Understanding Horizon NJ Health coverage for Suboxone® + MAT

Like much of the U.S., New Jersey has been battling an opioid epidemic. In recent years, the state's lawmakers have passed legislation to combat the crisis, including removing barriers to medications for addiction treatment (MAT)¹. Now, Horizon NJ Health and Ophelia have combined forces to further enhance access to MAT in the state.

Horizon NJ Health is fully owned by Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and is the largest healthcare management company serving publicly insured individuals in the state. It is one of the health plans included in NJ FamilyCare, the state's publicly funded health insurance program, which includes Medicaid populations.

Horizon NJ Health has more than 854,000 members in New Jersey and offers services in all 21 counties in the state. If you are one of their many members and you are struggling with OUD, help is available. Below, we explain how Horizon NJ Health members can access OUD treatment, including telehealth options.

OUD treatment for Horizon NJ Health members

MAT is considered the gold standard of OUD care. It works by providing patients with a prescription to a medication like Suboxone® (important safety information), which helps minimize uncomfortable withdrawal symptoms and reduce cravings.

In New Jersey, Medicaid covers Suboxone, a combination medication consisting of buprenorphine and naloxone, and the state has even taken measures to simplify access to such treatments. For instance, in 2019, it removed prior authorization requirements for MAT for Medicaid recipients, so these individuals can receive treatment as soon as a healthcare provider issues a prescription².

In another effort to address the opioid epidemic, in 2023, New Jersey Governor Phil Murphy announced a program allowing anyone 14 and older to acquire Naloxone at no cost from participating pharmacies across the state³. Naloxone is an effective treatment for opioid overdose and can be lifesaving.

Blue Cross Blue Shield Suboxone coverage is available for qualifying Medicaid recipients through Horizon NJ Health. Horizon NJ Health also provides coverage for substance use disorder counseling, individual and group therapy, and drug testing. Also covered are peer recovery support services, outpatient substance use disorder programs, and short-term residential programs for substance use disorder⁴.

Unfortunately, not everybody can easily access OUD, even when it's covered by Medicaid. Geography and travel are common barriers to care. Plus, not everybody can put work and family obligations on hold to attend inpatient treatment. Ophelia and Horizon NJ Health are making MAT available remotely to address these gaps.

How Ophelia + Horizon NJ Health provide remote OUD treatment

Telemedicine has made OUD treatment easier to access than ever before. In addition to removing geographic barriers to care, telemedicine also offers greater privacy and reduces the disruptions to everyday life associated with in-person treatment. With Ophelia, patients can access MAT from the comfort of their own homes while keeping up with their regular activities, like work, school, and childcare.

Treatment begins with an initial video call, which connects you to your clinical care team. If you're eligible for a Suboxone prescription, a clinician will call it into a local pharmacy for you. You then continue to have telehealth appointments to support you on your MAT journey.

At-home drug testing is part of the process and done with the goal of establishing a baseline and monitoring patient progress. We don’t penalize patients who test positive for substances other than buprenorphine; instead, we regroup to make sure your treatment plan truly meets your needs.

Ophelia’s partnership with Horizon BCBSNJ has expanded coverage in the state, and we now serving 89% of Medicaid patients⁵. If you are a Medicaid recipient and interested in OUD treatment in New Jersey, find out what Ophelia’s program looks like. 

Ready to find out if Ophelia is for you? The first step is to schedule a free, 15-minute welcome call.