View Full Version : How Will Insurance to Pay for 2 Pills/day?


oasismonkey
08-10-16, 08:38 AM
Hello,

For those that got your insurance company to pay for 2 pills/day please let me know how you did it. My unsuccessful story is below, and I'm quite screwed.

I have Aetna insurance. They have been pretty decent and have only rejected 2 of my claims. I appealed the first one and won. But they are holding firm that Vyvanse can only be taken once daily. I was on 40mg in morning and 40mg in afternoon.

My doctor specifically gave me 2 doses cause when I take it at 7 AM it wears off at 2pm. I lost my appeal for 2 pills daily, and my doctor was helping me with my 2nd appeal. Specifically, Aetna requests "peer reviewed research" showing that 2 pills/day helps ADHD and/or binge eating.
My doctor's office called Shire and they didn't have any such research available to give. Furthermore my doctor who went to 2 ivy league schools (college and med) can't find anything.

How are people getting insurance to pay for 2 pills/day? I'm out $600 cause I paid in cash for my first prescription, since I won my last appeal with Aetna, and I was confident they would cut me a check like last time. I need to get another month filled tomorrow. I don't start work until September and can't afford to pay $1,200 for 2 months of medicine.

aeon
08-10-16, 10:02 AM
Vyvanse is an expensive, brand-name drug with no generic equivalent.

Switch to Dexedrine spansules (generic equivalent), and you’ll likely
have coverage for up to 4 pills a day, and you can easily recreate a
twice daily regimen...all with the same active ingredient as Vyvanse,
but for a heck of a lot less money.

The closest dosage to mirror your Vyvanse would be 2 x 10mg spansules,
twice a day, for 40mg total (Dexedrine is much stronger than Vyvanse
for the same dose.


Cheers,
Ian

oasismonkey
08-17-16, 11:20 AM
My doctor changed me to once daily 70 mg Vyvanse, because of the good results with binge eating. I proposed the Dexedrine as another poster suggested, but he said no. The first question the doctor asked when he saw me was how much weight have you lost? It is such a relief not to have your brain demand sugary foods at 2 AM.

sarahsweets
08-17-16, 11:40 AM
My doctor changed me to once daily 70 mg Vyvanse, because of the good results with binge eating. I proposed the Dexedrine as another poster suggested, but he said no. The first question the doctor asked when he saw me was how much weight have you lost? It is such a relief not to have your brain demand sugary foods at 2 AM.

What was the doctor's reason for saying no? With all the hoops you have had to jumpr through why is he so hung up on vyvanse? ??

aeon
08-17-16, 12:32 PM
Might be one of those types who have negative associations with the brand name of Dexedrine.


Thanks,
Ian

sarahsweets
08-19-16, 04:43 AM
Might be one of those types who have negative associations with the brand name of Dexedrine.


Thanks,
Ian
Or one of those types that have positive associations with the brand name vyvanse. ;)

sleepy
08-30-17, 12:13 AM
You could split the 70mg. What aetna plan do you have. I have choice pos II and guess I got lucky that one covers it...

sarahsweets
08-30-17, 05:11 AM
You could split the 70mg. What aetna plan do you have. I have choice pos II and guess I got lucky that one covers it...

What do you mean split the vyvanse?

Lunacie
08-30-17, 11:47 AM
You could split the 70mg. What aetna plan do you have. I have choice pos II and guess I got lucky that one covers it...

While you can split a tablet evenly enough, a capsule filled with two different
kinds of beads is not able to be split evenly. Vyvanse comes in beaded capsules.

aeon
08-30-17, 12:46 PM
Vyvanse comes in beaded capsules.

Back when I trialed Vyvanse for a month, the blue capsules were filled with powder.

That was a while ago, though.


Thanks,
Ian

CharlesH
08-31-17, 04:14 PM
Specifically, Aetna requests "peer reviewed research" showing that 2 pills/day helps ADHD and/or binge eating.
My doctor's office called Shire and they didn't have any such research available to give. Furthermore my doctor who went to 2 ivy league schools (college and med) can't find anything.

Vyvanse is officially FDA approved for both conditions. It seems weird that there wouldn't be any peer reviewed research to back it up. A simple search on pubmed would probably yield a lot of results. Have you been diagnosed with either condition? My guess is that Dexedrine and Adderall would probably have similar effects on average for both ADHD and binge eating, with each individual reacting differently.

sleepy
09-15-17, 12:06 PM
While you can split a tablet evenly enough, a capsule filled with two different
kinds of beads is not able to be split evenly. Vyvanse comes in beaded capsules.

Vyvanse has powder not 2 kinds of beads. That would be adderall xr.

Lunacie
09-15-17, 01:32 PM
Vyvanse has powder not 2 kinds of beads. That would be adderall xr.

I'll take your word for it because I've never opened a Vyvanse capsule to see.

However, it would still be difficult to divide a powder into exactly halves without
special tools.

jennywas
09-15-17, 02:57 PM
In 2012 I was prescribed Vyvanse 70mg and Adderall IR 30mg 2x daily. Now I have been diagnosed with ADHD for 6 years, and I believe I was undiagnosed during high school especially and also college. I can't seem to find any doctor who is open to either prescribing two different medications or two vyvanse a day and I have been to 3 doctors in the past 15 months. They all seem afraid or dismiss it as unnecessary. I just started working a few weeks ago in an office hours 1-6 and around 2 (like right now) I just lose focus. I'm supposed to be making calls right now and can't bring myself to do it. I am having an uptick in OCD/anxiety habits and I want to do a good job and be productive all day I feel like I am getting paid for nothijng.

sarahsweets
09-15-17, 04:09 PM
My doctor changed me to once daily 70 mg Vyvanse, because of the good results with binge eating. I proposed the Dexedrine as another poster suggested, but he said no. The first question the doctor asked when he saw me was how much weight have you lost? It is such a relief not to have your brain demand sugary foods at 2 AM.
No? Did you ask him why?

sarahsweets
09-15-17, 04:13 PM
In 2012 I was prescribed Vyvanse 70mg and Adderall IR 30mg 2x daily. Now I have been diagnosed with ADHD for 6 years, and I believe I was undiagnosed during high school especially and also college. I can't seem to find any doctor who is open to either prescribing two different medications or two vyvanse a day and I have been to 3 doctors in the past 15 months. They all seem afraid or dismiss it as unnecessary. I just started working a few weeks ago in an office hours 1-6 and around 2 (like right now) I just lose focus. I'm supposed to be making calls right now and can't bring myself to do it. I am having an uptick in OCD/anxiety habits and I want to do a good job and be productive all day I feel like I am getting paid for nothijng.

But why do you need either two different meds or just vyvanse? Why not just adderall or dexedrine?

jennywas
10-09-17, 01:20 PM
But why do you need either two different meds or just vyvanse? Why not just adderall or dexedrine?


I don't know if I need 2 different meds. Just two vyvanse/day. Don't know anything about dexedrine.

Lunacie
10-09-17, 02:05 PM
But why do you need either two different meds or just vyvanse? Why not just adderall or dexedrine?


I don't know if I need 2 different meds. Just two vyvanse/day. Don't know anything about dexedrine.

The quote feature is easy to use. Just look in the lower right corner of the post
you want to quote and press the button. It was very confusing to have Sarah's
comment first and not have it in quote format.

It's fairly common to take one extended release med first, and then take a
different instant release med in the same family as the first one is wearing off.
Like Vyvanse and Adderall or Dex. Or Concerta and Ritalin.