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Old 01-05-12, 12:31 AM
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Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Hello Everyone --

This is my first post as a member of this forum -- I believe I've selected the correct discussion area based on my search, but please let me know if this should be (or has been) discussed elsewhere.

FROM ADDERALL IR TO VYVANSE :: THUMBS UP
I've recently switched from Adderall IR to Vyvanse. The switch was driven by the Adderall shortage that has occurred in several states, including the one in which I live -- Washington. Since Adderall and Vyvanse are both very similiar, my doctor started me on Vyvanse last month. I've taken it for 30 days. I do like it so far -- it's more "smooth" than the Adderall IR.

VYVANSE NOT COVERED BY INSURANCE :: THUMBS DOWN
The major problem? My insurance provider (Lifewise of Washington) does not cover Vyvanse. After my pharmacy (Walgreens) told me my insurance would not cover it, I found documentation that stated they were supposed to cover it in 2011 when I was first prescribed the medication, since I had the plan that covered "Tier 3 medications." But despite 2 phone calls, they insisted they did not and would not, so I ended up paying for the first prescription out-of-pocket.

Then the Lifewise (and many other providers') plans changed Jan 1, 2012. Now it is clearly documented that they do not cover brand-named (non-generic) drugs.

I contacted Shire to inquire what their plans were, since the President's new healthcare reform plan would affect brand-name drug coverage, with the first big impact happening Jan 1, 2012. They told me about the coupon, which I did try with the first prescription, but it wouldn't work, since I needed more than 30 pills that first month as we experimented with dosage.

SHIRE'S 50% DISCOUNT CARD :: DENIED
Shire then sent me a discount card, which was basically the same as the coupon - up to 50% off a copay or out-of-pocket expense. I received it just last week in the mail. Today I registered it online, as instructed in the packet, and I tried to use it at the same Walgreens, after receiving a new prescription from my doctor for 30 pills (60mg).

My pharmacist informed me that after talking with my insurance and Shire, Shire said they canceled the program -- "not just my card, but the entire program," were his exact words. The pharmacist said he told the Shire represenative that my new card had a May expiration date, and Shire told him they had the right to cancel at any time.

I'm sorry -- but that's ridiculous. I just checked the Shire site, and the program is clearly still available.

SOMETHING SMELLS FISHY :: AND IT ISN'T THE SALMON IN SEATTLE!
So - what am I doing wrong? It seems like there's some sort of data or information about me / my situation they are evaluating -- something that is making them reject my attempts at the discount. Why would they say they aren't honoring the discount program at all for anyone, when obviously they are -- I can see from other posts about Vyvanse that others are using the discount coupon.

Is it because I purchased it out-of-pocket last month so they assume I will again? Is it because when I registered the card I selected "current Vyvanse patient" instead of "first time prescription" so they assume I'll buy it since just stopping taking it would have negative consequences? Or maybe it isn't Shire at all and it's Walgreens, not wanting to be affected by any absorbtion of the cost or not wanting to be bothered with the process?

Maybe it's nothing. Maybe Shire did suddenly, only 30 minutes after I registered and they activated my card, decide to "cancel the entire program" -- only to reactivate the program when I returned home a few minutes later to check out the website. Something smells fishy -- and it's not the Salmon in the Puget Sound here in Seattle!

TIPS FOR HOW TO EASE THE IMPACT OF THE COST?
Any tips or advice or guidance would be really appreciated. $140+/- a month for this medication just isn't sustainable. I'm at a loss for how to overcome this situation. Last month it was rejected because my prescription was for too many pills. This month the # of pills was correct, but there was some other mystery excuse.

I'm getting irratitable, and it's not the Vyvanse side-effect I was just planning to call Shire in the morning to find out what's going on, but something tells me I won't learn the truth with that phone call, either.

Thank you! And thank you for reading my very first post
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Old 01-05-12, 12:36 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

This is ridiculous, and sadly... unsurprising. I'd talk to your doctor about switching to dexedrine, which seems to have withstood the shortage rather well. You can get IR, just like your former adderall while reaping the benefits of the active ingredient in Vyvanse that seems to have worked well for you. Generic, so you shouldn't have insurance issues and cheap enough that it doesn't really matter anyway.
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Old 01-05-12, 12:40 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Tell your doctor that you cant afford it and ask for the equal dosage of dexedrine which is what vyvanse is lycein ( an amino acid) bound non abusable time release form.

Or you can insist that your doctor give you free samples, my friend who does social work told me that me recomends this to his behavioral cases who cant afford meds. He said doctors make half their salary from drug reps.

Or you can look into what state funded programs help with prescription coverage.

Your easiest solution is to just ask for dexedrine.
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Old 01-05-12, 12:49 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Maybe try a different Walgreens? I used the card there to get my prescription filled (the one that expired 12/31/11) and requested the new one that expires in May from Shire. I'm going next week to get my new prescription filled...so it'll be interesting to see what they say.

Maybe try contacting the insurance company? My mom's insurance (Blue Cross Blue Shield of NC) didn't originally approve the medication for her, but the pharmacist and doctor submitted a waiver of some sort on her behalf and they decided to cover it (if I'm getting the story right). I'm covered by the Blue Cross Blue Shield Federal Employee Program, and they've always covered it. It's still $40 a month without the 50% off though.
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Old 01-05-12, 01:06 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Quote:
Originally Posted by trishcan View Post
This is ridiculous, and sadly... unsurprising. I'd talk to your doctor about switching to dexedrine, which seems to have withstood the shortage rather well. You can get IR, just like your former adderall while reaping the benefits of the active ingredient in Vyvanse that seems to have worked well for you. Generic, so you shouldn't have insurance issues and cheap enough that it doesn't really matter anyway.
Super helpful -- thank you Trishcan and never2late -- I will inquire about Dexedrine. And never2late, I did just find a state-sponsored prescription drug program, and I signed up. Can't hurt to check it out -- thanks for the tips!

-- Victoria
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Old 01-06-12, 12:04 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Quote:
Originally Posted by VictoriaS View Post
Super helpful -- thank you Trishcan and never2late -- I will inquire about Dexedrine. And never2late, I did just find a state-sponsored prescription drug program, and I signed up. Can't hurt to check it out -- thanks for the tips!

-- Victoria
I take Dex IR as an evening booster or for short term use on occasionally weekend days (usually I take weekends off the meds). It has the exact same therapeutic effect for me as Vyvanse...which is to be expected! It works for ~3.5-4 hours when taken on a weekend, easy onset, easy fade off. Ritalin by contrast always sort of kicked in hard and left the same way. The IR meds for all day coverage take some practice to get right with timing doses, IMHO. My smartphone was great for that when I was on Ritalin IR.

There is a Dex shortage right now, so if you are going to try to switch to you might want to start with pharmacies at big box stores like Costco, Walmart, Target, etc. I think I pay about $15 for a 30 day supply of 5 mg tablets, which is under my minimum co-pay so it's the actual price.

And good luck with the drug coverage! US health insurance is a moral crime.

Last edited by quark; 01-06-12 at 12:20 AM..
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Old 01-07-12, 02:33 PM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Hello, I am new to these forums too. Had ADHD all my life and am 51.

My doctor just prescribed Vyvanse (20 mg capsules since I am new to ADHD meds) for me and on January 3rd Walgreens filled the perscription and I used the Shire card the doctor gave me earlier in the day and after activiting the card via my phone to cover half my co-pay. So the program is still in effect. No issues.

I am in kind of the same position of having my insurance cover "extra" medication due to trying different doses. My doctor wrote the prescription for 30 tablets (20 mg) and said that after 5 days if I did ok on 20 mgs, he'd write me another perscription for 20 mg tablets and I could double up for 40 mgs a day. Well, insurance only will pay for one Vyvanse per day.

This is my 4th day on Vyvanse and the 20 mg/day is too low. The first couple of days were better, but i'm distracted today. I think I'll just wait out the 30 days and then ask my doctor for 30 mg capsules, or 40 mg, if he thinks that is appropriate.

One thing you could do to get around your insurance limitation is ask your doctor to consider perscribing a similar medication to increase the dose, so to say. From research I have done, generic dextroamphetamine may well suffice. After all, Vyvanse metabolizes into dextroamphetamine after taken. If insurance refuses to cover the additional medication, its only about $25 a month.

BTW, the retail price of my Vyvanse perscription was $185. I have a $35 co-pay and Shire picked up $17.50 of that.

--Nate
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Old 01-07-12, 06:28 PM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Are you in a position to get better or supplemental insurance? Nate is charged $185 for Vyvanse; I'm charged $190. That might cover an upgrade to a PPO. Or it may not.

The insurance industry seems to be there to screw with us. For instance, I'm on Abilify as a mood stabilizer. My insurance covers it, but keeps trying to get me to take their "preferred generic" instead -- which, get this -- is risperidol! EFFING RISPERIDOL. A medication that my pdoc said is only prescriped to floridly psychotic patients. It turns them into zombies, but at least they can't hurt themselves in that state.

I wish I had something more for you. Best of luck dealing with this.
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Past Meds: Adderall, Lexapro, Abilify, Dexedrine Spansules, Dexedrine IR, Ritalin, Nortriptyline, Amitriptyline, Wellbutrin


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Old 01-08-12, 07:56 PM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

I just used the coupon YESTERDAY and it was accepted; it reduced the amount I had to pay out of pocket to $80.00. Without the coupon, I would have had to pay the entire $160.00 out of pocket. My insurance has a deductible and since vivanse is "tier 3", I have to pay the full price until I reach my deductible.
I can't believe they told you that the coupon had been "cancelled".
That's a joke - what the heck?? I hope someone is able to give you some answers!
FYI: I am prescribed 50mg which I take 1xper day; my prescription was for 30 tabs.
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Old 01-09-12, 01:59 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

If you are unable to obtain a suitable covered medication due to unavailabiity/shortages, you might try submitting a claim for your $80 out of pocket anyway and then appealing the denial.
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Old 01-12-12, 12:46 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Thank you very much for the feedback and suggestions. All very helpful - thank you! Quick update -- I contacted Shire (the makers of Vyvanse and the company who mailed the discount card to me). I explained to them what happened at Walgreens, and they responded to my email inquiry right away and confirmed the program was not canceled on that date and asked for my discount card & Walgreens contact information. They are going to call Walgreens. =) This should be quite interesting. =)
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Old 01-31-12, 03:09 PM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

I would see if your MD would write 2 scripts so you at least get some of it for the discount. and check into walgreens prescription saving club i'm not sure its covered but ask your walgreens. or you could ask for partial fill we do it when you we don't have your full script. you'll pay a little now a little later but you'll have to have it filled at the same location because it is a control. hope this helps.
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Old 03-28-12, 01:40 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

Final update -- Shire did call Walgreens and then called me back, providing me with a number to call if I had any other issues -- it was a direct line to the Shire rep who helped me with this issue. The discount card should work, and it can be used for 30-count prescriptions. If you have trouble using the card, I recommend contacting Shire - they were very helpful. Thanks for all the help and guidance - it helped me reach a solution!
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Old 03-28-12, 10:52 PM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

You may have already resolved your issue with the Vyvanse but I wanted to share how I handled the issue for my son. He responded well to the Vyvanse but we had the same issue with the discount card not working but once a month. While he was adjusting the medication, I had him write the prescriptions for 5-10 days and I paid out of pocket. Came to about $5/pill. Because I had quite a few of the 20 mg, we would double to make 40 mg, 20 plus the 30 for 50 mg and so on. He is at 60 mg and holding at that dosage. Just today, the doctor told me that they (Shire) have a new discount card that should make it $30/month. Haven't figured that one out yet and still working on it but thought it's give you a quick post. My son likes the Vyvanse and said that he doesn't feel it "kicking in" or wearing off. As long as we can afford it, we'll stick with the Vyvanse.
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Old 03-29-12, 03:40 AM
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Re: Vyvanse Not Covered by Insurance & Shire Rejecting Discount Coupon

This is my first month on it, and with the discount we get from Blue Cross and then the 50% off thing, I paid like $85.00 for it. Its much more expensive than Ritalin, I was paying $18.00 for 90 Ritalin 20 mg. But it sure is smooth compared to Ritalin, it is such a mild, mellow drug but it seems to really help me focus without all the up and down mess of the instant release med. If this discount thing disappears though, i dont know what i am going to do. Maybe Adderall?
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