There is a huge need for outpatient programs in every state that offer Vivitrol/naltrexone because of the opioid epidemic that has taken our nation.
The Opioid Epidemic
The epidemic has ravaged our country. Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.
It is estimated that 23% of individuals who use heroin develop opioid addiction. Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015.
Because of the epidemic, the addiction market is $35 Billion a year, according to Forbes Magazine.
What this means is that there is a huge need and demand for addiction outpatient services, such as Vivitrol injections and Naltrexone implants, that insurance is currently mandated to pay for to help save people from crisis.
What is more, services that can be delivered by addiction companies owned by non-clinicians and clinicians alike.
What is Naltrexone?
Naltrexone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. An opioid is sometimes called a narcotic. Naltrexone is used as part of a treatment program for drug or alcohol dependence.
Vivitrol is the brand name of naltrexone.
Naltrexone is used to prevent relapse in people who became dependent on opioid medicine and then stopped using it. Naltrexone can help keep you from feeling a "need" to use the opioid.
Naltrexone is also used to treat alcoholism by reducing a clients' urge to drink alcohol. This may help client drink less or stop drinking completely. Naltrexone will not cause a client to "sober up" and will not decrease the effects of alcohol you recently consumed.
It is fast to diagnose and to deliver, meaning that with right marketing and partnerships, there will always be someone needing and benefiting from it.
Outpatient Clinic Naltrexone Reimbursement by Insurance and Private Pay
Insurance companies are much more likely to pay and quicker to reimburse for medical/pharmacological intervention than mental health for addiction, although they are both necessary for a client’s recovery.
The cost of naltrexone differs by insurance type and is often covered by a client’s insurance.
For instance, Vivitrol reimbursements is usually range from $2,000 to $5,000 per month. Naltrexone implants, which is a simple 10 min outpatient procedure can pay from $6,000 to $26,000
(Stahl, S. M. (2014). Prescriber's guide: Stahl's essential psychopharmacology (5th ed.). New York: NY: Cambridge University Press.)
But keep in mind, sometimes insurance companies will require you to submit a prior authorization before they will cover naltrexone. A prior authorization requires you to meet certain criteria. Please ask us if you have questions about what prior authorization.
Starting an Outpatient program
Unfortunately, addiction is around us everywhere. But, we can help those who are suffering by having simple but effective outpatient program that can get people the help they deserve.
The steps are simple in concept, but, heavily regulated in practice.
The first steps, is to find an outpatient facility that is up to code with local zoning ordinances. For most municipalities, a general commercial zoned building is enough, but check with your local zoning office to be sure.
Second step, is to license that facility. Every state, has its own licensing criteria and procedures for licensing a medical or outpatient program. If you are unsure, contact a local licensing expert.
Third step, finding staffing, with the most important person being a licensed physician to help diagnose, write orders, perform some outpatient services, and chart with additional staff to assist the physician with outpatient procedures, and others for mental health services, and others to do billing, HR and other back office duties.
Fourth step, making sure that all medical records, and procedures are done within regulation and compliant with any law.
Fifth step, is to be able to send out proper bills to the client’s insurance companies that fit within their definition of medical necessity, and be compliant.
If you have any questions about anything within this article, Khatri Med Law can assist you with answers, and assist a complete start to finish services for a turnkey Naltrexone Implant/Vivitrol business.
Call for a free 15 min consultation today.