Worth reposting--
You have to change the conversation to........ "You're getting a bup product or nothing" and "extra cost does not mean vicodin/percocet just because they are cheaper"
You should be aware that butrans is now generic and with a discount card such as goodrx and particularly with specialized discount cards your local pharmacist can provide, the monthly cash price for butrans will be $50-70, usually around $60. I'm not going to post my discount card numbers as they are region specific, but speak to a local pharmacist at a private (not corporate) pharmacy) and ask him/her to look this up for your area. My assistant has these codes saved and we just print a sheet for the patients prescribed bup.
With that background, if I see a patient that has failed everything else and we are having a conversation about starting opioids, I just say butrans is what I recommend and I mention its safety, dramatically less tolerance, etc compared to standard opioids.....and then I tell the patient that their insurance company will most likely NOT cover butrans and if they want it they will need to pay out of pocket for it, end of story and I give them a discount sheet with the codes on it. I also tell the patient that this is the only opioid I will write. If they can't accept that, they can go elsewhere.
No phone calls for your assistant to deal with because the patient learns insurance doesnt cover it and wants something else or needs to try fentanyl for a month per the insurance guidelines BS. You're just done after one quick discussion.
The patient expects their insurance won't cover it and is either surprised if insurance does cover bup, or the patient just pays for bup in cash because if insurance doesn't cover it as expected. You have a brief conversation, hand them the discount sheet and you're done. The patient is told this is their only option, they will have to pay a modest amount out of pocket for it if they want it. Everyone can pay 50-60 dollars a month for something if it is important, even gramps on medicare.