Suboxone Clinic: Current Fee Schedule (Effective January 1, 2020)

I no longer provide at-home or in-office induction. I only accept patients/transfers who have been on Suboxone in the past. All patients have to go into full withdrawal before initiating treatment, but not everyone is a suitable for going into unsupervised withdrawal or induction. That determination is made on a case by case basis.

I have been a Suboxone provider at Murfreesboro since 2010. I am a small one man practice and do not have the resources to offer induction. Induction is the process where a patient is evaluated and enrolled in the treatment program, examined for symptoms of opioid withdrawal, and is administered initial doses of Suboxone under direct supervision.

At-home induction and in-office inductions are alternatives to in-patient induction that is provided in hospitals or addiction treatment facilities. Outpatient induction is the less expensive alternative that does not require admission to a facility. It is still a time consuming process that requires half-day to a full day of patient’s and provider’s time. You can ask your insurance, PCP, counselor, pharmacist, friends and family … about other providers who offer this service. You can also locate providers at the website https://findtreatment.gov

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Initial enrollment + Induction

I no longer provide in-office or in-home induction. This is required for patients who have never been prescribed Suboxone, and for those who are transitioning from Methadone. Please look for a program that provides this induction.

It is also available as an option for patients who request it. For example patients who are coming off high dose opioids, or those who have been using long acting or delayed release opioids like Oxycontin, MS-Contin, Opana-ER, Fentanyl dermal patch, etc.

These patients find it difficult to go through the 24 to 72 hrs of opioid free interval required to reduce the amounts of opioids in their body, so as to reduce the risk of precipitated withdrawal when initiating treatment with Suboxone.

This is normally a two day process.

On the first day patient presents to the office/facility for enrollment and medical examination. The process involves reading and completing consents, providing medical and substance use history, followed by a medical examination and discussion.

Patients do not have to be in withdrawal for this step. This takes one and half to two hours. Patients are given a prescription for Benzodiazepine and Clonidine for one to three days with instructions to abstain from any further use of opioids, or are provided these medications at the facility.

Benzodiazepines and Clonidine ease the withdrawal symptoms that the patients experience after stopping the opioids. Benzodiazepine reduces anxiety and provides sedation to help patients sleep in spite of withdrawal. Withdrawal is also likely to increase the heart rate and blood pressure, and that is what Clonidine is for. Not everyone requires Clonidine, but it is there if the patient needs it.

On the second day patient is checked for withdrawal symptoms and given a prescription for Buprenorphine for in-office induction. Some facilities provide these medications. Patients take the first dose in the clinic, and are observed for 20 to 30 minutes. If the patient has abstained from opioids as was directed then the patient will start feeling better within 10 to 20 minutes and will feel almost normal in an hour. Patient is also observed for allergic reactions if any. Allergic reactions to Buprenorphine is extremely rare.

Patients are then provided a prescription for one to two weeks and a follow up appointment is made.

Initial enrollment (Transfer or Initiating treatment after relapse). Procedure in my practice.

This is a one day process. Patients who have been prescribed Suboxone or other Buprenorphine preparation in the past are not offered induction unless requested. The enrollment and medical examination is completed the same day. It takes about one to two hours.

This requires reading and completing consents, providing a medical and substance use history, followed by a medical exam and discussion. Due to Covid health emergency the physical exam is currently not being done, other than what can be observed over a video meeting. Patients are then provided a prescription for 30 days and a follow up appointment is made in three weeks.

Unless you have relapsed and are taking Methadone, high doses of opioids, or long acting opioids you can do without the induction process.

If you are restarting treatment after a relapse then you are required to be in withdrawal to start the treatment.

If you are transferring from another practice and are already on Suboxone then you do not have to be in withdrawal.

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Counseling

My practice does not have a licensed counselor. Patients are free to enroll with a licensed counselor of their choice.

Patients are provided a written taper plan to work through and are advised alternate dosing methods if they are unsuccessful. There are links under self-help resources to sites from where patients can download free workbooks.

Patients are seen once a month. Patients who have tapered their dose to 2mg/day or less, are allowed to follow up as needed.

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Current medication dosage protocol.

Patients are started at their last prescribed dose or 12mg/day. I do not prescribe more than 12 mg/day, and do not prescribe that dose for more than 12 months. Most patients are able to taper their dose to 8mg/day within three to six months. They are advised to enroll in another program if they are unable to reduce their dose to 8mg/day in 12 months.

Maintenance dose in my clinic is 8mg/day or less. Patients receive the medication support for as long as they need it. Many patients are on this medication for years. It is not ideal … but it is preferable to having a relapse and the downward spiral that results from it. Patients who do not demonstrate satisfactory progress, have frequent relapse, etc., … are advised to enroll with an addiction specialist for ongoing treatment.

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Tests required:

These tests are to be done through your Primary Care Provider. These are routine and inexpensive tests that are usually covered by your insurance. If your PCP and insurance provide it then it is better to do a “wellness panel”

On initiation, and once a year if indicated:

1. A comprehensive metabolic profile (CMP) is required once a year. It includes basic liver and renal function tests, and is done on a blood sample.
2. Other suggested tests are complete blood count (CBC), Electrocardiogram (EKG), and for men Testosterone levels.

These were most likely done by your PCP on enrollment … please bring a copy of the report. It is recommended to be done again a few months after initiating Suboxone therapy to check for any elevation of liver enzymes. In my practice I have not seen any elevation of liver enzymes.

Male patients should also get their Testosterone level checked, and if low, should seek replacement therapy through their PCP. Long term use of opioids interferes with Testosterone production and results in lower blood levels. Replacement therapy is available to raise your testosterone level to normal range.

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Payments:

Fees are payable at the time of service. Fees cover the medical evaluation and management by the provider, and do not cover medications, or lab tests.

Payment is made through online payment using a credit/debit card. Patients can use their HSA cards. Prescription is sent by e-prescription to a pharmacy of patients choice.

My self-pay programs are only for patients who are uninsured, or have commercial insurance but do not need to file claims. Patients who have government funded insurance, medicare or medicaid, can not be accepted as self-pay patients.

I no longer participate in any insurance program, private or government funded. If you do have insurance, then it is better to receive services through your network provider. Your insurance carrier should be able to assist you in locating a provider.

Your prescriptions may be covered by your insurance or your prescription plan. You have to check with them as to the conditions for coverage. Typically there is a limitation to the dose and duration for which it is covered. The program may require that you attend counseling regularly to be eligible for the prescriptions. Some programs will not cover the prescription if it was prescribed by an out of network provider.

I am not willing to call your insurance/prescription plan for pre-authorization.

Fees do not strictly follow the standard CPT codes that are followed by insurance carriers.
My fee schedule is designed for self-pay patients who need to have a predictable fee, so that they can plan and budget for it. There is no separate charge for urine drug screen. The urine drug screen is done at random and the cost is averaged out and included in the fee.

For patients who are filing their own claim, the bill will reflect the actual procedures for that day.

If you have insurance coverage:

Insurance benefits depend on your insurance policy. Your doctor has not read your policy, … and is not willing to read it. Your benefits keep changing at the whim of your insurance carrier, and there are unwritten and undisclosed limits to your benefits. Your doctor has no idea as to what benefits you have used up, and what is still left there.

Your insurance carrier offers several plans, each with a different policy. Your doctor has no way of knowing which policy covers what, and what is the rate of reimbursement. I do not have the resources or time to deal with your insurance carrier. It is your insurance … you deal with it.

I will not be able to assist you in filing your claims, other than providing you a receipt for payment received and details of service provided.

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Buprenorphine medication costs:

Cost of Suboxone (Buprenorphine+Naloxone combination) … it varies from $1 to $5 for each generic 8mg tablet/film so please ask around, some pharmacies may honor discount cards like GoodRx. Not all pharmacies stock this medication. Most pharmacies allow you to obtain a partial fill of your prescription. For example you may obtain three to seven days supply at a time, thus reducing your upfront treatment cost.

Zubsolv and Bunavail are similar medications, and for equivalent dose … they cost the same as Suboxone.

You can compare costs at area pharmacies from the website:

All manufacturers provide discount coupon through their websites:

Most pharmacy chains also offer their own membership programs that provide substantial savings on these medication. Please ask your pharmacist.

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I do not dispense any medication.
You receive a prescription for 30 days that you can take to any pharmacy of your choice and have the medications dispensed to you. You do not have to buy the entire prescription at one time. You can pay for and get a part of the prescription. Please ask your pharmacy about it.

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This page was last modified on: April 21, 2023