View Full Version : Switch from Dex to Phendimetrazine- insurance issues


j_dubs
07-07-15, 05:10 AM
I'm on my parents insurance and it ends August 1st when I turn 26 and I won't be able to draw obamacare being unemployed...I was thinking about trying to switch to something cheaper than amphetamines for ADD other than Ritalin, and looking online Phendimetrazine seems solid enough and is cheaper without insurance. It's used as an appetite suppressant...haha, well i've already lost so much weight from being on amphetamines my pants don't fit. Now if I'm cool with my doc why shouldn't I be able to get on this which is a much cheaper drug and less abused than the original Preludin.

Long story short, I got switched back to adderall stupidly from dex a few months ago and it was pretty much hell. I had to get switched back before the 3-month psych appointment. Sandoz is strong as crap, I was on the 30s and not even taking that much give me physical sides and irritable stomach and come down the next day. Almost to where I flipped out on my family when they were dog sitting and an unfamiliar dog was snappy and I was crashing from adderall. I'm back on my mallinckrodt 10mg dex 4 a day....the adderall takes a few weeks then it's side effects outweigh the benefit, which does not happen with Mally dex, my preferred brand.

Anyone know what to do about that insurance thing? Would Medicaid even cover either Phendimerazine or any amphetamines? Are there cheap coupons or med plans like those coupon websites say to go if you dont' have insurance? I'm solid with my P-doc and it's cheap enough to go not switching to go to another doc, but I want to prepare for what to say to him and have it factually oriented, same for sleeping medicine (Seroquel expensive and Neurontin helps with anxiety but not sleep and Clonidine kinda sucks for sleep as well. Belsomra is weird and I got a sample and do NOT recommend taking it).I'm also wondering how bad just stopping would be. I've cut back but I still would like something similar to amphetamines so I can focus to function. Sorry for the rant, but hey, life hits ya sometimes right...

namazu
07-07-15, 06:02 AM
A few thoughts [EDIT: OK, more than a few!]:

1. You don't have to be employed to qualify for a plan under the Affordable Care Act ("Obamacare"). (Whether or not you can afford a plan is another issue.) See details here. (www.healthcare.gov)

2. Because you will be losing your insurance when you hit 26, you may be able to enroll in a plan under the "special enrollment" thingamabob -- you don't have to wait for an annual enrollment period to begin.

3. Most of the plans with low monthly premiums have high deductibles, so whether or not you'd break even -- assuming only your regular medical care and meds, nothing catastrophic -- seems questionable. That said, backup in case of something catastrophic is a very helpful thing to have.

4. Are you sure you qualify for Medicaid? If your ADHD (plus any other disabling conditions) is severe enough, it's possible. But in general, if you're a relatively healthy young person, even unemployed and with little/no income, and not pregnant, it's often tough to qualify for Medicaid.

5. Would your parents be willing to chip in to help you cover your own insurance plan or medication co-pays, even if they can't technically keep you on their plan?

6. Don't go the phendimetrazine route -- especially if you already experience weight loss from amphetamines. It's not meant for ADHD and hasn't been tested for that purpose. Have you tried any of the methylphenidate-based medications? The generics are pretty cheap.

7. Some of the manufacturers of brand-name ADHD stimulant meds have "patient assistance programs" that provide discounts or free meds if you lack insurance and meet income guidelines. Shire has one for Vyvanse (https://www.shire.com/patients/patient-services/shire-cares), there's a discount available for Zenzedi (http://zenzedi.com/savings.php) (but still a $50 copay, which may be more than generic dex) and a similar one for Evekeo (https://www.evekeo.com/patient-savings-support/instant-savings-card).

8. But you may find that it works best -- both for cost and for not fixing something that ain't broke, in terms of effective treatment -- is to stick with generic Dexedrine, and use a combination of comparison shopping sites like GoodRx to find the lowest prices in your area and discount cards to (maybe) save money off that.

9. As for sleep -- do you have sleep problems independent of the ADHD meds, or is the ADHD meds that cause the sleep problems? You can get melatonin over the counter, and that's effective for some people. If you need something to really knock you out, that's another issue.

10. While it's a good idea to do your homework, you might find that asking your doctor for help choosing affordable medications will ultimately work better than throwing the internet advice dice. Though cost isn't usually most docs' big concern, if you explain the situation, the doc should be able to help guide you towards options that are medically sensible for you.

Best wishes!

j_dubs
07-07-15, 07:26 AM
A few thoughts [EDIT: OK, more than a few!]:

1. You don't have to be employed to qualify for a plan under the Affordable Care Act ("Obamacare"). (Whether or not you can afford a plan is another issue.) See details here. (www.healthcare.gov)

2. Because you will be losing your insurance when you hit 26, you may be able to enroll in a plan under the "special enrollment" thingamabob -- you don't have to wait for an annual enrollment period to begin.

3. Most of the plans with low monthly premiums have high deductibles, so whether or not you'd break even -- assuming only your regular medical care and meds, nothing catastrophic -- seems questionable. That said, backup in case of something catastrophic is a very helpful thing to have.

4. Are you sure you qualify for Medicaid? If your ADHD (plus any other disabling conditions) is severe enough, it's possible. But in general, if you're a relatively healthy young person, even unemployed and with little/no income, and not pregnant, it's often tough to qualify for Medicaid.

5. Would your parents be willing to chip in to help you cover your own insurance plan or medication co-pays, even if they can't technically keep you on their plan?

6. Don't go the phendimetrazine route -- especially if you already experience weight loss from amphetamines. It's not meant for ADHD and hasn't been tested for that purpose. Have you tried any of the methylphenidate-based medications? The generics are pretty cheap.

7. Some of the manufacturers of brand-name ADHD stimulant meds have "patient assistance programs" that provide discounts or free meds if you lack insurance and meet income guidelines. Shire has one for Vyvanse (https://www.shire.com/patients/patient-services/shire-cares), there's a discount available for Zenzedi (http://zenzedi.com/savings.php) (but still a $50 copay, which may be more than generic dex) and a similar one for Evekeo (https://www.evekeo.com/patient-savings-support/instant-savings-card).

8. But you may find that it works best -- both for cost and for not fixing something that ain't broke, in terms of effective treatment -- is to stick with generic Dexedrine, and use a combination of comparison shopping sites like GoodRx to find the lowest prices in your area and discount cards to (maybe) save money off that.

9. As for sleep -- do you have sleep problems independent of the ADHD meds, or is the ADHD meds that cause the sleep problems? You can get melatonin over the counter, and that's effective for some people. If you need something to really knock you out, that's another issue.

10. While it's a good idea to do your homework, you might find that asking your doctor for help choosing affordable medications will ultimately work better than throwing the internet advice dice. Though cost isn't usually most docs' big concern, if you explain the situation, the doc should be able to help guide you towards options that are medically sensible for you.

Best wishes!

Thanks for the advice, the sleep problems were already there but I can get knocked out, seroquel just started weirding me out, so I need to switch but a lot of the anti-depressant class or antihistamines he threw last time don't work and have mad side effects. #8 seems like a good choice, I'm going to get an appointment and figure that out before the month ends and start going through those apps. But very helpful thanks once again.

j_dubs
07-09-15, 02:31 AM
Once again looking through, is Evekeo a new brand? That's amphetamine sulfate, different tahn the Adderall mix which is what makes me lose weight and irritable moreso than dex. But I'm thinking even tho pharmaceutically clean, being a Richard Hell/punk fan....that's teeth grinding speed. Desoxyn obviously super stigma and out of the question but Dexedrine really is the champion, and it's controllable to give me energy and focus which the loose ends in my life I cannot tie together without which drives me to mental issues and drink and drugs.

I just want to be prepared to talk to the doctor, as I think I'm just going the insurance-less route- 30mg zenzedi with a 50$ co pay is manageable, and I get tired of taking so many 10mg pills.

namazu
07-09-15, 03:04 AM
Evekeo is a new brand. It may or may not cause the problems that Adderall did, depending on whether it's the specific amphetamine salts in Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate), or whether you just need the "dextroamphetamine".

Here's some info from the prescribing info for Evekeo:
Amphetamine, as the racemic form, differs from dextroamphetamine in a number of ways. The l-isomer is more potent than the d-isomer in cardiovascular activity, but much less potent in causing CNS excitatory effects. The racemic mixture also is less effective as an appetite suppressant when compared to dextroamphetamine. There is neither specific evidence which clearly establishes the mechanism whereby amphetamines produce mental and behavioral effects in children, nor conclusive evidence regarding how those effects relate to the condition of the central nervous system.

EDIT: I'm actually a bit confused now, because I thought "dextroamphetamine" just referred to the dex- isomer of amphetamine, but this makes it sound like it's different... Hmmm...

Protazoid
07-09-15, 09:09 PM
Evekeo is a new brand. It may or may not cause the problems that Adderall did, depending on whether it's the specific amphetamine salts in Adderall (dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate), or whether you just need the "dextroamphetamine".

Here's some info from the prescribing info for Evekeo:


EDIT: I'm actually a bit confused now, because I thought "dextroamphetamine" just referred to the dex- isomer of amphetamine, but this makes it sound like it's different... Hmmm...

Yes. It is different.

Dextroamphetamine is 100% of the d-isomer. All brands use the sulfate salt, I think.

Adderall (amphetamine salts) is a mixture of 4 amphetamine salts. Two of them are racemic, two of them are pure d-isomers. That gives roughly 25% L-amp, and 75% D-amp.

This new drug is comprised only of one racemic amphetamine salt. So it would be 50% L-amp, and 50% D-Amp. This is what Benzedrine was back in the day.

In most cases the L-amp molecule doesn't provide much theraputic effect on its own, but combined with the D-amp it can give some synergy that people respond well too. Thats why some people prefer Adderall.

Interestingly enough, the L-methamphetamine is perfectly legal (in the us). This can be bought at the store in nasal inhalers. On its own the L-isomers just cause increased peripheral stimulation without much to the central nervous system.

j_dubs
07-09-15, 10:35 PM
Yes. It is different.

Dextroamphetamine is 100% of the d-isomer. All brands use the sulfate salt, I think.

Adderall (amphetamine salts) is a mixture of 4 amphetamine salts. Two of them are racemic, two of them are pure d-isomers. That gives roughly 25% L-amp, and 75% D-amp.

This new drug is comprised only of one racemic amphetamine salt. So it would be 50% L-amp, and 50% D-Amp. This is what Benzedrine was back in the day.

In most cases the L-amp molecule doesn't provide much theraputic effect on its own, but combined with the D-amp it can give some synergy that people respond well too. Thats why some people prefer Adderall.

Interestingly enough, the L-methamphetamine is perfectly legal (in the us). This can be bought at the store in nasal inhalers. On its own the L-isomers just cause increased peripheral stimulation without much to the central nervous system.

Yeah, that's why I'm thinking it might be pretty good, I had a few Barr Adderall left over and taking a quarter of one of those for example doesn't seem to wire me as bad as a 30mg Sandoz-that stuff is strong yo!

I mean, I've cut back so much, I can get by with taking a 10mg or 7mg of Adderall for 7 hours or so. But I'm looking for what I can get deals for and this and zenzedi are new, so it seems like a win win, and I wonder if I could get samples from my doc for this? I'll see, he gave me that Belsomra, which is interesting at a lower dosage maybe, but it seemed to make my liver or something feel strange...

j_dubs
07-15-15, 03:21 PM
I took a chance and got scripts to Zenzedi 20mg. Now to see how much it will be w/insurance and a pharmacy that carries...any info would help.