View Full Version : Issues Filling RX

10-09-15, 01:44 PM
Hey everyone, a bit of backstory: 23 yo Female, recently DX'd about two weeks ago ADHD Combined. PCP suggested Concerta and I figured it was a good enough option to start with considering i've never tried any type of adhd medication (except for wellbutrin, treating what we thought was depression, which tipped me off on adhd and thus started the testing process)

I dropped my rx at walgreens on tuesday (10/6) and It still has not been filled. I've been on them about what the hold up is and at first they couldn't tell me, only that it was an insurance issue. It turns out my insurance (united healthcare) wouldn't cover the generic, even though when I look online it says it is covered and has a $10 copay. My medicaid wouldn't even look at the request until my primary insurance paid at least part of it. My primary said that they'll cover the name brand, but they need a prior auth to process it.

I called my doctor yesterday (10/8) to get the ball rolling and they said they'd call me when the doctor has done the prior auth and sent it to the insurance. They still haven't called. Is this a typical issue? Should I be calling my doctor again? calling my insurance? should I ask for a different med that causes less issues with my insurance? I can't afford to pay out of pocket.. it comes out to over $10/pill. What do I do?

10-09-15, 07:11 PM
This usually happens for people over the age of 17. (Typically insurances don't cover adhd medication for adults unless they jump through hoops)
Your doctor should of made a prior authorization with the insurance right after you dropped it off at the pharmacy.

Since most insurances won't allow a PCP to write a prescription for any adhd drug, unless you get referred to a least that is my experience.

10-10-15, 07:08 AM
IME any doctor can conceivably write an rx for a stimulant, its not limited to a p-doc only. I would personally show up at the office and explain the situation and ask if the office could "help" you. Usually when it comes to the overrides the doctors themselves are not the ones checking into it, its the office staff and many times you can get lost in the shuffle. They may not understand just how hard it has been for you and making eye contact and speaking to them in person helps.