Jefferson Health Plans* is a major provider of healthcare coverage in Pennsylvania, with about 350,000 people in its Medicaid and Medicare enrollment alone, most of them in Philadelphia. In 2023, the provider expanded its offering to include individual and family plans on Pennsylvania's official state insurance marketplace, Pennie®.
Like many states, Pennsylvania is dealing with an opioid use disorder (OUD) epidemic. As the state continues to take steps to reduce barriers to OUD treatment, Jefferson Health Plans is following suit. Thanks to this partnership, Ophelia has achieved 100% Medicaid acceptance for medications for addiction treatment (MAT) in Pennsylvania.
Below, we explain how Jefferson Health Pennsylvania Plan members can access OUD treatment.
OUD treatment options for Jefferson Health Pennsylvania members
Jefferson Health Plans PA takes a multifaceted approach to OUD care. MAT is one option available. Considered the gold standard of OUD care, MAT uses medications like Suboxone® (important safety information), which reduces cravings and withdrawal symptoms. In Pennsylvania, Medicaid covers Suboxone as well as generic alternatives.
Overdose prevention measures are also covered, as the Pennsylvania Department of Health has signed a standing order prescription for naloxone, which means the medication is available without a specific doctor’s order. Sometimes referred to by its brand name, Narcan®, can help reverse the effects of an opioid overdose. This lifesaving medication is useful for people living with OUD, as well as their friends or family, to have on hand. Naloxone and educational services are available throughout the state, typically at no cost. The medication is also available over the counter, but costs will vary depending on a person’s insurance.
Finally, members of Jefferson Health Plans in Pennsylvania can also access centers of excellence (COEs) for OUD care. These providers take a comprehensive approach to OUD treatment. Ophelia is proud to be the first and only telehealth OUD provider in Pennsylvania to receive this designation.
Jefferson Health Partners even provides non-emergency transportation benefits to help members access the care they need. The Medical Assistance Transportation Program (MATP) can help individuals get to qualified Medicaid Advantage-enrolled medical providers and pharmacies.
Unfortunately, even with measures like these, not everybody can easily access a COE for OUD care. Luckily, there are alternatives available. Jefferson Health Plans PA has partnered with Ophelia to make MAT available through telemedicine, an effective way to overcome geographic barriers to care.
How Ophelia + Jefferson Health Plans PA partner to provide OUD treatment remotely
With Ophelia's telemedicine approach, patients can access MAT from the comfort of their own homes. This can help make care more affordable and convenient. There's no need for patients to disrupt their everyday lives—and responsibilities like work, childcare, or elder care—to get the OUD treatment they need. Telehealth MAT can also be more discrete since the sessions take place at home.
How does it work? An Ophelia telehealth appointment is very similar to an in-office appointment, except you meet over a video call instead of in person. In an initial video appointment, you connect with your provider. If you are eligible for a Suboxone prescription, your clinician will send it to a local pharmacy and help you start using the medication. They’ll also set up a regular meeting schedule to provide ongoing care. Nurses are available seven days a week to provide support outside your regularly scheduled appointments.
It's even possible to do at-home drug tests through Ophelia's program. To start, you receive an unmarked package containing a testing kit, which includes a urine cup in a sealed bag. Hold onto the kit until you have a video call with a care team member. On your call, you open the kit on video before stepping away to fill the cup off camera. When you return to the video call, you show the clinician the cup, with results visible in five minutes. These results help us establish a baseline and ensure patients are following their treatment plans. We take a non-punitive approach to testing and do not kick people out of their program for a positive drug screening—instead, we focus on getting your treatment back on track.
Jefferson Health Partners is eager to support access to care with innovative solutions like Ophelia's. The JeffConnect telehealth program provides 24/7 access to Jefferson Health Partners PA providers, for example.
In addition to working with Jefferson Health Plans, Ophelia further accepts a variety of insurers in Pennsylvania. You can use the online tool to see if you're covered. The Ophelia team can also help you determine your eligibility with a free 15-minute welcome call.
You can learn more about how Ophelia works with the complete treatment guide, which covers everything from onboarding to maintenance.
*Jefferson Health Plans is the marketing name for certain products from Health Partner Plans, Inc.
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