View Full Version : My insurance does not cover meds, can I ask my primary physician to prescribe meds?


tompost
07-23-17, 09:28 PM
Hi! so im new to this forum and one of the main reasons for joining was to get feedback on a few questions i had, one of them being: Can I ask my primary physician to prescribe my adhd meds that my psychiatrist has prescribed me? Reason being is that my insurance does not cover mental/behavioral health benefits, and the cost of adhd meds without insurance is at most, about $375 for a month's worth. I know that it may depend on my own physician and what they say, but I would love to hear your own feedback on similar experiences. If further information would help, I was prescribed vyvanse, which is, as some of you may know, one of the most expensive meds out there. I have been on this medication before when I was a teenager, so I know that, for me, it works, but I would also be asking my physician to prescribe me lexapro, as I have been recently diagnosed with Generalized anxiety disorder.

Thanks!

sarahsweets
07-24-17, 05:03 AM
If your insurance doesnt cover meds why would it matter who prescribed them?

Cyllya
07-24-17, 05:18 PM
Primary care providers can prescribe ADHD meds and other psychiatric meds. However, for covering the cost of the actual medication itself, I think insurance companies generally don't care who prescribes it.

If their coverage decisions are based on what you're being treated for, they look at the diagnostic info sent by the doctor, not the doctor's specialty. (Like, getting a psychiatric med prescribed by a non-psychiatrist doctor won't trick the insurer into thinking it's treatment for a non-psychiatric problem.)

If they cover the meds but don't cover the office visits with the psychiatrist, then having the PCP prescribe is indeed the solution.

If I remember right, back when I had insurance without mental health coverage, they covered psych meds the same as other meds, they just wouldn't pay for therapy or a psychiatric specialist. That may be the case with you. However, they have "tiers" of meds and they sometimes won't cover more expensive stuff. Sometimes they will cover the more expensive stuff if the doctor tells them the low-cost options don't work for you, but that will usually require you to trial the low-cost meds first, if you haven't already.

tompost
07-24-17, 05:57 PM
@ sarahsweets When I was 15-17, my insurance was not able to cover my vyvanse because they would not cover the psychiatrist who prescribed it (weird, I know, but thats just how it was), which is one of the main reasons that I went off it (and because, truthfully, my psychiatrist was adamant on me staying on vyvanse and refused to prescribe me something else other can concerta, which did not fit well with me). This was about 5 years ago, as I am 20 now and have a new psychiatrist and handling things on my own, but my father still pays for family health insurance (BCBSTX). After seeing a couple of posts on here regarding insurance and meds, I think that it may best to ask my psychiatrist to potentially put me on something else that has a generic counterpart. Thank you for your reply. It really made me think about why it would matter who prescribed the meds and encouraged me to find out more details about that.

tompost
07-24-17, 06:12 PM
@Cyllya Thank you so much for your reply. Now that I think about it, I believe my insurance had covered my concerta when I was prescribed it (it ended up not being right for me, so I went back on vyvanse), but that was a while ago. I think my best case is to go back see my psychiatrist and ask him to prescribe something else that preferably has a generic counterpart. The reasoning behind my initial question was that, when I was preparing to move to a new city for school, I was concerned about my meds and whether or not I would be able to make a smooth transition to a new psychiatrist. I called a few places a couple of weeks ago to inquire about the costs and what would work best when I would be out of town and potentially pay for my own meds when before my parents would pay (though, it was still super expensive and we did try to get coupons and discounts when we could). One of the places that I called said that if my insurance does not cover mental/behavioral health benefits, I could use the prescription from the psychiatrist and present it to my primary physician and that she would be able to prescribe it and that my insurance would cover it, which is where my question came from. Your reply helped me greatly and has lowered my anxiety regarding this, so thank you!

CharlesH
07-25-17, 03:24 AM
Generic IR Adderall is relatively cheap, even without insurance (like $1/pill), comes in a wide dosage range (5mg-30mg), and are scored so you can split them in halves/quarters to save even more money (cost for most meds is more based on number of pills than dosage per pill). Vyvanse is about $10/pill. Is Vyvanse really 10x better than Adderall on average? For most people, the answer would be a resounding no.

Insurance can't restrict what meds your doctor prescribes, or what meds you receive. But insurance can deny financial coverage for those meds. Of course, people who can't afford to pay out-of-pocket might view this as a distinction without a difference. A responsive doctor should take into account your insurance and financial situation when prescribing potentially-expensive medications.

tompost
07-26-17, 02:13 PM
@CharlesH Thank you for your reply. I really am considering speaking to my psychiatrist to see if he'd prescribe something I can afford on my own like Adderall. I believe that my insurance just declined to cover the vyvanse I had been taking at the time. Maybe this time it will be different if I have a cheaper medication. Your reply had a plenty of great information. Thank you so much!

sarahsweets
07-26-17, 04:18 PM
@CharlesH Thank you for your reply. I really am considering speaking to my psychiatrist to see if he'd prescribe something I can afford on my own like Adderall. I believe that my insurance just declined to cover the vyvanse I had been taking at the time. Maybe this time it will be different if I have a cheaper medication. Your reply had a plenty of great information. Thank you so much!

Vyvanse is VERY expensive with no generic alternative. Insurance companies often do not cover it.

CharlesH
07-27-17, 04:40 PM
@CharlesH Thank you for your reply. I really am considering speaking to my psychiatrist to see if he'd prescribe something I can afford on my own like Adderall. I believe that my insurance just declined to cover the vyvanse I had been taking at the time. Maybe this time it will be different if I have a cheaper medication. Your reply had a plenty of great information. Thank you so much!

You're very welcome! Come to think of it, generic IR Dexedrine/Dextrostat would be a slightly closer match than generic Adderall. Vyvanse is acts like an extended release version of dextro-amphetamine, while Adderall is a mix of dextro/levo-amphetamine, and Dexedrine/Dextrostat is only dextro-amphetamine.

Though generic Dexedrine/Dextrostat is about 50% move expensive per pill than generic Adderall, and the dose options are only 5mg and 10 mg. You can look at the goodrx website to get an idea of out of pocket costs, and you can get free coupons. But I'd imagine that almost any insurance would cover generic IR Adderall, Dexedrine, and Dextrostat since they are all relatively cheap.

Dexedrine has a bad reputation among some doctors since many decades ago (before Adderall existed) it was heavily abused. Times were different back then, and I think amphetamines were even available over-the-counter at one point!