Independence Blue Cross PA for Suboxone® + MAT

Independence Blue Cross PA (IBX) is the largest health insurer in the Philadelphia area, serving almost three million people in the region¹. As a major insurance provider, IBX plays a key role in shaping healthcare for patients in Greater Philadelphia and the rest of Pennsylvania. The opioid crisis remains a significant concern for Pennsylvania residents, and IBX is working to make treatment for opioid use disorder (OUD) more accessible. The insurer’s partnership with Ophelia is one step toward that goal. 

If you have IBX insurance in Pennsylvania, explore your OUD treatment options here. 

OUD treatment for IBX members

Independence Blue Cross has “prioritized expanding access to behavioral health care across [their] community” so members can access the services they need². These behavioral health care services include addiction support and resources, such as coverage for OUD treatment. The trained behavior health team helps IBX members understand their treatment options and find in-network providers who offer care for substance use disorders³.

IBX may also refer patients to telehealth OUD treatment providers, like Ophelia. Through one of these telehealth providers, patients can access OUD care, including Suboxone® and other medications for addiction treatment (important safety information). 

Your coverage for OUD treatment options may vary depending on your insurance plan through IBX. Currently, brand-name Suboxone is a non-preferred drug on IBX’s drug formulary⁴, and it’s subject to quantity limits. Generic buprenorphine-naloxone films and tablets are covered under Tier 1, making them a lower cost option that insurance companies prefer to cover. 

You may need to request a prior authorization request, or paperwork explaining that a brand-name medication is the only effective treatment option, to get coverage for Suboxone OUD treatment through IBX.

Consult your plan documents or contact IBX for more detailed information about your plan’s benefits and coverage. You can also get in touch with Ophelia’s enrollment team, who will help you understand whether your IBX insurance will cover your OUD treatment plan.  

Does Medicaid cover OUD treatment in Pennsylvania?

Pennsylvania residents with IBX Medicare coverage may wonder whether their insurance covers OUD treatment. The good news is that Medicaid does cover Suboxone in Pennsylvania, as well as other medications for addiction treatment (MAT).  

Since 2017, Pennsylvania has been the state with the third-highest drug overdose rate in the United States⁵. Medicaid coverage for MAT is part of Pennsylvania’s efforts to fight the opioid crisis and protect residents. Pennsylvania has also introduced the Centers of Excellence for Opioid Use Disorder (COEs), which are healthcare centers that provide exemplary comprehensive support to patients with OUD.

COE care management services are recognized as State Plan covered services for Pennsylvania’s Medicaid recipients. Ophelia recently became the first and only telehealth provider to achieve the COE distinction in PA. This distinction honors the innovative, high-quality virtual OUD care Ophelia provides to improve outcomes for patients with OUD. 

How does telehealth OUD treatment from Ophelia work?

Telehealth has transformed OUD treatment by breaking down barriers to quality care, such as a lack of local care providers and scheduling difficulties. Thanks to telehealth, patients who need OUD care can now access it privately and conveniently from the comfort of their own homes. The OUD treatment process through Ophelia generally follows these steps:

• Welcome call: You meet with your Enrollment Coordinator over Zoom to discuss your questions, insurance coverage, and other housekeeping items. 
• Initial visit with a clinician: Next, you’ll talk to your clinician, who will design a customized OUD treatment plan with you. 
• Medication: If it’s right for you, your clinician will prescribe Suboxone or a generic version and send the prescription to your local pharmacy. You pick it up and prepare for your induction with the help of your clinician.
• On-going support: You receive continued individualized support throughout treatment and access to additional resources like peer coaching and diagnosis of related mental health conditions as applicable. 

Telehealth OUD treatment is designed to work around your schedule and fit into your life. You get full-time support from your dedicated Ophelia care team to help you through the process. Explore your treatment options through Ophelia today and get started with a free 15-minute welcome call.