Does Cigna Cover Suboxone?

October 17, 2022

Table of Contents

Cigna plans have different drug lists, but many include Suboxone as a higher-tier medication and the generic equivalent as a cheaper, lower-tier medication. This means you can likely get either Suboxone or a generic drug that does the same thing for treatment purposes covered by your plan.

Does Cigna Cover Suboxone Therapy?

Every Cigna plan has an associated formulary, a list of the drugs your plan covers and at what tier the listed medications are covered.[1] Higher tier medications receive lower coverage, and they may require prior authorization.

A generic medication is more likely to be covered and will almost always be a better tier than its brand-name counterpart. Note that generic medications work the same as the brand-name medications to which they are equivalent.

Looking through the various drug lists associated with Cigna plans, it appears many (possibly all) list Suboxone as a Tier 3 medication or the equivalent. This means you can potentially get coverage for the medication, but it may still be expensive.

Its generic buprenorphine-naloxone equivalent also appears on the lists we checked as a Tier 1 medication, meaning most people with Cigna plans should strongly consider going generic unless their doctor gives them a medically important reason not to.

What Affects the Level of MAT Coverage?

As with any insurance company, your plan can have a significant impact on your coverage. In addition to potentially affecting what drugs are covered, you also want to pay attention to the way different tiers of medication are covered in a given plan.

Even if plans use the same formularies, they may have different levels of coverage for the same tier of medication. For example, if the generic equivalent of Suboxone is Tier 1, one plan may charge less or nothing for that medication, while another still covers it but at a higher cost.

Fortunately, most plans will offer significant coverage for Tier 1 medications, but always make sure to read and understand a plan’s explanation of benefits.

MAT Coverage Under Cigna

The same drug lists we looked at earlier did not list naltrexone, another common Medication for Addiction Treatment used to treat opioid use disorder (OUD). At least with lower-level plans, it appears that buprenorphine-naloxone is the only covered MAT option.

Naloxone options are also covered. This type of drug can help counteract opioid overdoses, but it is not typically used as an MAT on its own.

Methadone also wasn’t listed, but this is typical, as methadone treatments work differently than standard drug treatments. Regulations require methadone be administered at specialized sites, so most insurance companies cover it differently, if they do at all. You will have to check the specifics of your plan to find out if methadone treatments may be covered.

Are Other Types of Addiction Treatment Covered by Cigna?

Addiction treatment that is considered a “medical necessity” is generally covered by Cigna if you use an in-network provider.[3]

Cigna has a variety of specialists in its network who can provide various kinds of addiction treatment, including detoxification, inpatient care, and counseling. They also note on their site you can call them, using the number on your ID card, to get help finding a provider appropriate to your needs.

Checking Your Coverage With Cigna

Cigna recommends logging into your account to check coverage, which can also help you find in-network care providers, view your claims, and more.[4] If you can’t find the information you need, you can also call them directly via the number on the back of your insurance card.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

Is Suboxone treatment a fit for you?

Contact us directly to speak with a specialist.

Citations

  1. 2022 Cigna Individual and Family Plans Drug List. Cigna. https://www.cigna.com/individuals-families/member-guide/prescription-drug-lists/. Accessed September 2022.
  2. Behavioral Health Providers. Cigna. https://www.cigna.com/knowledge-center/faq-behavioral-health-providers. Accessed September 2022.
  3. Mental Health and Substance Use Benefits. Cigna. https://www.cigna.com/individuals-families/shop-plans/plans-through-employer/mental-health-insurance-and-substance-use-benefits. Accessed September 2022.
  4. Check Coverage. Cigna. https://my.cigna.com/web/public/guest. Accessed September 2022.

Imagine what’s possible on the other side of opioid use disorder.

Our science-backed approach boasts 95% of patients reporting no withdrawal symptoms at 7 days. We can help you achieve easier days and a happier future.

Get Startedor book an enrollment call