View Full Version : Insurance says Dex isn't FDA approved and won't pay for meds...


Funky1
01-10-17, 01:38 PM
What? Did I miss something here? Had no issues with BCBS, but Cigna won't pay for my meds. Can I fight this?

ginniebean
01-10-17, 01:52 PM
I would. Since what they told you is a lie.

Fraser_0762
01-10-17, 02:06 PM
What's your location? Is it available on prescription where you are?

Little Nut
01-10-17, 05:18 PM
Dextroamphetamine sulfate is approved to treat ADHD. Quick search found this. http://www.fda.gov/Drugs/DrugSafety/ucm279858.htm

I am going to guess that the issue isn't FDA approval, but that it is not a drug preferred by your insurer to treat ADHD. I would ask the pharmacist what the specific issue my insurer has just to confirm it is a payment issue. Get as many details from the pharmacist and talk to your Doctor's staff. If you want a better understanding of the issues you should be able to ask your insurer for a copy of the Drug Formulary that applies to you. It is probably posted on their site. HTH, -LN

Little Missy
01-10-17, 05:30 PM
Cigna made a huge change in their formulary this year on top of it is just about impossible that ever even pay the pharmacy at all. When I got the notice stating that all opioids are off unless you try all of the non-opioids to their satisfaction, my druggist put me on a different one with no premiums and it covers everything. Even the druggist gets paid well finally.

I just could not imagine trying that many different meds if you just had your leg cut off or something.

Little Nut
01-10-17, 05:43 PM
notice stating that all opioids are off unless you try all of the non-opioids to their satisfaction

WHAT!! I believe you, but it did get the confused look stuck to my face again for a bit.

I guess in the future you could use the letter as proof in a court of law that opioids may be off-formulary, but that "Crack" is on-formulary because it is obviously being used by whomever came up with this.

Funky1
01-14-17, 06:39 PM
They sent me a letter specifically stating that they were denying payment because the drug I had chosen was not FDA approved for my condition. Like I said, I didn't have this problem with Blue Cross. Thankfully, I did find that I can buy my prescription through Costco cheaply enough to get by for now, but for what I pay my insurance company I'd really prefer if they paid for it.

Jenn1202
01-14-17, 07:04 PM
I'm not sure, but I think what your insurance is doing is illegal. Maybe they're saying because based on this source (http://www.myadhd.com/treatment_tools/medicationchart.html) it hasn't been approved because it hasn't been approved to treat ADHD in adults over the age of 16?

Have you tried talking to your doctor about this? Your pdoc could try to work it out with your insurance or simply request an exception by submitting a form.

Joey P.
04-27-17, 04:43 PM
Hello everyone. First post after reading the Forums for a while. True, it's not, not if you are an adult. If you read the FDA prescribing info, adult treatment of ADHD is not mentioned as being an approved use. Adderal is though. I have no idea why.

But your Dr. can prescribe it to you.

With that said I have CIGNA insurance and dextroamphetamine sulphate is covered. I pay a $10 copay. I would appeal this.

sarahsweets
04-28-17, 06:19 AM
I think adderall xr is officially approved for adults with adhd and maybe vvyanse?

AED1955
04-29-17, 11:37 AM
It's all about cost, not FDA guidelines. My drug coverage is through an HMO which basically uses the Medicare formulary for determining if a drug is covered. They do not cover Dex but do cover Adderall. I pay $150.00 a month for 90 5mg tabs of IR Dex but when I was taking Adderall I had a copay of $18 a month for 120 10mg IR generic Adderall.

I had a pharmacist tell me that almost no insurance companies cover Dex anymore, even though it is more or less the same drug as Adderall.

Little Missy
04-29-17, 11:41 AM
Medicaid will pay for Adderall for an adult. Mine does, it says: Special Help.

sarahsweets
04-29-17, 04:36 PM
I had a pharmacist tell me that almost no insurance companies cover Dex anymore, even though it is more or less the same drug as Adderall.

Not only was I on dex spansules at one point, I am not on adderall xr and dex ir. I have had many different types of insurance companies over the years and never heard that almost no companies cover dex.

Little Missy
04-29-17, 06:05 PM
Medicaid will pay for Adderall for an adult. Mine does, it says: Special Help.

Mine also pays for Dexedrine.