As mental health practitioners, Blue Cross Blue blue cross blue shield therapists Shield therapists encounter requests to manage and support patients for various behavioral health concerns, including substance use disorders. Vivitrol (naltrexone) is one of the most effective medications for treating opioid and alcohol dependence and plays a vital role in helping patients achieve sobriety and recovery.
Vivitrol is a prescription medication that reduces opioid and alcohol dependence by blocking their effects on the brain. As a therapist, you may be counseling your patients on medication-assisted treatment (MAT) within an integrated care framework for addiction. Understanding the question of where to get Vivitrol is important, and this guide aims to clarify questions regarding Vivitrol’s accessibility and the insurance processes for BCBS.
Understanding Vivitrol
Vivitrol is a medication that requires understanding before recommending it to patients. It is prescribed for opioid addiction and alcohol dependence. Vivitrol, like all naltrexone medications, blocks opioid receptors, eliminating cravings.
Where to Get Vivitrol: Treatment Facilities and Clinics
Vivitrol injectable is given in a healthcare setting and needs to be obtained through a service provider. Patients are guided through the process of getting Vivitrol by you, the therapist.
a. Outpatient Clinics
Vivitrol injections are available at most outpatient addiction clinics. These outpatient addiction treatment centers have the appropriate facilities and training to support medication-assisted treatment with Vivitrol. Keep in mind that the clinics have a Controlled Substances Registration, which allows them to treat clients using Vivitrol.
b. Detox and Inpatient Facilities
Individuals in detox or inpatient rehabilitation may integrate Vivitrol into their treatment plan. Some inpatient facilities will start Vivitrol treatment during detox to help curb cravings and decrease relapse potential. These programs tend to be more costly, and while more limited in their scope, BCBS does provide coverage for patients within an active in-network treatment program.
c. Primary Care Physicians (PCPs) or Addiction Specialists
Addiction medicine primary care physicians and some addiction specialists might be able to prescribe and administer Vivitrol. These practitioners usually have some degree of familiarity with medication-assisted treatment and will help your patients begin Vivitrol therapy.
Ways to Search for Vivitrol Providers
There are some tools that can help you better assist healthcare clients locate suitable healthcare providers for their clients who use Vivitrol.
a. Provider Directory for Blue Cross Blue Shield
BCBS has an In-network provider search tool for prescription patients. Tell your patients to look up addiction Vivitrol providers clinics with specializations near them using the directory. This ensures that care is reachable and that the patient does not have to stress about high associated costs.
b. SAMHSA’s Treatment Locator
The Substance Abuse and Mental Health Services Administration (SAMHSA) has a treatment locator that patients can visit on the Administration’s website. With location and specification of treatment type alongside other data, patients may find facilities for medication-assisted treatment such as Vivitrol.
c. Local Addictions Help Centers
Some Community-based Addiction recovery centers may also carry out the Vivitrol injection procedures. These Centers provide some procedures on a sliding scale fee basis, which makes them ideal for resource-strapped patients.
d. Telemedicine Providers
For some time now, therapy and medication sessions have been offered through telemedicine due to its convenience. Some telehealth providers offer Vivitrol evaluations and may assist with broken visits to an addiction specialist for injection appointments.
Insurance Coverage and Authorization with Blue Cross Blue Shield
Vivitrol is covered under the pharmacy benefits of Blue Cross Blue Shield, but your patients need to do a few things to make sure the medication will be covered.
a. Pre-authorization Requirements
Most of the BCBS plans are going to need prior authorization for Vivitrol. This means your patient may need to provide an addiction diagnosis and documentation from a therapist or physician attesting to having tried other treatments. Sometimes, BCBS may require the patient to have completed a rehab program as well.
b. In-Network vs. Out-of-Network Providers
Like any other insurance, BCBS covers treatment by in-network providers. It is crucial to determine whether the clinic or physician providing Vivitrol services is in-network to prevent unforeseen expenses. You can assist your patients by checking network status and making BCBS referrals.
c. Drug Formulary
Please check your patient’s BCBS plan to see if Vivitrol is covered under the specific drug formulary. In case Vivitrol is not covered, BCBS may have another form of medication-assisted treatment, or your patients might have to appeal for them to include this medication.
d. Copays and Deductibles
With some BCBS plans, copay rates for Vivitrol may differ. Make sure to communicate to your patients all expenses that are likely to be incurred, including deductions or co-insurance, which may be different depending on the place of service.
Support for Patients Starting Vivitrol
Along with Vivitrol initiation comes a unique set of challenges that can be highly distressing for many patients. Therapists can provide help by addressing the following aspects of addiction treatment:
Counseling and Support: Maintain consistent counseling sessions. Medication-assisted treatment (MAT) is most effective when it is integrated with psychotherapy and supportive services like Cognitive Behavioral Therapy (CBT) and 12-Step Programs.
Monitor Progress: Follow up with patients regarding their concerns and how a particular medication affects them. If they express discomfort or have cravings while being treated, you can assist them in managing treatment with their physician.
Peer Support Groups: Promoting participation in peer recovery groups fosters the growth of community and support networks as many individuals dealing with addiction recovery tend to do better in a socially supportive setting.
Conclusion
For you as a therapist for Blue Cross Blue Shield patients, understanding how to assist your clients in obtaining Vivitrol can be a key part of the therapeutic strategy. Vivitrol can be strategically used for the treatment of alcohol and opioid dependence through outpatient Vivitrol treatment centers, by primary care doctors, and addiction specialists. By managing insurance, referring appropriate providers, and guiding clients through the recovery support continuum, you help your clients attain enduring sobriety.
Be sure that you do not stop educating your patients with everything they need to know regarding the methods of treatment you provide, and navigate with them to give in a more thoughtful and comprehensive manner to the treatment you supply. Vivitrol can be medication, but it’s your therapy that will actually change their lives.
