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

Does Highmark Wholecare insurance cover Suboxone and MAT? Explore the accessible care options available through Ophelia’s partnership with Highmark Wholecare in Pennsylvania.

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Substance use disorders affect millions of Americans, with opioid use disorder (OUD) being one of the most dangerous. Fortunately, medications for addiction treatment (MAT) have shown significant success in helping individuals recover, with Suboxone being a leading medication used in this approach. If you're a Highmark Wholecare member in Pennsylvania, here's how you can access Suboxone medication and start treatment with Ophelia.

Understanding Highmark Wholecare's Coverage for MAT and Suboxone

Highmark Wholecare insurance offers comprehensive coverage for substance use disorders, including MAT with Suboxone. This coverage is part of Highmark Wholecare's commitment to provide members with access to effective treatment options for OUD.

Coverage Details

Highmark Wholecare typically covers the following aspects of MAT:

  • Doctor visits for MAT evaluation and prescription
  • Cost of Suboxone medication
  • Follow-up consultations and therapy sessions as part of a comprehensive treatment plan

It's important to note that coverage can vary based on your specific plan. Some plans may require pre-authorization, or there could be differences in co-pays or deductibles. Always verify your coverage details by contacting Highmark Wholecare customer service or checking your plan details online.

Why Choose Highmark Wholecare for MAT?

Highmark Wholecare stands out for its comprehensive coverage and support for individuals struggling with opioid use disorder. With a focus on evidence-based treatment options like MAT and Suboxone, Highmark Wholecare ensures that members receive the care they need to recover and lead healthier lives.

Moreover, Highmark Wholecare partners with providers and organizations, like Ophelia, that specialize in substance use disorder treatment, offering members access to quality care and support throughout their treatment. Highmark Wholecare’s partnership with Ophelia helps expand coverage even further by bringing members an online treatment option so that they can receive care from the comfort and privacy of their homes.

Understanding your Highmark Wholecare insurance coverage for Suboxone and MAT

Use the following steps to navigate your insurance coverage effectively:

  • Review insurance policy and covered medications: Take the time to review your Highmark Wholecare 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 Highmark Wholecare. Our care coordinators can help you navigate the insurance process, answer questions specific to your treatment plan, and assist with any financial concerns. Text or call us today at (215) 585 2144.
  • Contact Highmark Wholecare: Reach out to Highmark Wholecare directly to inquire about your coverage for Suboxone and medications for addiction treatment (MAT). You can reach Highmark Wholecare’s support team by calling the number on the back of your insurance card.

Using Highmark Wholecare insurance with Ophelia for effective treatment

Recovering from opioid use disorder is a challenging but incredibly rewarding experience. With Highmark Wholecare's coverage for Suboxone and MAT, you have access to effective treatments that can help you reclaim your life. If you're ready to take the first step, contact Ophelia’s care team, or Highmark Wholecare customer service today to learn more about your coverage and how to start treatment. Remember, treatment is not linear, Ophelia is here to support you every step of the way.


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