would have to not have insurance. Also it is for patients who are using the strip form of Suboxone.
I know how expensive Suboxone is. Weather it be tablets or strips, both are expensive.

Back in September the makers of Suboxone announced that within 6 months they would be stopping the production of Suboxone tablets. I doubt that is the reason for your not being able to get your medication but I did want to make you aware of it.
You can read the announcement here, on the RB website: http://www.rb.com/site/RKBR/Templates/MediaInvestorsGeneral2.aspx?pageid=1328&cc=GB

Try calling the number for member services and see if you can get anywhere that way. If you don't get anywhere by calling I would suggest that you appeal the decision. As a patient you do have that right.
Please let us know how it goes, I hope you are able to get this straightened out. Please let us know if we can be of any help.
Dee

Hello Alynn,

Welcome to our forum.
I am so sorry to hear what your going through. I understand the urgency of finding out
what is going on.
I see that Dee gave you some numbers to call and some good suggestions but definitely
get on the phone this morning and start calling around. Maybe your doctor can write you a 2nd script for just a few that you could buy out of pocket to hold you over. Just a thought.

I think that pharmacist is a piece of SHIT for saying that to you and I would complain to HIS superior and even further up the corporate latter. Make sure to get his name and the date and time he said that to you. What gives him the right to say a word to you about your
medication.
Would he tell a diabetic that he's been on his medication to long?
Seriously, who the F does he think he is???

You have our support and we are here for you. Please keep us posted as we do care.

Peace,

Blue

Hello Alynn,

Let us know what's going on when you have a chance.
Hope things are better.

Peace,

Blue

Number of posts : 4 Registration date : 2012-10-06

[b][i]Hello.
I thank you for responding to my post I really appreciate it.
So I havent had much luck as of yet finding out WHY I was denied prescription coverage for my Suboxone all of the sudden this month by my insurance after they paid for it all this time. There is no number on the insurance card they send every month, (UNBELIEVABLE) and I had to do research online just to find contact info. Every number I call seems to be a dead end. I just want to know WHY it was denied so if its something simple like the doctor put in the wrong code it can be fixed or something more serious like they will no longer cover it I can file my appeal knowing what my argument should be.
I seriously just dont know what to do at this point. I have this feeling of dread inside me and it wont go away. I know I cannot afford this medicine and it has been such a BLESSING that the insurance covered it for so long, but surely they didnt help me stay off drugs and pay out all this money for my therapy all this time to cut me off cold turkey and me possibly relapse due to withdrawl in the end. SERIOUSLY.
Time just keeps going by and still I have no answers and thats the most frustrating thing of all. I would think it would be so simple to just tell me the reason they denied it. Guess I thought wrong. Or I just havent found the right person to talk to yet.
Ive looked and looked for reasons online for my denial or new policys and did find something stating that my insurance will be limiting Suboxone therapy to 6 months from now on. But when I called and told them how long Ive been on it the prior authorization line said that shouldnt apply to me since I was already on it for so long before the policy went into effect, and even if it did, at the very least I would get 6 months to be tapered off of it. Again she wouldnt even take my name or give any personal info to me but said to have my pharmacist call if they refused to talk to my doctor. GREAT. Im sure the man who thinks I shouldnt be on it will be a HUGE help in getting them to approve it. YEAH RIGHT.
So Im not giving up and will call every day until someone tells me SOMETHING. This is unreal. If they were planning to cut my medicine off completely a notice of some sort would have been nice.
I just wish I knew of someone else going through this right now or previously so they could tell me what they did to resolve it.
I will check back in as soon as I have an update. Hopefully that will be sooner than later.
Hope you are well.
~A

Number of posts : 4 Registration date : 2012-10-06

Hello.
I hope everyone that reads this is doing well. And even those who dont.
I have an update to my issue with my insurance (Medicaid) and thought I should share.
After ALOT of calling around I was finally given a reason for the denial for my prior authorization. Apparently my doctor, the doctor I have been seeing for over 2 years, is not a registered Medicaid provider for my state. I live right on the line of 2 states and work in the state next to mine so it seemed logical to get a Dr on that side of the river as well. Not to mention 2 years ago there weren't many to choose from when it came to suboxone doctors.
So thats it. A medication that my Dr has been writing and Medicaid has been paying for for this long they will no longer pay for unless I find a Dr that takes my states Medicaid and HE or SHE writes me the script. Seems easy enough right? I wish it were. The few Drs that are in my area in my state are either not accepting new patients or do not take medicaid. So while I search for one that does, all this time keeps going by and they could care less whether or not I am able to get a medication that saved my life and is dangerous for me to stop taking. Nice.
I of course appealed their decision on Friday once I found out the reason behind the denial. I faxed it in, and simply stated that I have been on this for quite some time and it changed my life and has helped me to be an active member of society, and of course threw in any and all health complications I could find from stopping the medicine without tapering off. They have paid for it for so long, and tho I have been on it for a long while the difference between me now and the person I was before when I was still using is remarkable.
I get that there are new rules for medicaid as of July 2012. What I dont get is why they didnt give me any sort of notice on these new rules so I could have had some time to figure soemthing out. For me to go in for a refill and be told "Sorry they wont cover it anymore" is unacceptable. It took me a week to even fiund out WHY!
Ok this is really long so I will wrap it up. I just paid $197 for 19 Suboxone 8mg pills. I had the pharmacist run 3 different free prescription cards I found online and the one that gave me the most off was the NuLegacy RX card. Id post a link if I knew how. I had a small emergency supply and thank GOD I did because my script was actually due on Sept 27th! My REAL pharmacist was back when I went in today and I have to say he was a sight for sore eyes. He really took the time to try to help me save the most money, and didnt have any rude comments about how I shouldnt be on my Sub this long, and even tried to think of Drs he might know that take my insurance. The other one wasnt so kind and helpful. It was just nice to feel like I had someone rooting for me.
I had to really scrape this money together and it KILLED me to spend it on myself. I have tried cutting down a little on the Sub to stretch it out but the difference in how I feel now from when I was taking my normal dose is not good. I have to get this resolved. I pray that they actually read my appeal and maybe at least allow me to fill whats left of my original script from my Dr so that maybe I can have a little time to work on a solution. Nothing I can do now until Monday so guess I better try to get my mind off of it. Hard to do though.

Have a great day, Like a Star @ heaven

Amy[b][i]

While on the one hand I am glad you finally found out why this happened,
on the other hand, I think it SUCKS !!! I sometimes feel like Dr's, or Insurance Co
and even your least favorite pharmacist, all feel like they can play God. Just like
our old Drug Dealers use to do.

It's like, I have your drug, I know you want it, you
even NEED it, but I won't give it to you. Because I can.

ARGGGGGGG !!!!!

I am happy you bought some though and hate that your feeling crappy with a lower
dose.
Hope it helps to know we are here for you to vent, and hopefully it will help you feel better.
Stay Strong ! Things have to get better !!!

Peace,
Blue

Like Blue, I am happy that you were able to get some of your medication. I for one would be interested in knowing what they say to the questions, why now and why not then? Goes to show you just how much they really pay attention. And who is it that makes up all of these damn rules for medicaid? Not who should, that's for sure. It has always been my thoughts that it should be a panel of not only doctors that specialize in addiction but perhaps an advocate as well. Who else but someone like us would know just how important this medication is.

Keep on with your fight and don't give up. Ask your doctor if maybe he can recommend someone who may be taking patients. You never know. Good luck and hope to hear back soon.
Dee

You know that other pharmacist was out of line they way he treated you. He is not above reproach, take a look at the website for your states pharmacists licensing board, I would consider reporting him.

Number of posts : 4 Registration date : 2012-10-06

Hello again.

Something weird happened today. I got a call from my DR's office asking if I had a different number to call for my insurance because they were trying to get my Prior Auth approved but the line was busy and they couldnt get through.
She also asked how have I been getting my meds all this time and of course I told her I had to pay cash. She said they would keep trying but so far they could not get through??

This is weird to me because my DR's office had already been told since they didnt take my medicaid that they would not get the approval for the script anymore, that I had to see a DR in my state who took my medicaid in order to get the PA. The conversation happened so fast I didnt get a chance to ask her why they were calling again since they had already been told NO. Makes me wonder if they know something that I dont regarding my appeal. Like maybe they are going to approve it short term like I asked so I had time to find a different DR?
Who knows. I guess one can hope right?
I have been reading over some of the other discussions on here and though alot of them are older I still have found some useful info so thank you for creating this page.
I am so sick with worry about all this because I know I cant afford this medication so I pray that they see my appeal letter and that it changes someones mind.
I cannot give up. I wont. They are gambling with my life by doing this, and hopefully I can make them see that.

I really hope this gets cleared up quickly for you.

No, definitely do NOT give up !!! Keep calling them until you get an answer about
your appeal.

Good luck ! Keep us posted !

It could be that your doctor is not willing to take NO for an answer either. At any rate, please don't give up. Be persistent and let them know you are willing to fight for your medication. I understand the whole your doctor is not a medicaid provider but at the same time some insurance companies will still pay a part of the cost of the medication leaving you the balance.
Thanks for checking in

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