Discover if Healthfirst covers Suboxone and MAT. Learn about the evidence-based care options available through Ophelia's partnership with Healthfirst.
When it comes to overcoming opioid use disorder (OUD), having access to medications for addiction treatment (MAT)—specifically Suboxone® (important safety information)—is crucial. As a Healthfirst insurance member in New York, it is important to understand your coverage for these life-saving treatments. In this guide, we will explore the insurance coverage provided by Healthfirst and their Medicaid program, including their partnership with Ophelia, to help you work towards a healthier life.
Does Healthfirst cover MAT?
MAT combines medications for addiction treatment, such as Suboxone, with counseling and behavioral therapies and is widely acknowledged as the most effective treatment approach for OUD. Healthfirst NY provides coverage for MAT services, including the medications for addiction treatment and Ophelia telehealth care, ensuring you receive comprehensive treatment.
These services are also available to Medicaid recipients under Healthfirst. The Affordable Care Act (ACA) requires states to include treatment for substance use disorder (SUD) for those eligible for Medicaid, making treatment more accessible to low-income individuals and families. In addition to MAT prescription coverage and counseling, Healthfirst’s Medicaid Managed Care (MMC) plan has low to no copays, no monthly premium, and no deductible for doctor visits, hospitalizations, and more.
Does Healthfirst cover Suboxone for OUD?
Individuals with Healthfirst insurance are eligible for evidence-based treatment for opioid addiction and may be covered for Suboxone. If you are a Healthfirst member, you have access to Suboxone through participating providers, including the option of utilizing our services. However, it's important to note that coverage for specific medications can vary depending on your insurance plan's formulary. Please consult your plan documents or contact Healthfirst directly to confirm the inclusion of Suboxone or similar medications in your plan's formulary.
For Medicaid Managed Care recipients, Suboxone is covered by the NYRx pharmacy program. New York Medicaid covers Suboxone under a statewide formulary for Opioid Dependence Agents (Suboxone, buprenorphine) and Opioid Antagonists (naloxone, Narcan) as a preferred agent. Medicaid in New York also sets specified criteria and limitations, which may include dosage. Prior authorization may be required. Contact your pharmacy or MAT provider for more information.
Does Healthfirst cover telehealth services?
Due to the COVID-19 pandemic and reduced access to treatment and harm reduction services in recent years, New Yorkers facing OUD continue to be at risk. One way healthcare professionals can expand access to MAT and other addiction treatments is through telehealth.
Telehealth removes barriers to care, such as lack of transportation, privacy concerns, and distance from MAT providers. The convenience and confidentiality of telehealth have also been shown to keep patients in treatment for longer. Ophelia has demonstrated a 76% six-month patient retention rate—more than double the rate maintained by in-person MAT. Our comprehensive care extends to the diagnosis and treatment of behavioral, psychological, and psychosocial disorders. Mental health conditions, such as anxiety, depression, and insomnia can be exacerbated by opioid use, so it’s crucial for patients to receive behavioral support when they need it.
New York Healthfirst insurance members, including Medicaid recipients, can benefit from Ophelia telehealth service as well as 24/7 access to telemedicine care through Teladoc.
Understanding your Healthfirst insurance coverage for Suboxone and MAT
Follow the steps below to navigate your insurance coverage effectively:
- Review insurance policy and formulary: Take the time to review your Healthfirst 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.
- Consult with Ophelia: We can provide additional guidance and support in understanding your insurance coverage with Healthfirst. 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 Healthfirst: Reach out to Healthfirst directly to inquire about your coverage for Suboxone and medications for addiction treatment (MAT).
Using Healthfirst insurance with Ophelia for effective treatment
Take control of your opioid addiction recovery with Ophelia's partnership with Healthfirst. Get medication to ease withdrawal symptoms and receive support from experienced clinicians, all from the comfort and privacy of your home. Embrace the convenience and effectiveness of online MAT, and begin your journey to a healthier life today.
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