I have Anthem Blue Cross and once again they have denied coverage for my Adderall. And once again my GP has to fax a letter stating that I have adult ADD and I need medication. :rolleyes:

Look, we all know that adult ADD does exist. Why is it that a organization such as Anthem BCBS can be totaly clueless about such matters?

I'd like to approach Anthem directly about this matter but I'm not sure if this is the way to go. I could make the switch to Straterra but my fear is that they may deny me based upon their assumption that adult ADD does not exist.

if the adderal is your med and its working domo, i would not do a thing but wait and see.see if you get the override as a result of your gp writing the letter.then if youdont get the override you may wish to approach them directly.why would they cover strattera but not adderal?

why would they cover strattera but not adderal?

You have a point. I just think they're playing games with their "formulary" system. But honestly I do not know.

It may not be that fact that the insurance company doesn't believe in adult AD/HD. Strattera is the only medication which has been approved for Adult AD/HD. While all the other medications are prescribed to adults they have technically only been approved for children with AD/HD.

You may also want to think about contacting the makers of ADDerall and let them know about the issue.

Originally posted by livingwithadd
You may also want to think about contacting the makers of ADDerall and let them know about the issue.

I'm on the generic version. I don't know who makes it. I just would like to see Anthem get a clue.

Just to make things clear. They normally don't cover Adderall for anyone over the age of 19. My GP writes a request for an exception. That request lasts for 6-9 months. Every 6-9 months, my GP has to send that letter to Anthem. The whole affair is getting tiring.

BTW, I found out that Strattera is not on the formulary list.

The thing is that insurance companies don't have to cover AD/HD medications for adults with AD/HD because most of them have only been approved by the FDA for children. It has very little to do with the whether or not they believe the existence of adult AD/HD.

I have had my fair share of issues with health insurance companies so I am by no means am sticking up for them. But this goes beyond the insurance companies.

Shire( http://www.shire.com ) is the maker of ADDerall and even though you may be taking the generic medication they are the ones who really should be contacted.

I'm sure once they and other companies realize that they will be losing money to Eli Llly because Strattera is the only medication approved for adult ADD they will try harder to get their own medications approved for adult ADD.

Great idea Tara. I would not have thought of that.

Tara - nice idea. Who would we contact? Maybe we could get a form letter sent out for everyone. :)

I, too, am very frustrated with the hoops my p-doc & I have to go through in order to get my meds (Concerta) covered by the insurance company. Every time we alter the prescription (even to go from a 1-mo. to 2 or 3-mo. supply), a form has to get filled out, which, I can assure you, my dr. is not happy about doing. So, I hope my meds stay working for quite a while.

Domo - I feel your frustration, I've already been through a few struggles - the worse was with my pharmacy, actually. I had called the insurance co. They reasonably explained what I need to do, and what they were willing to cover (what prescription I was authorized for ) and then went to pharmacy to get prescription - and the pharmacy said that my insurance company wasn't going to authorize that. I tried real hard not to start yelling at them - I was SO frustrated. I kept telling them, yes, my insurance company WILL cover it - they told me they would.

And the pharmacy girl said, NO, I'd have to pay extra. I was so furious by then. I am SO tired of running in circles. I don't know what else they think I'm going to do with the meds - I have better things to do with my time than use them illegally, sell them, or who know's what else I could do with them!? (I don't know).I am just SO frustrated sometimes.

It turns out, (after I think I must have scared the girl off - she deserved it, though), another technician/pharmacist came over to help me & I reexplained the problem, he consulted my chart/computer record, ask the original girl who was helping me - the one who was going to give me the prescription to begin with (it was the 2nd girl who came over who decided - "no" I would have to pay full price if I wanted the meds - shows what she knows) - and said , that I had to wait 25 days between filling each prescription. So if I came back in 3 days, I could get the full prescription, without a problem , for just the copay. And that **** was trying to tell me my insurance company wasn't going to pay for it at all.I was so mad. She didn't even knowwhat she was talking about. I don't know why she butt in , anyway. Argh - I'm still annoyed - and it's been 2 months, lol. May try a different pharmacy next time.