<My insurance> last year they refused to cover the Concerta I was prescribed, so my doc went with Adderall IR-generic. That went fine until today-they wanted full payment for my "amphetamine salts". It came to about 75 dollars-but I cannot afford that every month. What is the point of paying for insurance when they won't pay for anything.
I went to my doctor and told them how my conversation with the insurance went down. They spelled out dextro-something and Ritalin as the only two available for coverage and I would need a prior auth for either. But no adderall would be covered. Are there any pharmacies with decent prices to send my RX? Walgreens, CVS, Target or Walmart? Help!
Last edited by Administrator; 02-18-2012 at 11:35 PM.
You need to get a copy of your plan's prescription formulary to see in writing what is covered.
I don't think you quite understand how prescription coverage works. If they're telling you that there are ADHD drugs that are covered, but require prior authorization, it means they ARE covered. They just require your doctor to submit a form indicating why the medication is needed. It's a simple process. You're not going to find affordable stimulants anywhere. They're all expensive. Work on getting the insurance to cover your meds.
I assume the insurance company was referring to "dextro-amphetamine". It's one of the components of Adderall, so it might work for you. Ask your doc for a script, tell him the insurance said it's either that or Ritalin. When you take it to the pharmacy and they process the insurance, they'll be notified that the prescription requires prior authorization and fax the info to your doctor.
The Following User Says Thank You to sue0317 For This Useful Post: Toby706 (02-21-2012)
I only have whats called a limited benefit plan. All of the major insurance companies provide them. I'm 41. I only pay $38 a month for it. I use walgreens. The Insurance company & walgreens have a deal. The majority of my medications are free. The plan says they only pay $15 toward the script, but my scripts are $1000.00 a month, I pay about $50.00 maybe $60.00. It may be worth your while to look into it.
The Following User Says Thank You to iluv For This Useful Post: Toby706 (02-21-2012)
thanks for you replies. The story continues with all this...my doctor's nurse called me and said your insurance will no authorize ritalin or adderall. I would have to pay for them out of pocket. But they wrote an RX for Straterra. Which i had no issue with until the pharmacist said give it a month or two to "kick" in before changing anything. A month or two??? ***.
My manager is going out on maternity leave in 3 weeks and I have to fill in for her-there is no way I need a med change right now. i don't care how, all the doctors I have ever seen avoid med changes in a time of change. I just don't see any way to get around this but pay out of pocket and go on the lowest effective dose to drag out the prescription.
Yeah, Strattera is very different from stimulants. You should investigate further into your prescription coverage. Get a copy of the formulary. Call again and ask more questions. A lot of plans won't cover stimulants for adults without prior authorization.
You should look into patient assistance programs. The expensive brand name drugs usually have programs to help out uninsured or underinsured people get medication for free/cheap. I'd be surprised if Adderall XR still had a program because its patent has expired. Vyvanse definitely would. Look up their website. They have a link on the homepage to Shire's assistance programs. It might take a while to get approval, and I'm sure you need the prescription before applying, so call your doctor's office and tell them you'd like to try Vyvanse because there's a patient assistance program.
BTW, Vyvanse is dextroamphetamine, with a molecule attached to make it long acting.
The Following User Says Thank You to sue0317 For This Useful Post: Toby706 (02-21-2012)
I got a hold of the nurse at my doctors office-and asked to go back with Adderall. I will pay out of pocket-but I calculated my work days and divided the price out(i only take it when I work) and it seems "do-able". But I am looking a patient assistance programs in the meanwhile. Thank you for you kind words here.
<Yeah, Strattera is very different from stimulants.>
Sue-you can say that again. I was very concerned because there is 50/50 shot of it working....in like 2 months. I get easily distracted and behind without adderall, I can't imagine for a minute going back to that. I spent a good deal of time researching Strattera last nite, and it sounds more like an antidepressant than an adhd med. I think I am going the right way with my decision
Good decision with the Adderall. Strattera works OK for some, but overall, I think it's kinda a crappy drug for ADHD.
You should seriously think about Vyvanse. Paying out of pocket can really add up. If you get approved for assistance, the worst that could happen is that you decide you prefer Adderall and switch back.
Strattera is junk. I've yet to see anyone, here or elsewhere, that it actually helped, while tales of side effects are rife. My own experience was horrific, with extreme nausea being the most pronounced effect.
As to Vyvanse, it's dextroamphetamine with an amino group attached, intended to cut down on the potential for abuse; overall it's a pointless addition, but shouldn't have a negative effect on the efficacy.
Straight dextroamphetamine (Dexadrine) would likely work fine, but assuming you're an American, it's unlikely you'd be able to get your hands on it. While it's technically legal, I know of people that have managed to secure scripts for it, just to have the pharmacies refuse to fill them. It's an unfortunate side effect of the 'war on drugs' that you have trouble getting legitimately prescribed medications.
You mentioned in your initial post that Ritalin would be covered, have you tried that? Methylphenidate and amphetamine are very similar meds, and many find that Ritalin works just fine for them. It might be an option to consider, assuming you can't find coverage for amphetamine.
I too ran into that problem. I had my addderall filled at walmart and it was $81.00!!! Oddly enough I get my wellbutrin there too and it was half its normal price....it was some self pay thing that the clerk gave me I guess. But when I got my adderall filled there (at a different location) it was $81.00 like I said. Thats CRAZY expensive for me.. any suggestions on where the best place to get it filled or the cheapest??
You're not going to be able to find "cheap" Adderall anywhere. Pharmacies often have pricing deals for the uninsured for commonly used drugs, but not for stimulants. Nobody's going to cut you a deal for amphetamines. Just isn't gonna happen. The OP said his was $75. Doubt you can get it cheaper.
The Following User Says Thank You to sue0317 For This Useful Post: rexeffects (02-24-2012)
I got my insurance to send me a denial letter on my Adderall. They say it is not covered by their formulary and an override would be granted if it is documented that Strattera did not work me. Then only a tiering exception would be offered-I am no good at insurance lingo. It then ended with them needing a statement to support my exception request.
That was two days ago-yesterday when I got my mail. There was another letter with more paperwork from them with an application for an expedited appeal or a standard appeal. As I say I am a real amateur at insurance stuff-showed it to a friend and she says-appeal it to the highest court in the land...well, that is a stretch But the paperwork says I need an "advocate"-relative, friend, or attorney...huh?? I just want my meds..this stuff looks very ominous?!?
The world of health insurance can be a scary place full of ominous words, confusing phrases, and supervisors who magically disappear anytime you ask to speak with them! AND YET, when you do get lucky enough to find a health insurance representative with a heart, they can work wonders for you!
I think the trick is to keep calling until you find the right person who is actually willing to work with you and help you through their muddled world! Once you find that person, get their name (first and last) and operating number, extension, employee number, or whatever, and always call that person when you have a problem. Of course, that will only work as long as that person still works there. As soon as the higher ups learn that someone is actually helping people, that person will mysteriously be, "no longer employed," there (FIRED).
In the case of your insurance not covering certain medications, you need to get a copy of their handbook and go through it before you just accept that they don't cover your adderall. Most of the time, there are loopholes, or exceptions, where if you do A, B, and C, then you will be covered. It might take a few months, where you will have to pay for the medicine yourself, BUT if you get your meds approved, you might be able to have it covered retroactively.
My mother just went through all this garbage with her insurance, too. She's been on adderall for almost 15 years, then switched insurance (she gets her insurance through the City, and the City decided to go for the cheaper, crummier insurance, because the City sucks!), and suddenly the new insurance company refuses to cover her adderall! They didn't bother sending her any notification, she found out when she got the bill. When she called the insurance company, she was told that she never "proved" that she needed to be on adderall.... even though she was diagnosed ADD and prescribed adderall from a licensed psych doc, and had been doing the same thing for almost 15 years!! Anyway, a lot of phone calls and angry letters, and a whole bunch of loopholes later, she finally got "approved" and got the few months she had to pay out of pocked covered, too.
SOOOO, keep calling and fighting. I have a theory that insurance companies are banking on the fact that a majority of people will just give up and pay stuff out of pocket, so the policy is, "screw people first, pay them later.... but only if they really insist...."