Using UPMC (PA) for Suboxone® + MAT

The opioid crisis has devastated communities across the U.S., and Pennsylvania is one of the states that has been hit the hardest. Every day, an average of 14 Pennsylvania residents die from overdoses. Patients dealing with opioid use disorder (OUD) need evidence-based, comprehensive treatment, but it’s not always accessible. Barriers like high treatment costs and a lack of local care providers can stand in the way of Pennsylvania OUD patients getting the care they deserve. 

Telehealth OUD treatment and insurance coverage help break down these barriers. Explore the options available to Pennsylvania patients with UPMC health insurance. 

OUD treatment benefits for UPMC members

UPMC members can access several different OUD treatment benefits through their insurance coverage. 

Medications for addiction treatment (MAT)

While many people picture rehab when they think of addiction treatment, MAT is considered the "gold standard" of care for OUD treatment. Suboxone® is one of the medications care providers prescribe to help treat patients with OUD (important safety information). But not all insurance providers cover Suboxone and other buprenorphine medications. 

So, does UPMC for You cover Suboxone? UPMC for You is the Medicaid plan affiliate of UPMC Health Plan. Pennsylvania Medicaid covers Suboxone, so there is UPMC for You Suboxone coverage. Patients with UPMC Health Plan don’t have coverage for Suboxone, but that plan does cover generic buprenorphine-naloxone, which has the same active ingredients. UPMC for You also covers the generic option. 

Telehealth coverage

Telehealth rapidly grew in popularity during the COVID-19 pandemic, and telehealth appointments are still much more common today than they were before the pandemic. For patients with OUD, telehealth care options help make treatment more accessible, especially if there are no OUD care providers in their area. UPMC Health Plan grants members access to several telehealth platforms to facilitate access to the care they need.

Although exact telehealth coverage varies by plan type, UPMC generally covers telehealth appointments with any provider in the UPMC Health Plan network. Pennsylvania UPMC members dealing with OUD can likely get their OUD telehealth appointments covered. 

Behavioral health

UPMC also offers additional behavioral health programs and services for patients dealing with substance misuse and addiction. For example, patients can get one-on-one behavioral health coaching to better understand their symptoms and learn when it's time to reach out for further help. 

What does telehealth OUD care look like?

Healthcare is always evolving to better meet patients' needs. With the rise of telemedicine, OUD treatment has become accessible to many more patients. Previously, patients who lived in more rural areas or other areas without local OUD care providers would be forced to travel to access treatment. Telehealth OUD appointments allow them to access care without worrying about transportation, missing time off work, or privacy concerns. The treatment they need is accessible from the comfort of their own homes through providers like Ophelia.

During telehealth OUD treatment with Ophelia, you meet with your clinical care team virtually through a video appointment. If you’re eligible, Ophelia will send your Suboxone to your local pharmacy. Further medical support appointments will also be virtual, and you can access support 7 days a week. 

Other OUD patient resources in PA

Beyond the coverage benefits available through UPMC, OUD patients in PA may benefit from other resources like local naloxone access. Naloxone is a life-saving medication that rapidly reverses opioid overdoses. Administering naloxone quickly can help an overdosing patient keep breathing so there’s time for them to receive further medical care. In Pennsylvania, several community-based organizations provide naloxone for free. People at risk of opioid overdoses or close to at-risk individuals can get this free naloxone to be prepared. 

Ophelia partners with UPMC PA to increase access to telehealth OUD treatment 

Recently, Ophelia partnered with UPMC PA to expand access to telehealth OUD treatment in Pennsylvania even further. Thanks in part to the partnership, Ophelia has been able to achieve 100% Medicaid acceptance in Pennsylvania. Ophelia also accepts insurance from a growing list of insurance providers nationwide, including other Medicaid and ACA-compliant plans. Check your coverage using Ophelia’s online coverage tool, and we’ll confirm your eligibility. 

We believe everyone who needs it should be able to access OUD treatment, regardless of income level or location. Our enrollment team will work with you to help you understand your coverage options and expected costs. Get in touch to learn more about your insurance coverage for OUD treatment visits with Ophelia.