Does Highmark Wholecare insurance cover Suboxone® and MAT? Explore the accessible care options available through Ophelia’s partnership with Highmark Wholecare in Pennsylvania.
This content has been reviewed and updated on October 4, 2024.
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. Suboxone® is a leading medication used in this approach and is often considered the gold standard of care for OUD treatment (important safety information). If you're a Highmark Wholecare Medicaid member in Pennsylvania, here's how you can access Suboxone and start treatment with Ophelia.
Understanding Highmark Wholecare's Coverage for MAT + Suboxone
Highmark Wholecare’s Medicaid insurance program offers comprehensive coverage for OUD treatment, including MAT with Suboxone, counseling, and telehealth. This coverage is part of Highmark Wholecare's commitment to provide members with access to effective treatment options for OUD.
Pennsylvania Medicaid covers Suboxone prescriptions with limitations. For example, patients may have maximum dosage guidelines and must be enrolled in SUD counseling, like Ophelia’s treatment program.
Highmark Wholecare Medicaid members can benefit from a personalized treatment plan led by a compassionate care team at Ophelia. We offer a full range of supportive services to manage OUD and everything that accompanies it, such as medications for withdrawal, comprehensive clinical support, and diagnosis and treatment for behavioral, psychological, and psychosocial disorders, like anxiety and depression.
With access to telehealth services, OUD treatment is more accessible for Pennsylvania Medicaid members than ever before. Finding a quality MAT provider can sometimes be a major hurdle. From distance and lack of reliable transportation to scheduling issues and the stigma of seeking treatment, relying solely on in-person visits can cut some of the most vulnerable populations off from care.
Telehealth presents an alternative with better outcomes. Research shows that retention in treatment for OUD is higher in telehealth programs than it is for office-based programs. With virtual visits that fit into your life and support available seven days a week, Ophelia’s telehealth program can provide the convenient, judgment-free space that meets your needs.
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
- Telehealth visits
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 copays 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 on Medicaid 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 that specialize in substance use disorder treatment, offering members access to quality care and personalized support throughout their treatment. Highmark Wholecare’s partnership with Ophelia helps expand coverage further with a virtual treatment option through telehealth, allowing members to receive care from the comfort and privacy of their homes.
Understanding your Highmark Wholecare insurance coverage for Suboxone + MAT
Use the following steps to navigate your Medicaid 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 experience. With Highmark Wholecare's Medicaid coverage for MAT, Suboxone, and telehealth, 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, but Ophelia is here to support you every step of the way.
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