I finally got the nerve up to get my Adderall script filled tonight and was told by the pharmacist that my insurance will not cover my adderall due to me being over the age of 22. I was flabbergasted and asked her to look into it and she called the insurance company and a rep. told her that my insurance co. does not cover ANY adhd medication for people over the age of 22. I am just stunned. This is my insurance company through my employer and it has a good reputation and covers thousands of people in this part of the state. Has anyone heard of this before? I want to fight this, for myself and the other adults that this company is covering.It sure seems like age discrimination. Any advice would be much appreciated.

Jen,

My HMO will not pay for Adderall - only for generic methylphenidate - regardless of age. So I pay my monthly premiums plus $120 for Adderal XR every month. Discrimination? No. It is specified in the contract. The only option is to switch carriers. Not worth it in my case because better plans would not be any less expense.

Generic adderall is fairly inexpensive but no generic for XR. Adderall has a rock solid 5 hour half-life. You might be able to buy the generic and simply take it 2x day. You should be able to cut the price in half.

Does your plan cover major medical costs and not leave you with thousands in co-pay or deductible? If so, you got good insurance.

Bob

I had a med my insurance company did not want to pay for.
After hearing from my doctor they started paying for it.
It's worth a shot to have your doctor contact them.
Good Luck

I was shocked yesterday!My insurance company payed over 40 bucks on my new Adderal script!Maybe cause it was generic.

This is very typical. Insurance companies do not typically pay for ADHD medications as ADHD is considered a psychological disorder of childhood. In some cases, insurance that _really_ wants to avoid paying will cite that ADHD is a childhood disorder that cannot develop in adulthood and therefore that it is a de facto preexisting condition. Those arguments are solid and very difficult to beat.

In most cases, prior authorization from the doctor will get them to pay, but the authorization often needs to be renewed yearly. In other cases, the insurance company simply will not pay because ADHD can be called a preexisting condition. I've seen doctors change the Dx on the books to narcolepsy, but that's a very shady practice and makes things difficult when changing practitioners.

At any rate, best of luck. And please don't blame the pharmacy or the pharmacists for this, or the technicians...far too many times at work do I get blamed for something that is the insurance company's fault.

As I always say, "the purpose of the insurance company is to cover the costs of any medical condition you don't have."

i am having the same problem with my insurance. they told me my doctor would have to switch me to strattera instead of adderall because strattera is the AD/HD med made for adults, not adderall. i'm still trying to work this out, but for this month i said screw it and paid for it myself. i was lucky to find a pharmacy that only charged $60 for 90- 10mg tabs generic adderall, one month's worth. walgreens wanted over $130. this particular pharmacy is pretty small and deals alot with medicare/senior patients. i'm not sure if this has anything to do with the price difference. call around and get price quotes. the pharmacy i went to is called Value Care Pharmacy in Menomonee Falls, WI 53051. I would look up their # and call to see if they have any affiliates in your area.

My insurance pays but initially I had to get a letter from the doctor. Plus they want one every year. This year I found out if the doc puts the diagnosis code on the script they don't bug me for a letter. :D

I have not had this problem, but I am 23 and still on my parents' healthcare plan for the next few months. Our insurance covered it, but that doesn't mean that everyone will.

As for the Adderall, generic regular Adderall is going to be cheaper than brand name Adderall or AdderallXR, but when my insurance screwed up and I had to pay full price, it was still 80 dollars for my month's prescription.

I finally got the nerve up to get my Adderall script filled tonight and was told by the pharmacist that my insurance will not cover my adderall due to me being over the age of 22. I was flabbergasted and asked her to look into it and she called the insurance company and a rep. told her that my insurance co. does not cover ANY adhd medication for people over the age of 22. I am just stunned. This is my insurance company through my employer and it has a good reputation and covers thousands of people in this part of the state. Has anyone heard of this before? I want to fight this, for myself and the other adults that this company is covering.It sure seems like age discrimination. Any advice would be much appreciated.
Call your insurance company and ask if they have an appeal process, that sounds flawed on their end trying to save some money.

Simply call and ask them if they would show up at a pharmacy with a prescription for Strattera (for the same condition), would they cover it? That doesn't make sense.

I had the same troubles Jen, with Dex. my dr. had to contact my Ins. company each month in order for me to fill it.

My insurance pays for my concerta; all I pay is a $10 co-pay.

If the 'powers that be' at your insurance company are so ignorant that they don't recognize adult ADD and the benefits of medication, maybe they need to be educated.

If there is a local ADD support group, you might want to work together to change that; or perhaps your doctor can help. You can't be the only patient in need of ADD meds.

Sounds discriminatory to me.

I plan to fight this but in the mean time I have started generic Ritalin, which is the only med I can afford out of my own pocket. Thanks for all the advice!!...:)