Why Don’t Insurance Companies Cover Low Dose Naltrexone?

Low dose naltrexone is a proven treatment for drug and alcohol treatment. Yet despite all the plaudits it receives, hardly any insurance companies offer coverage for the medication.

Why Don’t Insurance Companies Cover Low Dose Naltrexone?

Why is that?

Stick with us as we try to get to the bottom of this. 

What Is Low Dose Naltrexone?

Naltrexone is a pharmaceutical drug used to treat people suffering from opioid addiction and alcoholism.

The term low dose naltrexone or ‘LDN’ merely refers to the low doses of naltrexone, ranging from 3mg to 10mg per day. 

Sometimes referred to as ‘Vivitrol’, it can be administered via injection or orally

How does Naltrexone work?

Naltrexone is an opioid antagonist and it works by nullifying the effects of opioid chemicals on the brain.

Opioid chemicals are common natural bodily chemicals that can elicit sensations such as bliss, relaxation, and relief (from pain).

When you take naltrexone, it prevents the brain receptors from receiving the message that an opiate has reached the brain.

This reduces cravings for alcohol and opioid-based substances, making it an effective treatment for drug and alcohol addiction and preventing relapses. 

With such a proven track record and FDA approval, it’s a wonder how it isn’t covered by many insurance companies.

Why Don’t Insurance Companies Provide Low Dose Naltrexone?

The reason your insurance doesn’t provide you with low-dose naltrexone is that it’s a compound medication.

Compounded drugs are medications that are a mixture of drugs or medications which have had their ingredients altered to meet the needs of an individual patient. 

You may be surprised to learn that many doctors have never even heard of LDN before! Pharmaceutical companies do not mass produce low-dose naltrexone, it’s not taught in medical schools, and so rarely would a doctor recognize it.

And if the doctors don’t recognize it, then it’s likely the insurance companies won’t either.

It’s also worth noting that low-dose naltrexone is fairly inexpensive. It’s usually cheaper for you to buy your prescription or monthly supply than it is to via your insurance.

Ultimately, having a low cost makes it accessible to individuals who cannot afford an insurance plan which covers LDN.

Is Low Dose Naltrexone Safe?

LDN is perfectly safe and it can be very effective when used properly as a treatment for opioid or alcohol addiction; reducing a patient’s reliance on the substance without causing withdrawal symptoms.

4.5-mg is the recommended dosage of LDN, however, thorough studies on the correct dosage of LDN are yet to be performed to identify an individual’s optimal dosage.

Many variables may impact your response to the recommended dosage, such as body mass index, differences in metabolism, immune system strength, and opioid receptor sensitivity.

As far as side effects are concerned, such a low dosage means the side effects are minimal.

Patients have been known to experience deeper sleep but also insomnia. Mild side effects like nausea or constipation usually end in 2-5 days. 

What If I Am Prescribed Low Dose Naltrexone But My Insurance Doesn’t Cover It?

What If I Am Prescribed Low Dose Naltrexone But My Insurance Doesn’t Cover It?

If you are prescribed LDN but your insurance doesn’t cover it, you can still pick up your prescription from a compounding pharmacy.

You’ll just need the prescription from your doctor or prescriber, detailing your patient-specific dosage, for your order to be processed.

The pharmacist will then compound and dispense your dosage accordingly.

Make sure you pick up your LDN prescription from an experienced and accredited pharmacy because compounded LDN capsules must be immediate-release tablets, free from certain binders and fillers.

It may still be possible to get insurance coverage for LDN under the Affordable Care Act’s requirement for insurers to offer treatment for drug and alcohol addicts.

As mentioned earlier, naltrexone is a proven treatment for opioid addicts and on that basis, you could be entitled to LDN coverage. 

In the majority of states, insurance companies are required to provide coverage for treatment programs, under certain conditions.

But in some states, insurance companies can deny treatment programs that aren’t under Medicaid coverage.

Be sure to check with your provider and your state’s policy on whether you may be covered for LDN.

Low Dose Naltrexone Alternatives

If you’re refused LDN coverage by your insurer and you’re struggling to find a compounding pharmacy that can dispense LDN for you, then you may want to consider these FDA-approved alternatives to naltrexone.

Acamprosate

Acamprosate calcium is a pharmaceutical drug that is used to treat people suffering from alcoholism.

Research shows that drinking alcohol tampers the chemical balance of neurotransmitters in your brain.

Acamprosate specializes in restoring the balance of neurotransmitters in your brain, back to working order.

However, unlike naltrexone, Acamprosate doesn’t prevent withdrawal symptoms, which makes it a less effective treatment. 

Acamprosate’s recommended dosage is 666 mg (two tablets), taken 3-times every day.

But for further details about your recommended dose, make sure you contact your doctor.

Disulfiram

Disulfiram, or Antabuse (brand name), works differently from naltrexone and acamprosate because it’s essentially a deterrent to drinking. Its goal is to make your drinking experience as unpleasant as possible. 

Alcohol is converted into acetaldehyde when it enters your body before it’s then converted into acetic acid.

Disulfiram intercepts the conversion from acetaldehyde to acetic acid, resulting in a toxic build-up of acetaldehyde.

This causes you to feel sick every time you drink alcohol, essentially deterring you from drinking alcohol. 

Much like acamprosate, disulfiram doesn’t prevent withdrawal symptoms nor does it reduce cravings for alcohol. It is merely a deterrent to drinking.

Disulfiram’s maximum recommended daily dosage is 500 mg. Contact your doctor for your recommended dose.

Final Thoughts 

So the next time your insurer denies you low-dose naltrexone coverage, you’ll know why.

And you don’t need to fret because LDN is affordable and available at your local compounding pharmacies when you bring your doctor’s prescription. 

Remember to check with your insurance provider to see whether you’re covered for LDN.

And don’t hesitate to contact your doctor about any of the aforementioned medications and your recommended dosage.

Ryan Ascroft