Waiting for Insurance Co. to renew Adderall script

[1lama3]

My 17-yo son has ADHD and has been doing pretty well after playing with a mixture of meds over the past year. Now it has been a year since diagnosis. I went to the Dr. and got a refill on his prescription and am awaiting insurance review and approval. I only have 2 days of meds left and figured that I'd skip and keep those for school days. Last night I picked him up from his girlfriend's house and he was a mess. Crying about the future, and fears that he doesn't have to worry about just yet. I just want to get him through High School. I'm so angry and frustrated and just needed to rant. Thank you.

[Onthemove1971]

I am so sorry for him to have to experience what it is like without medication. I am also sorry you have to go through this.

In the past my pharmacy has given me a short supply when needed.

Can you try this? Also the company who disturbed the medication ( not the maker) might be able to give your doctor samples?

Good luck! Big hugs

[1lama3 in reply to Onthemove1971]

Thanks, that is a great idea. They are trying to put it through again today as urgent.

[Hidden]

I have posted about this before. It's an outrage. Between the doctor not being able to do the refill to the pharmacy not stocking the drug and the insurance holding the acceptance... ARRGGH. I just feel like don't they understand that my child needs this medicaiton NOW? Listen insurance company, DO YOU KNOW WHAT IS ABOUT TO HAPPEN? And yes, I am going to call you EVERY SINGLE MORNING until you approve this because you have NO IDEA what this is like for my child and I. Would you like to come experience this first hand? Seriously, this is outrageous. I promise I am not selling this on the street, this is for me child that desperately needs this TODAY. HUGS. We have all driven four different places to get the script filled, waited on the insurance, called four hundred times....it is maddening. Hang in there.

[Ers3278]

We have a 15 year old young girl and she periodically wants to come off her medication on the weekend. Within hours of being off her medication she questions her confidence and the next day she awakes with a tremendous headache. We had her headaches checked out by her doctor but he claims it affects children differently. I feel your frustration, stick in there he'll be fine. We may age a little faster but that's part of being a parent.

[azgin]

Our insurance, Cigna, won't cover any ADD medications at all. We pay out of pocket $75 a month. seriously stinks.

[La_Indy in reply to azgin]

Azgin,

Does your insurance company cover other prescription medications? If they pay for antidepressant medication, then they would legally be required to pay for medication for ADD/ADHD. I know many plans require you to spend a certain amount out of pocket before they will start paying. ADHD is a neurochemical imbalance, and thus is a medical disorder.

[azgin in reply to La_Indy]

They told me that I have to meet my deductible first which is $6500 a year. Never going to hit that number. it's strange to me that they cover antibiotics and pain medication when we are sick but not this for a cronic problem. I've wondered if i'm the only one paying out of pocket for these pills.

[Elijah1]

Three points

1. There are no samples of stimulant medications such as Adderall because they are controlled substances (DEA Schedule 2).

2. If you are paying out of pocket, use a discount card such as goodrx.com. For generic drugs, it can be a big cost savings (up to 80%). Also, the immediate release tablets of the stimulant medications (Adderall, methylphenidate) are less expensive than the time release capsules and tablets. You have to give a dose at lunchtime at school but the savings can be dramatic.

3. If you have no insurance, Shire will provide Vyvanse at no cost (at least they did so in the past).

[azgin in reply to Elijah1]

I use GoodRX for our meds, that's how I get them at $75 a month. If I paid using my health insurance it's $150. So so lame

[beemom in reply to azgin]

Same-high deductible so w/ goodrx we get it down to 95 (and of course this means it doesn't even count toward chipping away at that high deductible because once you apply goodrx it doesn't go thru the insurance at all....ARGHHHHH).

[azgin in reply to beemom]

i guess it's some what comforting that someone else pays retail. it's just not right though

[beemom in reply to azgin]

Oh, it's hideous. I hate that this drug that is basically essential for my child to function is treated like a luxury item. Our health system is broken.

[seller]

I didn't realize that my insurance (UHC) apparently conducts a review on all of the meds prescribed for everyone on my plan once a year. In February, we had problems getting my son's Vyvanse in a timely manner because they were reviewing the need for it and ended up asking his doctor for a letter stating why he still needed it. This might be why your son's medication was late getting filled. I can't think of any way to fix this, since it's a controlled substance in our state, can't be ordered in advance, etc. I was fortunate that I had some spare Vyvanse from a few years ago and we filled in with that. At least now I know they will review it once a year and we will problems getting it filled on time.

[1lama3]

Thanks everyone. You are all correct. They had to review, then my plan year restarted on my high deductible plan (I exceeded my deductible last year because he was in a psychiatric hospital for 2 weeks) which is how I got his ADHD diagnosis. I got the approval but now it will cost over $200 a month plus his other prescriptions. I am trying to get the script changed to methylphenidate which will only be about $75.

[1lama3]

I finally got a resolution after a stress filled couple of days. The Dr. changed our meds to Adzenys XR-ODT which is a time release medication that we had before. It was a new med last year and we had a coupon for free for the first 3 months. We changed to Adderall when I found out the copay for this would be around $400 per month. The Dr. called her drug rep yesterday, who told her about a discount pharmacy which will allow me to get this medication for $35 per month. Why must I almost have a break down to get this knowledge. So frustrating. Thank you for all of your support.