What is Medication-Assisted Treatment?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 21.6 million people in the United States needed substance use treatment in 2019.
However, only about 12.2% received specialty treatment. One of the main reasons is the cost associated with comprehensive treatment plans.2
What is the Cost of Medication-Assisted Treatment?
The cost of MAT varies significantly depending on factors like:
- The type of medication used
- The frequency of doctor’s visits
- Counseling and therapy needs
Average Monthly Cost of Medication-Assisted Treatment
It is reported that the average monthly cost for buprenorphine, a commonly used medication in MAT, is about $100. Methadone can range from $350 to $450 per month.3
These costs, compounded with the expense of counseling services and necessary lab tests, often make MAT financially challenging.
This emphasizes the importance of understanding the cost of medication-assisted treatment. It is also important to learn about financial assistance programs and cost-saving strategies.
The Cost of Medication-Assisted Treatment vs. Other Forms of Addiction Treatment
Comparing MAT to other forms of addiction treatment can be complex. This is because it depends on the specific comparison.
For example, comparing MAT to residential treatment programs, outpatient treatment programs, or detox programs can yield different cost comparisons.
MAT vs. Residential Treatment
Residential treatment programs often have a high upfront cost. This is because they provide 24/7 care and housing.
But, these programs can sometimes be more cost-effective in the long run. This is especially true if they lead to a sustained recovery and prevent future relapses and associated costs.
MAT vs. Outpatient Programs
Outpatient treatment programs can include therapy and counseling. They may have lower upfront costs than residential programs but can also add up over time, especially if the treatment needs to be prolonged.
MAT is a Worthwhile Investment
MAT can often be a cost-effective treatment approach for many people with substance use disorders. The upfront cost of medication-assisted treatment can be significant.
But, the potential for improved health outcomes and increased likelihood of sustained recovery can make it a worthwhile investment.
Some studies suggest that MAT can reduce healthcare costs in other areas. These areas may include emergency department visits and hospitalizations related to substance use.
Important Note about Effectiveness and Cost of Medication-Assisted Treatment
It is important to note that the effectiveness and cost-effectiveness of any treatment can vary significantly between individuals. Individualized treatment plans are often the best approach.
Factors that can impact the effectiveness and cost-effectiveness of MAT include:
- The individual’s overall health status
- The presence of co-occurring disorders
- The individual’s level of social support
What Components Make Up the Cost of Medication-Assisted Treatment?
The cost of medication-assisted treatment can vary significantly depending on several factors.
Below are the different components that typically contribute to the overall cost.
This is often the most direct cost associated with MAT. The cost of the medication itself can vary widely depending on:
- The type of medication used (methadone, buprenorphine, naltrexone, etc.)
- The dosage
- The frequency of use
Regular visits to a healthcare provider are necessary for prescription refills and monitoring of the patient’s response to the medication. The cost of these visits vary depending on the healthcare provider and the region.
Counseling and Therapy
MAT is most effective when combined with counseling and behavioral therapies. The cost of these services can depend on:
- The type of therapy (individual, group, family, etc.)
- The frequency of sessions
- The therapist’s fees
Depending on the person’s needs, additional services may get recommended. These may include:
- Vocational training
- Educational services
- Peer support services
The cost of these services can vary widely.
The patient’s health insurance can impact the out-of-pocket cost of medication-assisted treatment. Insurance may cover all or part of the costs listed above, or it may not cover MAT at all.
Additionally, the patient may have:
- Other costs associated with their insurance coverage
Depending on the location of the healthcare provider or treatment center, there may be significant travel costs associated with receiving MAT.
Contributing Factors to the Cost of Medication-Assisted Treatment
Medication-assisted treatment for substance use disorders typically involves the use of medications. These are typically used in combination with counseling and behavioral therapies. This is to provide a “whole patient” approach to treatment.
The cost of MAT can vary significantly based on several factors.
Type of Medication
The cost of medication-assisted treatment varies depending on the type of medication.
For example, methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) are commonly used in MAT. Methadone is typically the least expensive, while naltrexone can be more expensive.
Frequency of Treatment
The cost will also depend on how frequently the treatment is required. Some medications need to be taken daily, while others might be administered weekly or monthly.
Length of Treatment
The duration of the treatment also impacts the cost. MAT is often a long-term treatment. MAT can last months or even years, depending on the individual’s needs.
Healthcare Provider Costs
The costs charged by healthcare providers can vary significantly. This includes:
- Consultation fees
- Costs for therapy or counseling sessions
- Other administrative fees
The patient’s health insurance coverage can greatly impact the out-of-pocket costs of medication-assisted treatment.
Some insurance plans may cover the full cost of MAT. Others may only cover a portion. Some may not cover it at all.
How Do Insurance Coverages and Policies Impact the Cost of Medication-Assisted Treatment?
Insurance coverage and reimbursement policies can significantly impact the affordability and accessibility of medication-assisted treatment. Below are a few reasons why.
Insurance can cover a significant portion of the cost of MAT. This can make it more affordable for individuals.
Without insurance coverage, the out-of-pocket costs for MAT (including medication, doctor’s visits, counseling, and laboratory tests) can be substantial. These fees may be a barrier to treatment.
Types of Treatment Covered
Not all insurance policies cover all types of MAT. Some may cover methadone but not buprenorphine or naltrexone, or vice versa. Other policies may not cover MAT at all.
This can limit the treatment options available to individuals based on what their insurance will cover.
Insurance reimbursement policies can also impact accessibility. For example, some insurance companies may require prior authorization for MAT, which can delay treatment.
Others may only reimburse for MAT if certain criteria are met. Criteria may include demonstrated failure of other treatment options, or they may limit the duration of treatment they will cover.
Some insurance plans may only cover MAT if it’s provided by in-network healthcare providers.
If there are few in-network providers in a particular area, or if the in-network providers have long wait times, this can limit accessibility.
Even if insurance covers MAT, there may still be significant out-of-pocket costs that make treatment less affordable. These include copays and deductibles.
Insurance Coverage Restrictions
Some individuals may not have health insurance at all, or they may have insurance that does not cover SUD treatment. This is a significant barrier to both affordability and accessibility.
The Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care.4
This has helped to improve insurance coverage for SUD treatment. But, many of the above challenges still persist.
Public Health Insurance Programs
Furthermore, public health insurance programs, such as Medicaid and Medicare, have different coverage and reimbursement policies than private insurance.
Some states’ Medicaid programs provide robust coverage for MAT, while others may have more limitations.
In general, individuals considering MAT should contact their insurance company to understand what is covered and what out-of-pocket costs they may be responsible for. They may also want to explore other options for funding their treatment.
Is There Financial Assistance for the Cost of Medication-assisted Treatment?
There are several financial assistance programs and resources available to help offset the cost of medication-assisted treatment.
Medicaid is a state and federal program that provides health coverage to:
- Low-income people
- Families and children
- Pregnant women
- The elderly
- People with disabilities
Coverage for MAT varies by state, but many states provide at least some coverage for these services.
Medicare is a federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with end-stage renal disease
It covers various forms of substance use disorder treatments, including MAT.
State Substance Abuse Agencies
Many states have agencies or programs that provide funding for substance use disorder treatment for people who cannot otherwise afford it.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a directory of Single State Agencies (SSA) for Substance Abuse Services on its website.
SAMHSA also offers various grants to states, territories, and tribal organizations to provide substance abuse treatment, including MAT.
While these are typically not given to individuals directly, they can increase the availability and affordability of services in certain areas.
Patient Assistance Programs
Some pharmaceutical companies offer patient assistance programs to help cover the cost of their medications. The eligibility requirements and benefits vary by program.
Health Center Programs
Funded by the Health Resources and Services Administration (HRSA), health centers provide care on a sliding fee scale. This means the cost is based on your income.
Some nonprofit organizations offer financial assistance for individuals seeking treatment for substance use disorders.
To access these options, a person may need to apply directly to the program or through a healthcare provider. They should check the eligibility criteria for each program, as these can vary widely.
Discuss Concerns With a Healthcare Provider
In general, it’s a good idea to discuss financial concerns with a healthcare provider. Providers can provide information about available resources or refer the patient to a social worker or financial counselor.
SAMHSA’s national helpline (1-800-662-HELP) can also provide information about substance use disorder services in your area, including affordable or free options.
Other Strategies for Lowering the Cost of Medication-Assisted Treatment
While the cost of medication-assisted treatment (MAT) can be a significant barrier, there are several strategies and alternatives that can help to reduce costs without compromising the quality or effectiveness of care.
Use Generic Medications
When available, generic versions of medications used in MAT can be cheaper than brand-name versions, without compromising the quality or effectiveness of care.
It’s important to discuss this option with your healthcare provider, as not all medications have generic versions. In some cases, a brand-name medication may be more appropriate.
Compare Treatment Providers
Costs can vary significantly between treatment providers. It may be worth contacting multiple providers in your area to compare costs.
It’s important to ensure that any potential cost savings do not come at the expense of quality care.
Explore Telemedicine Options
Telemedicine can be a cost-effective alternative to traditional in-person treatment. This is especially true for those who live in remote areas or have difficulty accessing transportation.
Telemedicine can also make it easier to access counseling or therapy sessions, which are an important component of MAT.
Inquire About Sliding Scale Fees
Some treatment providers may offer sliding scale fees based on the patient’s income. This can potentially make treatment more affordable for those with limited resources.
Utilize Community Resources
Community resources such as support groups can be a valuable and cost-effective addition to MAT.
While they should not replace professional treatment, they can provide additional support and accountability at little to no cost.
Use an HSA or FSA
Health savings accounts (HSA) or flexible spending accounts (FSA) allow you to contribute pre-tax dollars to pay for eligible healthcare expenses.
This includes prescriptions and mental health treatment. This can help lower your overall healthcare costs.
Long-Term Benefits that Make the Cost of Medication-Assisted Treatment Worth It
Medication-assisted treatment can lead to significant long-term cost benefits, particularly when compared to the costs associated with untreated substance use disorders.
Some of the potential cost benefits of MAT include:
- Reduced healthcare utilization
- Lower criminal justice involvement (arrests, incarceration, court costs, etc.)
- Increased productivity
- Reduced social service utilization (child welfare services, housing assistance, etc.)
- Improved quality of life
Important Note About the Benefits of the Cost of Medication-Assisted Treatment
It’s important to note that the specific cost benefits of MAT can vary depending on a number of factors, including:
- The type of substance use disorder
- The severity of the disorder
- The specific medication used
- The individual’s health status
- The presence of co-occurring disorders
But, many studies have found that, on average, MAT is a cost-effective treatment for substance use disorders.
The Cost of Medication-Assisted Treatment at Rise Above
While the cost of medication-assisted treatment may seem daunting, the treatment is worth it.
The medication-assisted treatment program at Rise Above offers:
- A comprehensive patient assessment
- A personalized treatment plan that includes FDA-approved medications (like buprenorphine, naltrexone, or methadone)
- Behavioral therapies
Our Approach to Treatment
We offer a whole-person approach to medication-assisted treatment for substance use disorders. We know how difficult it is to consider the cost of medication-assisted treatment and how to pay for it. We are here to help.
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