How long might I take a treatment medication, and does insurance cover it?

Why there is no single answer

Medications for alcohol and opioid problems are used for different lengths of time. ASAM notes that some are used only for a short time, such as medicines for alcohol withdrawal. Others are meant to help over a longer period while a person rebuilds routines and relationships.

The right length is a clinical decision made with you, not a deadline set in advance. Ask your prescriber what they expect at the start, and ask again at each review. The answer can change as your situation changes.

Alcohol medications

ASAM's handout on medications for alcohol use disorder suggests taking the medication for at least three months if side effects are not bothering you, and continuing for as long as it is helping. It says naltrexone, acamprosate and disulfiram can be stopped at any time without withdrawal symptoms. Topiramate and gabapentin, which are sometimes used off-label, should not be stopped abruptly.

The handout also notes that the skills learned in counseling or support groups keep helping after a medication stops. That is one reason ASAM recommends combining the two.

Opioid medications

ASAM's patient guide on opioid treatment says methadone, buprenorphine and naltrexone can be taken safely for years. It says any decision to stop or switch should be discussed with the clinician and made together.

For methadone, NIDA's Principles of Drug Addiction Treatment describes twelve months as the minimum and notes that some people continue to benefit for many years. NIDA's page on medications for opioid use disorder says naltrexone can be as effective as buprenorphine when taken over a long period.

Because methadone and buprenorphine cause physical dependence, NIDA says stopping should be done by slowly reducing the dose rather than stopping suddenly. If you are thinking about stopping, raise it with your prescriber before you change anything. Stopping too early or too quickly can bring back cravings and withdrawal, and after a period without opioids an old dose of an illicit opioid can cause an overdose.

Questions about length to ask

At the start, ask how long the prescriber usually expects someone in your situation to take it. Ask how you will both judge whether it is working, how often you will review it and what would make them suggest stopping, changing or continuing. If you already know you would like to stop one day, say so, and ask how that would be planned.

Checking insurance coverage

ASAM's page on addiction says most health insurance plans cover addiction treatment in a similar way to other medical conditions. Coverage for a particular medication, form and pharmacy still needs checking with your own plan.

ASAM's opioid guide notes that insurance coverage and price can help decide which form of buprenorphine is chosen. Ask the prescriber whether there are options if the first choice is not covered.

When you contact your insurer, name the specific medication and form, such as a daily tablet or a monthly injection. Ask whether it is covered, whether prior authorization is needed, what you will pay per fill or per month and whether there is a limit on quantity or duration. Also ask whether the appointments and any counseling that go with it are covered.

Methadone for opioid use disorder comes from an opioid treatment program, so ask the program what your plan covers there and what you would pay.

If cost is a barrier

NIAAA's treatment booklet suggests checking your plan's coverage and asking programs whether they offer sliding-scale fees. If you are uninsured, ask the prescriber or program about lower-cost options and whether you may qualify for public coverage.

Tell your prescriber if cost may make you miss doses or stop early. That is information they need, not something to hide. A plan you cannot afford to keep up is not a workable plan, and there may be an alternative that works for your budget.