Additional Color from SA Comments
The revenue is truly ridiculous.
I run a well funded substance abuse/mental health field program. I work with psychiatrists and specializing doctors in this field. From single providers to organizations, I have first hand knowledge in diagnosing, stabilizing and qualifying a patient for the implant. The problems with the implant are as follows:
1. Patient inquires or is made aware of implant. Patient learns he/she has to have a stable dosage of suboxone first before implant. This process can be immediate if the patient is on maintenance or it can take weeks or even months!
2. Approval of the implant. Doctors were provided a 3-4 page application by Braeburn pharmaceuticals for authorization of implant. If you were lucky, it got approved right away (>5% of the time). Once you get initial denial, you contest the findings. The insurance company doctor and the requesting doctor hold a phone conversation regarding medical necessity of implant. This has a success rate of 50-60%. If this gets denied you file another dispute and you get the same conversation with a different independent doctor that holds the final ruling. This has a 60-80% success rate. Now this whole process of authorization is just for implant. A separate authorization is required for the actual procedure itself. Similar process but a bit less of a hassle.
3. Billing: doctors initially had no clue how to bill. They were given a self help booklet by Braeburn Pharmaceuticals but that didn't help. The J CODE used for billing initially was a $25 payout by Blue Shield and Anthem. The doctors were being paid similar to routine procedures and months late. Add to the hassle is That the patient has a 50% copay and if not the HMO plans literally might pay $10 for the implant procedure. Lets say provider is out of network But doctors don't know how much to charge since no one knows the industry set standard amount yet.
Insurance companies were not ready for the implant nor was Braeburn Pharmaceuticals. The launch was a mess. The first few months, the doctors were having a difficult time getting their certificate of procedure uploaded online for FDA approval to actually get the implants sent to. My providers were one of the first few to put the actual imlants. I have personally been involved in the approval with at least 5 patients.
