Aetna plans will cover Suboxone and similar medications for treatment of opioid use disorder (OUD). If your plan is from an employer, you won’t need prior authorization, but you likely will if your coverage is from a Medicare or Medicaid plan.
Does Aetna Cover Suboxone Treatment?
Aetna covers buprenorphine medications, including Suboxone, without prior authorization for employer-based plans.
Medicare and Medicaid plans also offer coverage, but they require prior authorization from a health care provider. If your use of Suboxone is for the purpose of treating opioid addiction and was prescribed by your doctor, this authorization should generally be easy to get.
Does Your Specific Plan Affect Coverage?
If your insurance plan provides pharmacy coverage, it will generally cover Suboxone and similar medications, keeping in mind that you may need prior authorization for your medication as discussed above. The level of coverage your plan provides is going vary, but your plan should generally provide at least enough coverage that Suboxone isn’t prohibitively expensive.
Insurance Coverage for MAT
Aetna plans generally cover all FDA approved Medications for Addiction Treatment (MAT), including buprenorphine, naltrexone, and methadone.
Importantly, methadone is distinct from other medications because it is provided in methadone clinics. Since patients can’t take it at home and it is given in medical settings, it is covered by medical insurance plans rather than pharmacy coverage.
Is Addiction Treatment Covered Beyond MAT?
As Aetna discusses on their site, their plans will cover the use of their in-network Aetna program, which is meant to provide treatment for mental health and substance use problems. This goes beyond MAT, and it also covers outpatient and inpatient addiction care services, including counseling and more.
Broadly speaking, a person receiving evidence-based treatment from an in-network provider can expect coverage. Your plan may also provide out-of-network coverage, although it will still generally cost significantly more for you even if you do have that coverage.
Checking Your Aetna Insurance Coverage
If you’re concerned about your coverage, Aetna cards have a toll-free, 24/7 number that you can call regarding your plan. Members can also follow the instructions on this page to get more information on how to email, call, or chat online with them about your plan.
Before you begin treatment, confirm your coverage with both Aetna and your care provider to ensure no interruptions in your MAT therapy.