So, I had an interesting experience... I was diagnosed with ADHD inattentive two weeks ago by my psychologist, she coordinated with my primary care physician who I saw today and discussed going on meds with... and I was given a prescription for 10mg of Adderall XR....

I went to my pharmacy, gave them my prescription, walked around for 20 minutes, came back and the pharmacist explained to me that my insurance company denied me coverage for this medication on the basis that I was "too old" to be receiving it.

The pharmacist said the woman she talked to from the insurance company said that they might be able to cover it, she just had to talk to some people. So, my prescription is currently sitting unfilled at the pharmacy, until she hears back one way or another.

That said, I'm kinda flabbergasted about the whole thing and not really sure what to think at this point.... It's possible that the insurance company will iron itself out and cover my meds.... but what if they don't?

Is it common for health insurance companies to deny coverage to meds based on the fact that they think you're "too old" to be receiving them?

I'm not sure if this is a policy that my health insurance company has just for Adderall XR, or if they say all of the drugs to treat ADHD I'm somehow "too old" for.....

Any thoughts or wisdom?

Any thoughts or wisdom?

I remember watching a documentary on ADHD in the UK (on youtube). It mentions what drugs were available and how it was officially limited to those 16 and under. So some health authorities not up on the research do view it as a childhood condition. Though I know an adult online from London who was rx dexedrine anyway. Your case is easy to explain though those crooks do not want to pay.

Yeah, you have to fight fo' yo' right. I can't think of any valid reason they could have for denying you these meds. They haven't seen those commercials for adult ADD?

My doctor said something to me about how it's "very rare for someone my age (seventeen) to be diagnosed with attention deficit." And that it's almost always children. I don't know if that's true or not. =/

My doctor said something to me about how it's "very rare for someone my age (seventeen) to be diagnosed with attention deficit." And that it's almost always children. I don't know if that's true or not. =/

Primary inattentive types are often not detected at a young age. Hyperactive types often get notice at a young age. The very notion of the word ADD/ADHD to me just 2 years ago meant dumb, hyperactive(bad behavior), young boys. I would not have thought for one second I had anything in common with them.

I have been having a similar problem. One of the first things my GP said to me when I broached the subject of ADHD was, "We don't usually diagnosed people your age." Needless to say, I was rather offended. (I am in my late 50s -- you didn't mention your age?)

I don't anticipate having any difficulty getting medication once I have a diagnosis, because our system functions differently. But getting a diagnosis has been a real *****.

Having said that, maybe I should look into the pharmaceutical situation, since some of our medications require an additional letter from our doctor in order for the prescription to go through. I ran into this problem with omeprazole, and I'm still not entirely sure why the additional barrier was put in place.

Good luck with your insurance provider. Why aren't they obliged to honor the recommendations of your doctor? Sounds like they are trying to practice medicine without a license :D.

Ducky

Yeah, I had one crappy insurance company that wouldn't cover my meds because I was over 18. They would cover the doctor visits under the "mental health" category, but not the meds the doctor prescribed to me. :mad:

Why aren't they obliged to honor the recommendations of your doctor?

Yeah. I was under the impression that if a doctor wanted to try a drug off label that it was up to his discretion. I guess then it's up to the insurance company to pay for it or not. The insurance company/nor the pharmacy doesn't have any idea what he's treating you for. You could be taking it for narcolepsy (I don't think there's a mythical age limit for that disorder). (They also give small doses of Ritalin to stroke patients...are these people too old too?) I guess it comes down to what's on your formulary and if your insurance company will honor off label use. If you want to find out for yourself you could call the number on the back of your insurance card.

Let us know how things work out.

That is something I cannot understand because the DSM-IV-TR has in it's diagnostic description specific symptoms and how they manifest themselves in adults.

I would look into a way to override this.

At this point I'm not sure how it's going to play out. The pharmacist told me to call back around 3 today to see if they were able to push it through...

I feel like I'm overly frustrated with the whole thing because I just don't cope well with the unpleasant surprises. If something is potentially not going to be covered, I'd like to know beforehand.... and I feel like insurance companies (in general) do a crappy job offering a way to find out that sort of information. I know most companies offer some way to check up on your status online, but I can't figure out how to set up an account on mine because our plan is sold through another insurance agency and the ID numbers that we have don't match the format of the ones on the overall insurance company's online account signup page... and I don't even really know if they'd provide useful info once I signed up anyway.

I think that Strattera may be the only ADHD drug 'approved' to treat Adults. I may be wrong, but I remember that was one of the big things they were touting when it came out.

It ended up all working out for the best, I called the pharmacy and everything went through and the insurance company approved it.... so just a minor blip in the radar I guess. :)

Must be nice to have insurance and not have to pay for both doc visits and meds out of your own pocket each and every time.

Still, I'm glad it worked out for you.

Glad it worked out for you. I was all puffed up thinking that age was going to be barrier for treatment.