Why the hell does Medicare not cover bupe?

[drrosenrosen]

Got this lovely message today, in regards to an 86 year old woman, whose 2 tramadol per day are not helping anymore: Buprenorphine 5mcg/hr patch - Drug not on formulary - Plan does not cover the medication - We cannot do PA. She provided the preferred alternative: Morphine Sulfate ER tablets and Oxymorphone HCL ER tablets, and she submitted a test claim for both medications, stating that it was paid and that no PA was required.

In the midst of the "opioid epidemic" that everyone is supposedly so concerned about, why is the safest medication in the class hidden behind a paywall, so to speak, while Opana ER is a perfectly viable option?

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[camkiss]

This drives me insane. I often get, "oh- you want a patch? Fentanyl patches are covered!" But we're the ones writing too much narcotic...SMDH

 

[paindoctor2014]

They also deny physical therapy, imaging etc. it all funnels back to generic opioids. If I won the lottery I’d buy a commercial on the Super Bowl and shout it from the rooftops

 

[Ducttape]

Because butrans is not generic now.

To be specific, Medicare does cover bupe, but not butrans.

 

[drrosenrosen]

Because butrans is not generic now.

To be specific, Medicare does cover bupe, but not butrans.

This was for generic transdermal buprenorphine.

 

[manowar rules]

Like most things driven by the government, their commitment here to the public good is all lip service. The decision makers behind these policies really need to start putting their names onto their decisions.

 

[Agast]

This was for generic transdermal buprenorphine.

I’ve had it covered for some Medicare primary patients - still $100 a month but definitely cheaper than cash pay. I think it depends on what supplement they signed up for to get their meds filled. Your patients who went with the cheapest plans are going to have the worst coverage.

 

[bedrock]

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.

Worth reposting

 

[Ducttape]

You also have to ask if the "lack of coverage" is from the secondary carrier.

So maybe Medicare covers 80% but the 20% is not covered by secondary carrier so it is not approved....

 

[GoBeers]

Worth reposting

what percentage of your patient population is on buprenorphine at this point?

 

[TIVAndy]

For our patients belbuca is.covered. i still prefer butrans though

 

[GatorCHOMPions]

I have not had good therapeutic success at all with Butrans or Belbuca. Maybe 1-2 out of 10 of my patients have reported benefit. I haven’t gone higher than 10 mcg Butrans or 150 mcg BID Belbuca, is that my problem? I would go higher but with 0 benefit the patients seem to lose faith and don’t want to. These aren’t patients I’m transitioning from high MME, but ones that I’m using as first line or those that are on 10-30 MME beforehand.

How have your experiences been?

 

[lobelsteve]

Start at 10, about a third go to 20.
Belbuca start at 150, most go to 300 bid.

 

[bedrock]

I have not had good therapeutic success at all with Butrans or Belbuca. Maybe 1-2 out of 10 of my patients have reported benefit. I haven’t gone higher than 10 mcg Butrans or 150 mcg BID Belbuca, is that my problem? I would go higher but with 0 benefit the patients seem to lose faith and don’t want to. These aren’t patients I’m transitioning from high MME, but ones that I’m using as first line or those that are on 10-30 MME beforehand.

How have your experiences been?

I’ve had many patients do best at 15mcg/hr. Don’t stop at 10 with butrans unless major side effects.

 

[drrosenrosen]

I have not had good therapeutic success at all with Butrans or Belbuca. Maybe 1-2 out of 10 of my patients have reported benefit. I haven’t gone higher than 10 mcg Butrans or 150 mcg BID Belbuca, is that my problem? I would go higher but with 0 benefit the patients seem to lose faith and don’t want to. These aren’t patients I’m transitioning from high MME, but ones that I’m using as first line or those that are on 10-30 MME beforehand.

How have your experiences been?

I'm sure the people who lose faith in Belbuca would be happy to ask for "something stronger" if Norco 5 tid wasn't working...

 

[kstarm]

The safety profile is high with bupe. I tend to be a bit more aggressive in increasing it. For my geriatric patients I always start low with the patch or belbucca but am not afraid to go up if they are tolerating it. I have a number of people happy with the change, most were on full-agonist before I saw them though. I don't start very many naive patients even on bupe.

 

[Agast]

The buprenorphine patch is working so well for my patients that I’m worried in two years they’re going to announce it’s horribly addicting and bad