Buprenorphine at the Opioid Treatment Program: Wave of the Future

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Figuring out how to provide quality treatment at a reasonable cost is one of the most difficult snags of incorporating buprenorphine into an opioid treatment program

Buprenorphine is much more expensive than methadone. With methadone in the opioid treatment program, the money patients pay each day isn’t really for the methadone, which is pennies per dose, but for the personnel of the clinic: counselors, nurses, doctors, and support staff. With buprenorphine, those costs are still present, plus the increased cost of the medication.

There’s no generic for the brand name product Suboxone. Suboxone, now only available in film form, is a combination product containing the active ingredient, buprenorphine, plus naloxone, and opioid blocker that’s only active when injected. This combo product is preferred by doctors because it is less subject to diversion and misuse.

If you read my blog, you know plenty of addicts have written comments meant to cast doubt on that last statement. They say they can still inject Suboxone. I have no reason to doubt that, and I know no medication containing an opioid is diversion- or misuse-proof. But research shows the combo product isn’t as likely to be injected and has a lower street value, compared to the monoproduct containing only buprenorphine. The monoproduct is the equivalent of the name brand Subutex.

The retail pharmacy cost of Suboxone, based on what my uninsured office-based patients tell me, costs anywhere from $7 to $12 for an 8mg film. With a maximum dose of 24mg, that means the cost could be as high as $720 just for medication. Opioid treatment programs could get a better deal from Reckitt-Benckiser, manufacturer of Suboxone, if they buy wholesale and in bulk, but the cost is still significant. At a small opioid treatment program that I helped to start, the company wasn’t able/willing to drop their prices enough to make it affordable for patients who are mostly self-pay.

So we considered the generic form, the buprenorphine monoproduct. It is significantly cheaper than the name brand, though still much more expensive than methadone. I prescribe it for some of my extremely stable self-pay patients I treat in my office practice, and they tell me they spend around $3 to $4 per 8mg generic tablet. One patient found it for $2 per tablet at a Sam’s club pharmacy (I didn’t even know they had a pharmacy).

I had to consider the safety of the monoproduct, given the information that it’s at least somewhat more subject to abuse that name-brand Suboxone. But what was the other option? Methadone? There’s no contest. I decided, in consultation with some of my colleagues, that generic buprenorphine was so much safer than methadone that it outweighed the risk of misuse. Plus, opioid treatment programs can use diversion control methods like more frequent pill counts/bottle recalls with patients on the generic monoproduct.

At both my clinics, patients on buprenorphine pay more than patients on methadone, if they need more than one eight milligram tablet. For a patient who requires twenty-four milligrams, the cost is more than with methadone, but still attainable for many patients. I’m hoping that the generic cost will continue to drop, so we can make this option even more affordable in the future.

The profit margin is, I suspect, slimmer for opioid treatment program owners of programs that offer buprenorphine. This might make it unattractive for some for-profit businesses that own treatment programs. These may continue to be traditional methadone-only programs, and there’s nothing wrong with that. Methadone, appropriately prescribed, has been saving lives for decades.

But it’s great to have options. I’m proud and pleased that both of the for-profit companies I work for, one locally owned and one a large national company, are determined to provide buprenorphine as an option for patients at their programs. It’s the wave of the future.

My experience is with programs that do not accept Medicaid as payment. I don’t know how buprenorphine could fit into an opioid treatment program that does accept Medicaid. There’s no doubt it would get more patients into treatment, and since Medicaid patients tend to be much sicker, they could potentially benefit more than self-pay patients. It will all depend, I suspect, on re-imbursement rates. Medicaid demands a higher level of paperwork and documentation for payment, so I assume personnel costs would be higher. I hope the programs that accept Medicaid will be able to offer buprenorphine, since it is a safer and better medication for some opioid-addicted patients.

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4 responses to this post.

  1. Posted by Benjamin K. Phelps on February 7, 2013 at 2:08 pm

    Curiosity question: When did the pill finally stop being produced? B/c my clinic still is dispensing name brand Suboxone tabs at the window each day. I don’t think they give ANY takehomes at mine, but that’s not surprising to me, given all I know about them. I could be wrong on that, though.

    Reply

  2. Posted by Krysta on March 26, 2013 at 2:32 pm

    Bad news for Sams Club members. As “advantage plus” members we used to get 40% off of the generic Subutex. As of two days ago they changed that to 8%. We used to pay $90 for 45 tablets. Now it will cost us $143. We spoke with the manager today who told us it was likely because this is one of their most popular selling prescriptions. I think it is very sad that this is such a successful drug yet so unaffordable to the majority of addicts.

    to become

    Reply

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