Understanding Anthem Blue Cross Blue Shield's coverage for medications for addiction treatment (MAT) is crucial for individuals seeking care for opioid use disorder (OUD) in New York. Thanks to advances in telemedicine, providers like Ophelia are making MAT more accessible. And with coverage from Anthem BCBS—previously Empire BCBS—NY residents can get the care they need more affordably.

In this guide, we explain Anthem BCBS NY's coverage options for Suboxone and MAT. We also highlight the insurer's partnership with Ophelia, which provides evidence-based, remote access to MAT, allowing patients to get the care they need from the comfort and privacy of their own homes.

Does Anthem BCBS NY cover MAT?

MAT is considered the gold standard of care for OUD. It combines the use of medications like Suboxone® (important safety information) with counseling or behavioral therapies to effectively address opioid addiction.

Individuals with Anthem BCBS NY insurance are eligible for comprehensive treatment approaches to OUD, including MAT. This enables individuals to access the necessary medications and supportive therapies for their recovery journey.

Does Anthem BCBS NY Cover Suboxone?

Suboxone is a medication that combines buprenorphine and naloxone, helping to reduce cravings and withdrawal symptoms. It has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of OUD since 2002.

Anthem BCBS NY members are eligible for the coverage of Suboxone for treating OUD. The insurance provider also covers Zubsolv® and various generic versions of Suboxone.

Does Anthem BCBS NY work with Medicaid?

Medicaid is a public health insurance program that's managed by individual states. Benefits will vary depending on where you live, making it important to research your location-specific eligibility requirements and coverage possibilities. 

In New York, you may be eligible for Medicaid through Anthem BCBS if you meet the age, disability, income, and/or resource requirements. You must also live in the Bronx, Brooklyn (Kings), Dutchess, Manhattan (New York), Nassau, Orange, Putnam, Queens, Rockland County, Staten Island (Richmond), Suffolk, Ulster, or Westchester.

New York State Medicaid covers prescriptions for all forms of buprenorphine under the NYRx Medicaid Pharmacy Program, while Anthem BCBS covers visits with healthcare providers.

Telehealth MAT with Anthem BCBS NY + Ophelia

Ophelia has partnered with Anthem BCBS NY to expand access to evidence-based treatment programs. The partnership ensures that individuals have reliable access to virtual visits and telehealth services, making care more accessible and convenient.

How does telehealth OUD treatment with Ophelia work? First, the enrollment team will start by helping you with the necessary paperwork and scheduling your initial virtual visit. They will also process your insurance information to make sure you're covered.

You will then meet your dedicated care team via video appointment. If you're eligible for treatment through Ophelia, a Suboxone prescription will be called into your local pharmacy. Note that if you qualify for Medicaid through Anthem BCBS NY, you can get your MAT prescription copays and renewals easily covered through the NYRx Medicaid Pharmacy Program. 

You then receive ongoing medical support via regular video appointments with your care team, which will include both care coordinators and clinicians. With Ophelia, at-home drug testing with care team guidance is the most common approach. 

Navigating your Anthem BCBS NY insurance coverage

To navigate your insurance coverage effectively, follow these steps:

• Review your insurance policy: Review your Anthem BCBS NY insurance policy documents. Look for sections that outline coverage for addiction treatment, prescription medications, and the specific medications used in MAT, such as Suboxone.
• Consult with Ophelia: We can provide additional guidance in understanding your insurance coverage with Anthem BCBS NY. 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.
• Contact your insurer: Reach out to Anthem BCBS NY directly to inquire about your coverage for Suboxone and MAT.

Ophelia's team can support you through this process, addressing administrative issues so you can get started with your treatment ASAP.

Opioid addiction resources from Anthem BCBS NY + Ophelia

Through our partnership with Anthem BCBS NY, Ophelia is dedicated to improving access to MAT for New York residents. Learn more about how our MAT program works from our comprehensive online guide to treatment. Anthem BCBS NY also has a recovery library with valuable resources that can be helpful as you start your journey.

Embrace the possibilities of effective treatment for opioid addiction by using your Anthem BCBS NY insurance with Ophelia. Receive medication to ease withdrawal symptoms and benefit from the guidance of experienced clinicians, all from the comfort and privacy of your home.