Blue Cross Blue Shield

Blue Cross Blue Shield and Suboxone Coverage

Blue Cross Blue Shield and Suboxone Coverage


If you're struggling with opioid addiction, a drug treatment facility that offers medically-assisted detox can make transitioning to a drug-free life that much easier. For those who may not be familiar with what a medically-assisted detox program entails, it involves the use of prescribed medication to help combat the severe withdrawals symptoms that will invariably present themselves when someone abruptly stops using opioids or other addictive substances. One of the most commonly prescribed medications used to help patients cope with their withdrawal symptoms is Suboxone, a combination medication comprised of both buprenorphine and naloxone.

Approved by the FDA (Food and Drug Administration) in 2002, Suboxone has quickly become a go-to treatment when it comes to helping patients overcome their addiction to opioids. According to the Drug Enforcement Administration, over 9 million Suboxone prescriptions have been filled in the U.S. since 2012 and shows no sign of relenting anytime soon. In this article, we will take a closer look at what makes Suboxone so effective and whether or not the medication is covered under your Blue Cross Blue Shield health insurance policy.


Originally marketed as a partial opioid agonist pain reliever, Suboxone is now used almost exclusively for the treatment of opiate addiction. The pills are denoted by a pinkish color while the strips are usually orange in color. However, both variations will have the dose amount indicated on them. Patients who take Suboxone are instructed by their physician to take daily regulated doses to help lessen the severity of their withdrawal symptoms while they go through detox. This dosage, however, will be decreased gradually to help wean the patient off of the medication as they approach the conclusion of their detox journey. In addition to soothing the painful withdrawal symptoms, Suboxone also provides the following benefits:

  • Reduced cravings
  • Improves the probability of sustained recovery
  • Minimizes the risk of relapse

The reason that Suboxone is so commonly prescribed is that prescription pain relievers have become widely abused. Also, those who abuse these medications, namely opioids, have a greater risk of becoming physically and psychologically dependent on them. While Suboxone only addresses the physical component of overcoming an addiction, it is highly effective when coupled with counseling and other treatment protocols designed to help patients achieve long-term recovery success.


In addition to buprenorphine, which is classified as a partial opioid agonist, Suboxone also contains naloxone, a synthetic drug that blocks opiate receptors in the nervous system. To better understand how these two drugs work synergistically, let's take a closer look at them individually:

Buprenorphine – This component of Suboxone works as a partial agonist, meaning, unlike full agonist drugs, it only has a partial effect on the brain's opioid receptors. Because Suboxone works as a partial agonist, individuals who take the medication do not benefit from the psychoactive effects normally derived from full agonist drugs like oxycodone, methadone, and similar drugs. Instead, they are more likely to benefit from the reduction in the severity of the symptoms associated with opioid withdrawal while going through detox.

Naloxone – This component of Suboxone works as an opioid antagonist, which is markedly different when compared to agonist drugs. In simple terms, naloxone serves as an inverse agonist that aids in the removal of other drugs, namely full agonist, which would otherwise bond to receptors in the brain and trigger a euphoric high. Naloxone is also useful in treating and preventing adverse health problems that are often correlated with consuming large amounts of heroin or prescription-based opioids. Some of these health problems include bradycardia (reduced heart rate) and respiratory problems, which can both be fatal if not promptly remediated.


One of the biggest benefits that come with having a comprehensive health insurance policy is that you can take advantage of medically-assisted drug treatment programs when you're ready to end your relationship with either heroin or prescription-based opioids. While quitting cold turkey is possible, it is not recommended as it can accelerate withdrawal symptoms that may be more intense than they would have otherwise been if you were to quit in a controlled environment while taking medication.

According to, an online resource covering topics related to addiction in America, less than 25 percent of patients who quit opioids cold turkey were able to remain drug-free for more than one year. The benefit of Suboxone detox is that it improves the likelihood of achieving long-term recovery in that it reduces cravings and the severity of withdrawal symptoms, not to mention the probability of spiraling towards a relapse.

It is also important to note that the success rate of medication-assisted detox in a controlled environment is quite high, generally in the neighborhood of 40 to 60 percent, which is measured according to retention and sobriety lasting for at least one year, from the time when the patient begins treatment.


During your initial consultation with a physician, he or she will decide if Suboxone should be made part of your detox program by taking into consideration a number of factors like the severity of your withdrawal symptoms and the potential for an adverse reaction to the medication, for example. Provided that you are a good candidate for Suboxone-assisted detox, you will likely start with a 2mg to 4mg dose. This initial dose allows your physician to gauge the effectiveness of the drug and whether or not it is well-tolerated before moving up in dosage.

This introductory period will usually last for about three days. As a side note, higher doses of Suboxone can vary from patient to patient and can be anywhere from 4mg to 24mg. While some residual cravings and withdrawal symptoms might continue, most patients will feel begin to feel more like themselves after taking the medication for about five days. As you begin nearing the end of your detox journey, your physician will begin to gradually lower your daily dose of Suboxone until you're completely off of the medication. Upon completing detox, you may be advised to undergo counseling to address the psychological dependence commonly associated with opioid addiction.


Of course, overcoming one's physical dependence on opioids is important; however, addressing the psychological component of addiction should not be overlooked. After all, the desire to start using again often begins with the thoughts that an individual may have coupled with the belief that returning to their old ways can somehow resolve their problems. Depending on your policy, counseling may be covered under your Blue Cross Blue Shield policy right along with your Suboxone coverage as the two go hand in hand. While undergoing counseling, patients are taught invaluable lessons concerning how to avoid relapse and how to respond to cravings. Beyond that, patients are also taught how to cope with stress and other triggers that could potentially result in the resumption of old patterns of behavior.


Because Suboxone has been identified as an effective way to treat opioid addiction, your BCBS policy will cover the cost of your medication if it is considered a necessary and integral part of your recovery. In saying that, it should be noted that there may be co-payments, deductibles, and other out-of-pocket expenses that you may be responsible for paying based on your specific policy. For example, some policies may require that you reach a certain deductible threshold before any needed treatments or prescriptions will be covered.

Ideally, it would be a good idea to reach out to your health coverage provider to go over the details of your policy before seeking treatment as this will allow you to focus on your recovery as opposed to worrying about what may or may not be covered. Although the specifics of your policy may not be your top priority while battling drug addiction, it is still important to know where you stand in terms of Suboxone coverage and any other aspect of your recovery program.

If you have a problem with opioids, you're encouraged to seek help as soon as possible. Also, you should know that you are not alone. According to data compiled by the National Institute on Drug Abuse, more than 2 million Americans developed an opioid addiction in 2012. The same data also shows that over 460,000 individuals became addicted to heroin, a street-level opioid that is just as addictive as its prescription-based counterpart. That said, if you have already made up your mind to end your relationship with opioids, you shouldn't let a sense of shame preclude you from getting the help you need. In addition to finding a drug treatment facility that meets your needs, you're encouraged to follow up with your BCBS representative today to go over your policy.