View Full Version : Insurance denied any coverage for ADHD medications


kasia71
09-28-16, 03:07 PM
I recently switched insurance plans back to Blue Cross; an expensive policy that claimed all generic medications were at no charge. Yesterday I was shocked to find out that Blue Cross categorized every single ADHD medication on the market, including my son's generic Concerta, as a tier two med that is NOT covered at all! I went from paying $15 for a month supply to $210! How can they dismiss the need for these kids to have their medication to be successful in life; academically, friendships, etc. I'm writing this primarily to get it off my chest how disgusted I am, but also curious how many other families out there have experienced the same thing. Luckily, my pharmacy told me about a site called Good RX that provides coupons for medications which is going to reduce the cost from $210 to $102. Regardless though....Blue Cross should be ashamed of themselves. My insurance policy has gone from $450 to $550 to $768 per month in 3 years but my policy continues to cover less and less.

What has happened to health insurance is a mess!!

Caco3girl
09-29-16, 07:56 AM
Sadly that whole insurance market is in serious flux! It isn't your imagination, they really do cost more and really do give you less. I've heard pregnant women have to pre-pay hospitals now to deliver their babies because they already know that insurance won't cover it all!

I took my daughter to children's urgent care where they determined via x-ray that she had cracked her skull and needed to be transported to the hospital for a catscan and to determine the extent of the damage, insurance didn't pay for the ambulance.

As for ADHD, the doctor prescribed concerta, my insurance said no, you have to try vyvanse and aderall before we will cover the concerta. I guess the insurance companies now know more than doctors on what will work for my kid.

ADHDWife&Mom
10-04-16, 10:58 PM
Im not happy with how our insurance covers the meds either but I am lucky and found out after some digging that we have a per person deductible for pharmacy. They never told me this so I had to call three times before someone could give me the right info. Basically you have to pay the entire price as many times as necessary to hit your deductible and then the lower price. We had to pay full price for generic Adderall 3 times before they would give it to us for the generic copay. I have meds for myself (not adhd meds) that I end up paying full price out of pocket because it is cheaper than paying their higher tier copays though.
You might check to make sure that isnt happening with yours. Im guessing you probably already checked but like I said I had to go through 3 ppl at my insurance company before they "found" it in my policy.

Swissy
10-22-16, 08:13 PM
Different medication, but I was prescribed Vyvanse at a whopping $250 because I haven't reached my insurance deductible. I let my dr know and he switched me to adderall IR, a more reasonable $41. Maybe ask your dr if there is a similar/ generic that would be cheaper. Sorry you are dealing with this, insurance companies are terrible.

ToneTone
10-22-16, 10:20 PM
So, in your plan, there are NO generic ADHD medications in Tier 1?

That's astonishing and ridiculous.

I know Concerta generics have had some issues ...The FDA wants to withdraw approval of Concerta generics ... Any chance your insurance company is requiring you to get the name brand? ... I know I'm being desperate here ... I'm just so sorry to hear of this ....

And you're sure there is no "prior authorization" gimmick? My insurer won't pay for any ADHD meds, name-brand or generic, without a special note from my prescribing provider.

Any chance you can ask for an appeal? ... It just seems in the past two years, my insurance company wants me to prove everything more ... adding new hurdles to screen people out, I presume ...

Anyway, here's the FDA announcement:
http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm

So sorry to hear this.

Tone

aeon
10-22-16, 10:40 PM
Dextroamphetamine sulfate CR (generic Dexedrine) with Good Rx coupon is $304 per month for 120 15mg spansules.

Is that the result of FDA quotas, or lack of competition among pharmaceutical companies, or Schedule II, or the gouging of a captive market?

Yes.

Without the coupon, it is $625.

All out of pocket.


Cheers,
Ian

CrazyLazyGal
10-24-16, 10:36 PM
I recently switched insurance plans back to Blue Cross; an expensive policy that claimed all generic medications were at no charge. Yesterday I was shocked to find out that Blue Cross categorized every single ADHD medication on the market, including my son's generic Concerta, as a tier two med that is NOT covered at all! I went from paying $15 for a month supply to $210! How can they dismiss the need for these kids to have their medication to be successful in life; academically, friendships, etc. I'm writing this primarily to get it off my chest how disgusted I am, but also curious how many other families out there have experienced the same thing. Luckily, my pharmacy told me about a site called Good RX that provides coupons for medications which is going to reduce the cost from $210 to $102. Regardless though....Blue Cross should be ashamed of themselves. My insurance policy has gone from $450 to $550 to $768 per month in 3 years but my policy continues to cover less and less.

What has happened to health insurance is a mess!!

Whoa! If they claimed to cover all generics but actually don't, you might have a case with with state insurance commission for deception.

Can you switch plans again?

Although it's certainly not ideal, immediate release Ritalin may be an option. It's the same medication as in Concerta, but the delivery mechanism is different, so he'll have to take it multiple times a day, and rebound can be worse. Some people actually do better on immediate release Ritalin than Concerta, however.

A month of generic Ritalin should be no more than $40.

ADDon1
11-05-16, 06:09 PM
O my God, that's insane! In my humble opinion organisations that carry responsibilities regarding our health care should be made non-profit or governmental. Putting profits before people is a very bad practice when health care is on the line.