Insurance will pay for Brand name Adderall XR but not the generic????

[ace7863]

I submit my script to the pharmacy and they come back and inform me that Anthem BCBS will not pay for the generic version of Adderall XR but will pay for the brand name. They stated they (Anthem) needed medical relevancy to determine whether or not it was medically necessary. Suffice it to say, myself as well as the pharmacist, were stunned. An insurance company won't pay for the generic and save money?????
I had already been on Adderall IR generic at 2 different strengths.

Has anyone else had this issue? On a side note, the pharmacist informed me that currently Shire is making both the brand name and generic versions of the XR but the patent will be soon or already has expired. Making way for others to sell the generic. Not sure about this but regardless it would seem they both should work the same.

I know with my synthroid for my thyroid condition, all of my Dr.s agree Brand Name is the only way to get consistency.

[FrazzleDazzle]

Maybe Anthem knows something you don't, about the feedback of some generics, hence the strange policy. Usually it's the other way around! Read the forums in Adderall to see the consumer feedback between the generics versus the brand. I hope you do well on the brand, I've not read much negative about it, as I have on the generics, tho many do very well on them.

The pharmacist told you what is rumored to be true regarding Shire manufacturing the generics for distribution under other labels. It doesn't mean they are exactly the same as the Brand. I can personally see the difference in the generic versus brand in my son.

[ScottInCA]

Same thing happened to me (UnitedHealth insurance). The pharmacist said that happens sometimes when a generic first comes on the market; the insurance companies have a "drug forumulary" list which splits all the drugs into tiers (i.e. Tier 1/Generic, Tier2/Brand, Tier3/Expensive or non-preferred). The problem is that the formulary is only updated periodically (like quarterly or maybe twice a year), and a generic that just hit the market may not be on it yet, or automatically is considered either tier 3 or not covered until they formally add it to their list.

[ace7863]

Originally Posted by ScottInCA

Same thing happened to me (UnitedHealth insurance). The pharmacist said that happens sometimes when a generic first comes on the market; the insurance companies have a "drug forumulary" list which splits all the drugs into tiers (i.e. Tier 1/Generic, Tier2/Brand, Tier3/Expensive or non-preferred). The problem is that the formulary is only updated periodically (like quarterly or maybe twice a year), and a generic that just hit the market may not be on it yet, or automatically is considered either tier 3 or not covered until they formally add it to their list.

UPDATE:

I was informed by Anthem that the reason it was declined was it required prior authorization. It also required that I had to be on a step program prior to the generic. My physician basically has to submit that we've tried X number of drugs before going to the generic XR. Funny huh?