Methadone is a synthetic opiate drug that is taken as a pill, liquid, or wafer to relieve extreme pain from a surgery, injury, or chronic illness. It is also used in the treatment of addiction to other opiods, such as heroin or narcotic pain killers. Methadone changes the way the brain and nervous system responds to pain, and is prescribed by a physician when a patient’s medical need outweighs the drug’s addictive nature and potential side effects. Special precautions must be taken when Methadone is prescribed, and dosage and directions must be followed exactly.

Methadone is used commonly to treat addiction over a long period of time as a part of a comprehensive treatment program. Methadone must be prescribed through an opiod treatment program that has been certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is strictly regulated by state and federal laws.

Treatment for Substance Abuse

The Centers for Medicare & Medicaid Services (CMS) provides a full range of services, including those services provided for substance abuse disorders. Medicare Part A (Hospital Insurance) may help cover the costs of inpatient care if you have been formally admitted into a Medicare-approved hospital or facility. Medicare Part B (Medical Insurance) may help cover the cost of care in an outpatient setting. Medications that are not usually self-administered may be covered under Part B if they meet all Part B requirements.

If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount of your services and supplies, and your deductible will apply. If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B coverage as Original Medicare, but many provide additional benefits, including an annual out-of-pocket maximum.

Medicare Part D Coverage of Methadone

According to CMS, Medicare Part D plans must include coverage for Part D drugs, either by formulary inclusion or via an exception, when medically necessary for the treatment of opioid dependence. Methadone is not a Part D drug when used for treatment of opioid dependence because it cannot be dispensed for this purpose upon a prescription at a retail pharmacy. It must be administered through a private or public Methadone clinic approved by the SAMHSA. State Medicaid Programs may continue to include the costs of methadone in their bundled payment to qualified drug treatment clinics or hospitals that dispense methadone for opioid dependence.

It is important to note that Methadone is a Part D drug when indicated for pain. Stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage plans with prescription drug coverage (MA-PDs) can vary in costs, and each plan may have its own formulary, or list of covered drugs. Due to the increased risk of addiction, overdose, and death related to opiod use, some Medicare drug plans have a program in place to help patients use these medications safely. Quantity limits and safety checks are in place to monitor these medications.

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