Navigating opioid addiction treatment in Pennsylvania is challenging and unpredictable, especially as solutions are often expensive and inaccessible. Ophelia is a medication-assisted treatment (MAT) prescriber with telehealth care options that can provide support for those dealing with opioid addiction. Our treatments are covered by Highmark Blue Cross Blue Shield (BCBS), a Medicaid plan that makes treatment simpler and more accessible for everyone. To better understand how treatment and coverage works, consult our guide below.
What opioid addiction resources can Medicaid members receive?
Of the 21 million people who need addiction treatment, less than 13% receive it, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The Affordable Health Care Act (ACA) has helped close the treatment gap by allowing Medicaid programs, like Highmark BCBS PA, to provide more extensive coverage to patients experiencing a substance use disorder (SUD).
Medication-assisted treatment (MAT)
MAT programs help patients safely manage their opioid addiction by using Suboxone® (important safety information) or buprenorphine to ease withdrawal symptoms. These programs have increased in use in recent years given their success, along with an Optum study that shows that patients who began treatment with buprenorphine were 76% less likely to overdose within three months and 59% less likely to overdose within 12 months. Pennsylvania Medicaid plans cover Suboxone MAT programs, providing more people with high-quality treatment options than ever before.
Behavioral health referrals
We understand that proper OUD treatment extends beyond receiving medication-assisted care. That’s why Ophelia’s care teams offer comprehensive support. Our clinicians offer flexible scheduling and customized plans to ensure patients receive treatments that are specific to their situations.
Moreover, our clinicians and care coordination team can provide referrals for patients who need behavioral health solutions to support their journey back to sobriety. We’ll work with you to ensure that these referrals are for providers who are in your Medicaid network, including Highmark BCBS PA.
Telehealth care
Since the height of COVID-19 lockdowns, remote healthcare has grown increasingly popular by offering the same quality as in-office visits with greater convenience. As a recent study notes, telehealth can effectively treat OUD.
This care also eliminates geographic and transportation barriers that have traditionally limited access to opioid addiction resources. Now, with providers like Ophelia, Pennsylvania residents can receive Suboxone prescriptions, guidance, and the routine check-ins they need to leave opioid addiction behind.
Outpatient treatment
Inpatient treatments have significant coverage limits and can take significant time to complete. They also present hurdles for people who may need to travel or make arrangements for family caregiving, which disproportionately affects women.
Since telehealth care and MAT programs have become more common, outpatient treatments—especially telehealth programs—are more feasible since they can be designed to fit into the patient’s schedule.
Outpatient treatments allow individuals to continue with their everyday lives while maintaining access to Suboxone treatments that can reduce cravings and withdrawal symptoms and decrease the risk of relapse and death from overdose.
How does Ophelia’s telehealth care work?
Initial meetings
A member of our enrollment team will call you to get the ball rolling. After they receive your information, you’ll have a video appointment with one of our clinicians who will get to know you better. It’s best to share your medical history and substance use history, along with some personal background that’s relevant to your care. This information helps our clinicians develop a customized care plan to treat your OUD.
Prescriptions for eligible patients
If you’re eligible, Ophelia’s clinicians will prescribe Suboxone and send it to your preferred pharmacy. Our care coordination team is available by email, text, or phone 7 days a week to help solve any issues that might occur, whether it’s with your pharmacy or your insurance provider.
Your prescription comes with specific instructions so your at-home induction goes as smoothly as possible. We’ll also schedule weekly calls to check in and make changes to your treatment plan if necessary. These calls are key to making sure you’re set up for success as your therapy goes on.
Continued support
Ophelia is on your side no matter what. Your care plan includes ongoing support at no extra cost, including peer coaching, addiction-related medical care, and referrals for associated behavioral, psychological, and psychosocial conditions.
Every step of the way, we ensure our recommendations align with your Highmark BCBS benefits, taking the stress out of comprehensive OUD treatment.
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