Understanding insurance coverage for Suboxone and MAT: A guide for Geisinger members in Pennsylvania

Geisinger provides affordable health insurance for tens of thousands of Pennsylvanians each year, and this care extends to people seeking treatment for medications for addiction treatment (MAT). This type of treatment is considered the gold standard for people with opioid use disorder (OUD) because it uses Suboxone® and other buprenorphine-naloxone medications to treat opioid withdrawal and cravings (important safety information).

Whether you’re new to Geisinger or seeking OUD treatment for the first time, it’s normal to wonder whether Medicaid covers MAT and Suboxone. Ophelia’s here to help you understand your coverage and get started with a treatment plan.

Geisinger insurance coverage for Suboxone

Medicaid recipients with Geisinger insurance are eligible for comprehensive opioid use disorder treatment coverage¹. This includes name-brand Suboxone and generic buprenorphine-naloxone; exact prescription coverage can vary by plan, so consult the formulary for your specific plan type². 

Geisinger’s comprehensive approach also includes supplementary care, such as counseling and behavioral therapy, to help Pennsylvanians get the help they need to succeed in their Suboxone treatment program³.

Is MAT compatible with telehealth?

Telehealth has grown considerably for a wide range of health needs, from general check-ups and exam follow-ups to mental and behavioral health appointments. What about OUD treatment? Not only is telemedicine compatible with this care, but it’s actually changing the landscape of Suboxone treatment programs by saving patients the schedule changes and travel time associated with in-person care.

Ophelia is the first and only telehealth provider to be named a Center of Excellence (COE) in Pennsylvania, and we’re partnered with Geisinger to provide expert care to those seeking remote Suboxone treatment. We take pride in offering top-tier opioid treatment services that are proven effective, discreet, convenient, and accessible. 

What does telehealth Suboxone treatment in Pennsylvania look like?

How telemedicine works

At its core, telemedicine isn’t that different from a regular trip to the doctor. It involves seeing a medical professional, discussing symptoms and issues, working on a diagnosis, and prescribing medications for treatment. Just like when you’re at an in-person clinic, everything is confidential and strictly secure. The only difference is that patients join a secure video call, such as a Zoom session. Appointments are conducted entirely remotely. 

These visits make high-quality health care more accessible to patients who may feel shut out from drug treatment programs due to geography, physical mobility, and available time. Telehealth is also effective and comprehensive. It’s possible for physicians to conduct many types of examinations remotely, and it’s even possible to have remote drug tests taken entirely during the length of a telehealth appointment. 

Is Ophelia’s treatment eligible for coverage on Geisinger Medicaid insurance plans?

Yes! Our Suboxone treatment program is covered by Medicaid throughout Pennsylvania. First, you’ll meet with our Enrollment Coordinator to verify your insurance coverage, learn about our privacy protections, and schedule a meeting with your clinician. Here’s what you can expect from the rest of our process.

The initial visit 

During the first clinician call, you’ll discuss your medical history and substance use history. This information helps your provider craft a specially tailored OUD treatment program, which may include Suboxone if you’re eligible. We’ll send the prescription to the pharmacy of your choice. 

Induction

When your prescription arrives, it’s time to start the induction process. This process can be uncomfortable, but it’s crucial to a successful treatment. It involves abstaining from opioids long enough for the beginning stages of withdrawal to take place. Unsupervised and untreated, opioid withdrawal is uncomfortable and potentially dangerous, but triage nurses are available 7 days a week to help you through the process.

Once withdrawal has been successfully induced, it’s time to take your first dose of Suboxone. This will help quell the worst symptoms of withdrawal while also curbing cravings. You’ll also meet with a clinician to take a urine test and establish a baseline for the rest of your treatment program. Ophelia takes a non-punitive approach to testing, meaning we don’t penalize patients for results that show substances other than buprenorphine—instead, we take it as an opportunity to help you get back on track.

Stabilization

Once you’re taking Suboxone at regular dosages and intervals, you’ll also meet with a clinician weekly to discuss treatment progress. The goal of these follow-up visits is to find the ideal treatment plan and maximize comfort and progress.

From here, you’ll have access to a gamut of individualized support options, including peer coaching treatment for other mental health issues, like depression, anxiety, and insomnia.  

If you’ve been looking for opioid treatment in Pennsylvania, Ophelia and Geisinger have you covered. Set up your enrollment call today.