medication

[Attentiondefdiff]

Have you been denied insurance coverage of your ADHD medication?

My company has medication listed as covered but when my doctor did the prior approval through they denied it because I’m over 18. Someone I know has been on a medication that worked well for several years and now the insurance won’t cover it. The new medication they recommended was not covered after a few months. In a year she has had to change medication 5 times. She has not had the same positive results of the original medication. I believe this is absolute disrespect of people’s health.

[BlessedLady]

It is common for Medicaid and other insurance to have different medications they cover for those under 18 vs those over 18. It is also common for them to change the drugs they cover during the year. Try GoodRx. They offer big savings on most prescription drugs. I know several people that used GoodRx or other Prescription Discount Cards to buy their ADHD medications.

[Attentiondefdiff in reply to BlessedLady]

yes thanks to good rx I can get a medication but not the best one. Even with good rx it’s over $300

[BlessedLady in reply to Attentiondefdiff]

The ones I know that use Prescription Discount Cards. Could not get their ADHD and other medications without the help. It can be helpful to talk with the pharmacist. The pharmacist where one of my friends gets her medications. Always checked for the cheapest card. My friend did have to ask the pharmacist to check for a lower price

[LisethHIS]

Hello, Attentiondefdiff

Thank you for contacting CHADD's National Resource Center on ADHD. When it comes to ADHD medication or other medication, I would recommend that you call your insurance company and get informed of your medication coverage. Your health insurance can deny medication if it's not in their formulary. Your doctor's office can submit a pre-authorization form on your behalf with all the medical information needed. It normally takes about 48 hours to get an approval or denial from your health insurance. The doctor is also able to appeal the insurance if denied but has to submit medical letter and documentation.

Here's a link that can be helpful, chadd.org/adhd-news/adhd-ne...

and

chadd.org/for-parents/medic...

If you have further questions, please let us know. We are here to help!

Liseth

Health Information Specialist

CHADD’s National Resource Center on ADHD

chadd.org

[Wasted71years]

I get great results with Vyvanse which is NOT covered by Medicare and therefore not by the Medicare part D supplemental insurance plans.

Frustratingly, the manufacturers discount coupon is not valid if you are covered by Medicare - although they don't cover it at all. They are pushing me to start over titrating with different medicines, but I don't want to waste months again. I am already 72 and I don't have an infinite amount of time to jump through hoops.

I do use GoodRx, which saved me substantially compared to the fully uninsured price - but still over 300 for a month out of pocket. I am (not so) patiently waiting for generics to arrive now that the exclusivity for the manufacturer expires in a few months. That should slash my costs and may even cause the plan administrator to start covering the generic version.

[LVinCali]

In addition to what others stated, I also experienced with my provider they wouldn’t cover Vyvanse until Adderall was tried and failed for a period of time. Then they covered Vyvanse which worked better for me, until ultimately I found one in a.m. and the other mid day was my ultimate answer to reasonable functioning AND managing anxiety brought on by inability to function. Perhaps that’s something to explore in case your provider subscribes to tricks like these. Good luck!

[Mamamichl]

I had my anxiety med not covered. My doc had to write a letter to insurance as to explain why it was needed (I tried many others and this was only one I wasn’t suicidal on). If it’s a med that works for you, have doc contact insurance, and you contact as well, explaining the situation. I had one insurance require off brand, and the other require name brand, and had to get good rx and go with a different pharmacy to get payments from 75 to 20.