Understanding insurance coverage for Suboxone and MAT: A guide for Capital Blue Cross members in Pennsylvania

Learn about Capital Blue Cross coverage for Suboxone and MAT. Find out how Ophelia's partnership expands access to evidence-based treatment.

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Access to evidence-based treatment for opioid addiction, such as Suboxone and medications for addiction treatment (MAT), is crucial for individuals seeking recovery. As a Capital Blue Cross member, it's important to understand your insurance coverage for these treatments. In this guide, we’ll explore the coverage provided by Capital Blue Cross, including their partnership with Ophelia, for Suboxone medication and MAT. By gaining insights into your coverage, you can confidently pursue effective and accessible care on your journey toward a healthier life.

Understanding the opioid crisis in Pennsylvania

Pennsylvania has been significantly impacted by the opioid epidemic, with an average of 14 opioid-related overdose deaths per day in 2021. Recognizing the urgency of the situation, the state of Pennsylvania declared a state of emergency to address the rising rates of opioid-related deaths and OUD. Ophelia's availability to Capital Blue Cross members in Central Pennsylvania and Lehigh Valley offers a crucial lifeline to those affected by the crisis.

Ophelia's approach to treatment

Our treatment model provides a lifeline to patients by offering telehealth OUD treatment. Patients receive personalized care from dedicated clinicians and are prescribed buprenorphine, a medication that reduces cravings and withdrawal symptoms. This virtual approach eliminates many barriers to treatment, such as geographic limitations and high costs associated with traditional clinic visits. It ensures thousands of Pennsylvanians can access life-saving treatment conveniently and effectively.

The effectiveness of MAT

Medications for addiction treatment—which combines medications, like Suboxone, with counseling or behavioral therapies—is considered the most effective approach for OUD. Research has shown that MAT can reduce overdoses by 76% and ER visits by 32%. However, traditional OUD programs often lack a medication-assisted component in their treatment plans, leading to a high relapse rate of 90% within three months. Capital Blue Cross's coverage for MAT ensures you have access to evidence-based treatment, increasing the chances of successful recovery.

Capital Blue Cross coverage for Suboxone and MAT

Capital Blue Cross members are eligible for the coverage of comprehensive treatment for OUD and medications used in MAT, including Suboxone. As a Capital Blue Cross member, you have access to these treatments through participating providers, including the option to utilize our services.

Ophelia's partnership with Capital Blue Cross

We have joined the Capital Blue Cross network, expanding access to their evidence-based OUD treatment programs in Central Pennsylvania and Lehigh Valley. This partnership brings science-backed treatment plans and 24/7 support to Capital Blue Cross members, aiming to improve the quality and accessibility of care for individuals battling opioid addiction.

Navigating your Capital Blue Cross coverage

To better understand your insurance coverage for Suboxone medication and MAT, consider the following steps:

  1. Review your insurance policy and formulary: Take the time to review your Capital Blue Cross insurance policy documents and formulary. Look for sections that outline coverage for addiction treatment, prescription medications, and the specific medications used in MAT, such as Suboxone.
  2. Consult with Ophelia: We can provide additional guidance and support in understanding your insurance coverage with Capital Blue Cross. Our care coordinators can help you navigate the insurance process, answer questions specific to your treatment plan, and assist with any financial concerns. Text us today at (215) 585 2144.
  3. Contact Capital Blue Cross: Reach out to Capital Blue Cross directly to inquire about your coverage for Suboxone medication and MAT.

Using Capital Blue Cross insurance with Ophelia for effective treatment

Get hassle-free prescriptions for easing opioid withdrawal and video chat with experienced clinicians any time you need extra support. Using Capital Blue Cross insurance with Ophelia offers you convenient access to online MAT for opioid addiction. Take control of your life and begin your treatment with confidence.


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