View Full Version : insurance limits on meds? (Focalin)

08-08-08, 10:14 PM
My nephew is 7, he has been on Adderall XR 10 mg for about a year now. His grades have improved and he can read and do math now, but his behavior in school is very distracting, so bad that his teacher called me one day to take him home because basically he got on her last nerve (I could not fault her for that either, because most days he gets on my last nerve too). His behavior at day care is good days or bad days mostly with not listening. His behavior at home with his day he was such a holy terror...jumping on furniture, running around, locking her out of her room, even so bold as to go outside unsupervised calling himself getting the mail :mad:. His behavior is abysmal most days-very poor impulse control and become more and more oppositional and just staying in trouble being disobedient.

I finally got him in with a psychiatrist and he will be starting therapy too. The psychiatrist said the dose of Adderall for him is too low (which I already knew but at the same token he also hasn't grown in the past 2 years and I'm trying to avoid side effects, plus monitor him for possible bipolar, anxiety, depression, OCD, and ODD which I do see a lot of traits going on there). We decided to try Focalin XR and she wants to put him on 20 mg.

So I took his final Adderall and his first Focalin to be filled at the pharmacy today. The pharmacist looks at it like why is he on both. I explain to him he is transitioning, not on both concurrently, and I need to try to Focalin at home on days I can observe him for side effects, before he goes to school. I'm not going to put him on a med and send him to school cold. School starts in 10 days. That would have given me 2 weekends to watch him on Focalin, and then having him on Adderall on my workdays, just to make sure physically he would be okay. The pharmacist then said he had to call the doctors to see if it was okay. Fine...this was 3 pm. I said just call me when it is filled. 7 pm no phone call, so I go to the pharmacy. The Adderall was filled but the Focalin was not. Supposedly my insurance has a max dose of 10 mg per day and will not fill it without speaking to the psychiatrist (so what is the point of writing a script? for a med that cannot be "called in" because it's controlled?) Fine...I was like I will pay for it out of pocket...$300 but it's worth it to me for his physical safety, right? But no the pharmacist still would not let me get the medicine because he wants to call the doctor and verify the script she wrote!! But did not let me know this until 7 pm when there was absolutely no way to try to reach her. :mad: I could understand the insurance people being flaky and having restrictions but why could I just not buy the medicine he needed on my own.

Any one else ever experience this "limit"? Especially when ADHD cases many are known to need high doses of the medicines.

I've been using this pharmacy for over a year so it's not like they don't know me but they have been fairly rude and getting on my nerves the past few months with getting his scripts once I had the new insurance. You can only fill it after a certain time frame no matter what date the doctor has written on the script (if I go out of town I cannot get any early). I understand the whole controlled substance issue and better than they think.

08-10-08, 03:15 PM
I am working through drs and meds like crazy and my phamacist(we live in a small town) hasnt even noticed. I am not sure what i would rather have a pharmacy that just fills whatever i bring em or one that would use some concern?

09-07-08, 02:31 PM
It is not the pharmacists place to question the physicians reasons for prescribing the medications, and it is illegal for them to withhold the drug if they know the prescription is valid. If you are willing to pay out of pocket, they have to give you the medication. Keep in mind, many pharmacists are just a bit resentful after not scoring high enough on the MCAT (this is a joke, obviously).

Also, taken caution with self-diagnoses:

plus monitor him for possible bipolar, anxiety, depression, OCD, and ODD which I do see a lot of traits going on there