Saturday December 3rd 2016

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Does health insurance cover Antabuse?

Yes. Insurance often covers medications that treat alcohol use disorders. More on how you can finance the cost of Antabuse here, with a section at the end for your questions.

Antabuse basics

Antabuse is a medication that deters drinking. It works by producing a sensitivity to alcohol that triggers a highly unpleasant reaction when someone ingests even small amounts of alcohol. Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms such as vomiting and nausea which persist as long as alcohol is being metabolized.

But how can you know if Antabuse is covered by your insurance? What are the differences in prices for this medication and what other alternatives exist for payment? Find the answers to these questions in the text that follows. Then, we invite your comments and questions at the bottom of the page.

Is Antabuse covered by insurance?

Yes, Antabuse is usually covered by insurance. Antabuse is only available by prescription. In any insurance plan, there is an amount you must pay each month for a prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. For Antabuse, general plans for in-network, out-of-network, and mail order pharmacies can range from $60 to $170 per month.

Antabuse insurance coverage

If you use a private company (such as Blue Cross Blue Shield) in order to be covered for insurance, they usually offer couple of pharmacy benefits. These may include a retail and/or mail service pharmacy program. A mail based pharmacy program is a convenient and cost-effective way to get your maintenance or long-term drugs. Antabuse is a drug you take regularly, and need to take long term. You can get a 90-day supply (minimum 22-day supply) through the mail order pharmacy for one copayment shipped straight to your door. In such packages you also normally have access to a registered pharmacist, 24 hours a day, seven days a week.

Is Antabuse covered by Medicare?

Yes. Medicare covers a full spectrum of substance abuse treatment services. Part D covers prescribed drugs for substance abuse treatment at the same coverage levels as other prescribed drugs. To get Medicare Antabuse coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

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Antabuse cost without insurance

Antabuse is supplied as 250mg and 500mg tablets. The cost of thirty (30) 250mg  tablets for use up to 30 days is around $80 without insurance.

However, there are some NGOs that offer voucher programs for prescription drug payment. One of them is NeedyMeds.org, a non-profit organization, which offers a free Prescription Drug Discount Card which can save up to 80% off the cost of prescription medications. The card is accepted at most major pharmacies including Walgreens, CVS, Walmart and RiteAid. For more info on this program, you can check their site.

Antabuse cost with insurance

In order to recoup the cost of prescription Antabuse, you’ll need to apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the “Coverage Gap”. Some sample costs insurance with prescription plans follow.

Example 1: Preferred Network Pharmacy $90 – This is a typical cost-share amount you would pay during the initial coverage phase for a 30-Day supply at a “Preferred” network pharmacy. In most cases, the “Preferred” network and network pharmacy pricing are the same.

Example 2: Mail Order $270 – This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).

Furthermore, insurance plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The plan may also have a separate copay/coinsurance for the same drug while in the “Coverage Gap”.

Medical insurance for Antabuse questions

Do you still have questions about Antabuse coverage and health insurance? Please leave your questions below and we will try to respond to you personally within a reasonable time.

Reference Sources: SAMHSA: Financing of Medications to Treat Alcohol and Opioid  
Use Disorders
Blue Cross Blue Shield Pharmacy Coverage
Medicare Benefits
DailyMed: Antabuse label

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