Buprenorphine and Medicare Part D

[teakabeagle]

I’ve been on Buprenorphine SL, .5 mg for the past year with excellent results. I had some issues with coverage from the Pharmacy initially, but got that cleared up. I recently retired and now have Medicare, medigap and Part D coverage.

I had to go through an appeal process because of it’s off license use for RLS( even though they cover Gabapentin and Lyrica which is also not licensed for RLS). As it is a tier 3 drug it falls under the deductible, which in my area is $545/ year! Since a 30 day supply last for 4 months as I only take a 1/4 tablet a day, I probably will not ever meet that deductible. I can get a 30 tablet prescription for it for less than $15 a month using Clever Rx which is better than the best Part D plan I could find in my location. Since you have to have a Part D, I am paying for a plan I currently don’t need and getting a better price without it! Go figure.

Fortunately, my pharmacy always has Buprenorphine under the Clever RX program.

[Joolsg]

Thanks for sharing. I have no idea how the USA healthcare system works. Europe is completely different.It seems you can get 4 months of Buprenorphine for $15 which is fantastic!

[SueJohnson]

And there are 2 other discount cards where I have found prescriptions cheaper than my Part D insurance GoodRx and SimpleCare.

[teakabeagle in reply to SueJohnson]

Clever RX had better discounts for Bup and Simple Rx for the Buproprion.

[Irmajs]

I take it you are in the US. I am on part C medicare through Cigna. With part C you won’t need Part D because it is included in all the plans. There is no deductible. I am in Phx area and looking for a dr to prescribe Buprenorphine or Methadone. Then I’m sure I would have to fight the insurance to pay for it. I will chk out the clever RX.

[vikkitennis in reply to Irmajs]

Try David Shprecher DO, with Banner, a neurologist. Cleo Rovers Memory and Movement Disorders Center in Sun City, AZ. He is with Banner. I was his patient for two years until I was able to be seen at Mayo. 623-832-6530. He prescribed the buprenorphine for me.

[Irmajs in reply to vikkitennis]

Thank you so much!

[teakabeagle in reply to Irmajs]

I didn’t do Plan C for a number of reasons. The most important is that most of the Dr in my area are dumping it and there are almost no doctors that are accepting Medicare C. The doctor I have for my RLS is not on their provider list.

You will likely have to do get prior authorization for either of those medications no matter what plan you have as Medicare has them listed for Opiod use disorders only. My prior auth was denied u der Medicare as it was under my private insurance. My doctor has submitted an appeal and we haven’t heard back, not that it will matter because of the deductible issue.

[Ticki]

hi I’m going to be 65 next year and have to start this Medicare process and I am scared that I am going to have trouble getting my Buprenorphine because it will be a different medical plan than what I used to have before the age of 65. That’s my fear that they’re not gonna cover it. I guess I’ll find out when I get to that process as u did.❤️‍🩹

[Ticki in reply to Ticki]

I’m in Washington state can I ask where about your located?

[teakabeagle in reply to Ticki]

Northern California if you were asking me

[SueJohnson in reply to Ticki]

You will have a choice of part D plans and can check online to see if they cover the medicines you are on. Medicare has a site for this.

[Ticki in reply to SueJohnson]

Great, thanks.

[teakabeagle in reply to SueJohnson]

The ones I have checked all have Suboxonenot subutex as the only indication Medicare has is for opiods dependence. Not surprisingly, the initial prior auth was denied. It is under appeal, but with the deductible issue( this is only in regards to tier 3 and 4 medications) almost makes it a moot point. I’ve got enough to cover me for the next 8 months, so I’m not going to bother with it until next year.

[teakabeagle in reply to Ticki]

You’ll need to get prior auth and they will likely deny it as Bup is listed only for opiod use disorder. Your doctor will have to file an appeal with evidence for its use in RLS. I had to do that with my private insurance befor I went on Medicare. You may need to rely on the discount drug cards like Ckever Rx, Good Rx etc. you may also have to fight the Oharmacy! My pharmacy refused to fill the RX . Took over a month to get it through that process.

[Ticki in reply to teakabeagle]

Thank you. It’s always been a war so I didn’t think it would differ any. Oh such a life.💜

[teakabeagle in reply to Ticki]

Wasn’t surprised by the denial at all. If I can used the discount program, it costs about the same, but my Dr. is putting in the appeal and it will likely be covered. He deals with this all the time and has a packet with all the studies, algorhythms a way not. He just adds in why you need it( I’ve been through the usuals)