Cigna Opiates Rehab and Opioid Detox Coverage

Medication Assisted Treatment (MAT) is an approved method for treating a patient during the maintenance, detoxification and medically supervised withdrawal stages of the recovery process. Cigna members can use their Cigna Opioid Detox Coverage to seek MAT treatment for substance abuse.

Medication Assisted Treatment (MAT) is Available to Cigna Members

MAT offers patients’ pharmacologic benefits as a means to support the efforts members make to achieve and then sustain sobriety. These medications may also assist the patient while he/she is addressing medical and psychosocial issues.

Two medications are approved for use in the maintenance treatment of opioids: sublingual formulations of Buprenorphine and methadone*.

Cigna Opioid Detox Coverage for Medical Assisted Treatment should only be considered upon the completion of a thorough substance abuse evaluation; additionally, all of the other available alternative levels of care should be considered first.

Substance Abuse Treatment

Sometimes, MAT is included in a comprehensive program that provides substance abuse treatment at various levels of care.

*Many of Cigna’s Behavioral Medicine benefit plans explicitly exclude the use of methadone for maintenance treatment. Methadone may also be governed by state and/or federal mandates. Members should refer to their plan’s benefits to determine the terms of their substance abuse coverage.

Cigna Opioid Detox Coverage requires that before the Initiation of treatment:

Medical necessity is proven.
The member is diagnosed as having a dependence on opiates.

At least one of the following must be met:

The member is pregnant.

Documentation verifies that the individual has struggled with opioid dependence for at least a year.

To take advantage of his/her benefit for substance abuse treatment, the member must:

Be willing to abide by all treatment plans and recommendations.
Be actively involved in his/her treatment. This may mean he/she must participate in community or on-site based treatment. This treatment may include group, family or individual treatment, as well as Intensive Outpatient or Partial Hospitalization.
Have a consistent and supportive environment.
Understand the importance of complying with the physician ordered medication dosages.
Be older than 18; or provide Cigna with parental consent.

Exclusion Criteria

To receive Cigna Opioid Detox Coverage for MAT, the member must not meet any of the exclusion criteria listed below:

He/She is currently having suicidal ideation.
The member has a mental illness that may interfere with his/her ability to comply or adhere to the treatment protocols.
He/She has dependence on or is actively abusing alcohol without engaging in a treatment plan.
The member has a medical condition that makes dosing dangerous.
He/She has a prior history of an adverse reaction to MAT.
The member is currently abusing or obtaining opiates from another source, giving his/her medication to others and/or is hesitant to participate in the treatment plan.

Regulations for Providers Offering MAT

Any provider who wants to offer his/her patients with treatment using medications must have the appropriate Drug Enforcement Agency (DEA) certifications. To ensure Cigna Opioid Detox Coverage for MAT, the provider must also fulfill all of the legally mandated requirements.