Opioid Addiction / Opioid Use Disorder

This page outlines the Suboxone treatment protocol followed in my clinic. There are some important differences from other clinics and these have been summarized below. It is best to do some research and enroll in a clinic that you find closer to your expectations … that way you are more likely to continue with the treatment, and improve your chances of making a complete recovery.

If you have insurance then look for a provider who is in your insurance network, and confirm that Suboxone related services will be billed to your insurance.

  • Maximum Dose Prescribed: Maintenance dose at my clinic is a maximum of 12mg/day for the first year in treatment, and 8mg/day for subsequent years. Patients are encouraged to use the least amount of medication necessary and complete the program according to their own schedule.
  • Frequency of Appointments: Patients are seen once a month, and given a prescription for 30 days. Patients who miss a month  are only allowed to continue at a lower daily dose.
  • Urine drug screens: Urine drug screens are done at random using the rapid-immunoassay cups, testing for ten or more drugs, there is no extra charge, the charge is included in the visit fee.
  • Counseling: Counseling by a substance use counselor or behavioral therapist is not included, and not provided at my clinic. Patients who are on 12mg/day are required to attend counseling at least once a month, under their own arrangement. Once patients have reached the maintenance dose of 8mg/day or less, then counseling is deemed optional.
  • Lost or stolen medications: Patients are discharged.
  • Insurance: I am not a provider for any insurance. I do not see Medicare or Medicaid patients. I do not provide any assistance with filing claims. Patients are provided a receipt that includes pertinent information suitable for filing. I do not provide assistance with any additional paperwork.
  • Pre-Authorization for prescriptions: Not provided.

Treatment with Suboxone is initiated on the day of enrollment.

Patients who require induction receive 3 days of Buprenorphine prescription, and 30 days of Buprenorphine plus Naloxone preparation after the induction. Patients who are allergic to Naloxone are not enrolled in my program.

Patients are given a prescription for 30 days at each clinic visit.

Patients who have never been prescribed Suboxone, their treatment is initiated at 16mg/day of Suboxone or equivalent preparation for the first month. Follow-up dose is 12mg/day for a maximum of 12 months. Most patients are able to taper their dose to 8mg/day by 3 to 6 months.

Patients who are transferring from another practice, … their treatment is initiated at the dose that they were receiving, up to a maximum of 16mg/day. Follow-up dose is as above.

Equivalent doses

Two newer brands claim better absorption and improved bio-availability and hence have marketed their preparation with a different amount of Buprenorphine and Naloxone.

Patients are free to chose one of the following medications at equivalent dose. The manufacturers provide their own discount coupons that can be downloaded from their website.

The following is a table of equivalent dose. One 8mg Suboxone film is equivalent to one 4.2mg Bunavail film, or one 5.7mg Zubsolv tablet.

 

Brand Formulation Cost
Suboxone 8mg film Buprenorphine 8mg + Naloxone 2mg $8-$10
Generic Suboxone 8mg tablet Buprenorphine 8mg + Naloxone 2mg $6-$8
Bunavail film Buprenorphine 4.2mg + Naloxone 0.7mg $8-$10
Zubsolv Tablet Buprenorphine 5.7mg + Naloxone 1.4mg $8-$10

 

Discount coupons

You can compare prices at area pharmacies by gong to

Enter the drug name and quantity, and it will give your the prices at the local pharmacies. The lowest prices are with coupons that you download to your phone, and show it to the pharmacist; goodrx also has an app.

Patients end up having to go to different pharmacies every month as the coupons sometimes are a single use coupon … check with your pharmacist if the discount coupon is also good for future prescriptions.

Download discount coupons, find doctors, and access useful educational resources from the manufacturer’s website.

Suboxone.com

Zubsolv.com

Bunavail.com

Your prescription plan may have a preference for a particular brand, … check with them before you go to the doctor.

Suboxone Dosing Protocol

Patients are welcome to taper the dose as fast as they can tolerate. I expect most patients to complete the program within one year, … however, some patients do take much longer.

The emphasis of my program is on complete recovery and not on maintenance. Some patients are not able to come off the medication within one year. Those patients are prescribed 8mg/day or less. Most of my long term patients are on 4mg/day or less.

Some patients may never be able to come off completely if they have uncomfortable withdrawal symptoms. Even for those patients the goal is to take the minimum acceptable dose, which varies from 4mg/day, to 2mg once a week.

The following is my current dosing protocol.

The cost of medication is calculated based upon Suboxone 8mg film being $10 per film. Actual cost is lower. Medications may be covered through your prescription plan. There may be quantity and duration limits, and pre-authorization is almost always required. Pre-authorization may be denied if you go to an out of network provider.

 

Month of treatment Dosing protocol Fee Schedule Aprox Medication cost
Enrollment Month 1 Suboxone 16mg/day $275-$375 $600
Follow-up month 2 to 6 Suboxone 12mg/day $145 $450
Follow-up month 7 to 12 Suboxone 8mg/day $95 $300
Follow-up month 13 and beyond Suboxone 4 to 8mg/day $95 $150-$300

 

Pre-authorizations

I do not see Medicare or Medicaid patients and do not provide any assistance with their pre-authorizations. Medicare and Medicaid, and most commercial insurances have their own contracted doctors; … it is best to go to them for this treatment. Other patients can bring the completed preauthorization forms for my review and signature.

I will not call your insurance or prescription plan for pre-authorizations.

Counseling with a licensed counselor is required once a month for patients who are on 12mg/day. Please bring workbook and counseling record as proof of counseling.

Counseling is made optional once the patient has tapered the dose to 8mg/day.

Patients on 2mg/day are seen once in two months, or as needed. Some patients are taking 2mg once every other day, they see me once in four months.


FAQ: My pharmacist said “ask your doctor to call this number; then you can get this medication for free or for a small copay”.

I will not call any one. Find another doctor.

The person who told you “your doctor can call this number and you can get this medication for free or for a small co-pay”, is not a pharmacist. He/She is a foot soldier to the pharmacist. A real pharmacist will know that it does not work that way.

A real pharmacists would know that you have to request a pre-authorization form, which magically is different for every medication. The form usually has four pages or more, you provide the information asked for … answer 13 questions, and certify 7 things … and have it signed by your doctor, fax it to your prescription plan, … and then your insurance and prescription plan will think about it for 72 hrs, and give a reply. More often than not it is rejected … because their was one box that was overlooked, … then you can file an appeal. In my case the commonest reason for rejection is “out of network provider”.

I am not a network provider, this has not changed … and will never change. So it is best to go to your network provider. I am in the business of providing medical care, and not in the business of fighting with your insurance.