Cigna won't cover "generic" for XR

[KADD1011]

Hi. I am new to the forums. They have been great insight from the moment I was diagnosed with adult ADD about 7 months ago. I have been taking generic 15mgs xr for several months now. I didn't even know the differences in generics and paid no attention since the capsules always seem to look the same. I started with a "generic" so I didn't know anything else.fficeffice" />>>
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The reason why I am quoting the word generic is because apparently there is no (at least at where I got it filled) FDA approved generic for Adderall XR that is therapeutically equivalent (Cigna's words) to the therapeutic effects of name brand Adderall. So I went to get it filled on Saturday, found this out and just paid the extra $45 for the name brand. (Looking back I should have just taken a few day drug holiday, but anyway).>>
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Yesterday was the first day taking the real XR and at first I was really amped up, not like I normally am on the generic (which my pharm is Teva's). Then about an hour later I had a horrible headache, had to pop an IB 600. Oddly the XR only worked about 4 hours for me, I crashed around noon (never really crashed on the generic).>>
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Today I took it again, didn't have the amped up feeling, but had a headache again. About 3 hours later when I was at the gym, I checked in my kids and my thoughts couldn't focus, it was weird. Got home from 2 hours of gym time (which I struggled through) and needed a nap, I crashed bad! >>
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Took a tiny nap (which thankfully my kids let me) and had some coffee and am good now. In my opinion the name brand shouldn't make me crash this bad when the generic never really did. It is just strange.>>
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I am going to get off it for 3-5 days and just drink a lot of coffee. I think maybe I will switch to IR. Anyone know if Cigna will cover the generic for IR? This is totally new to me. I have never had an insurance company deny a generic and demand name brand, only the opposite.>>
Sorry for the long story, obviously meds aren't working properly. My thoughts are all jumbled and I am very snappy.

Another reason why I think IR might work better is sometimes I have a hard time getting to sleep and have to take klonopin, it sucks because the next morning I am all groggy.

[ShredderGirl]

Sorry, I can't answer your question, but I do wonder:

A) What *specifically* is it about the generic XR that they find not to be therapeudically equivalent? You know there is one available, so what's wrong with it? The people with Cigna's prior auth department will have more detail as to the denial reason than already given to the pharmacy. I've dealt with stuff for over 10 years (from the doc's side) so I know for a fact they have the answer to that. If you can get one, that may shed a lot of light on what's going on lately regarding these scams.

And...

B) Crap, now I forgot the other question

[greylochdruid]

Originally Posted by KADD1011

Hi. I am new to the forums. They have been great insight from the moment I was diagnosed with adult ADD about 7 months ago. I have been taking generic 15mgs xr for several months now. I didn't even know the differences in generics and paid no attention since the capsules always seem to look the same. I started with a "generic" so I didn't know anything else.fficeffice" />>>
>>
The reason why I am quoting the word generic is because apparently there is no (at least at where I got it filled) FDA approved generic for Adderall XR that is therapeutically equivalent (Cigna's words) to the therapeutic effects of name brand Adderall. So I went to get it filled on Saturday, found this out and just paid the extra $45 for the name brand. (Looking back I should have just taken a few day drug holiday, but anyway).>>
>>
Yesterday was the first day taking the real XR and at first I was really amped up, not like I normally am on the generic (which my pharm is Teva's). Then about an hour later I had a horrible headache, had to pop an IB 600. Oddly the XR only worked about 4 hours for me, I crashed around noon (never really crashed on the generic).>>
>>
Today I took it again, didn't have the amped up feeling, but had a headache again. About 3 hours later when I was at the gym, I checked in my kids and my thoughts couldn't focus, it was weird. Got home from 2 hours of gym time (which I struggled through) and needed a nap, I crashed bad! >>
>>
Took a tiny nap (which thankfully my kids let me) and had some coffee and am good now. In my opinion the name brand shouldn't make me crash this bad when the generic never really did. It is just strange.>>
>>
I am going to get off it for 3-5 days and just drink a lot of coffee. I think maybe I will switch to IR. Anyone know if Cigna will cover the generic for IR? This is totally new to me. I have never had an insurance company deny a generic and demand name brand, only the opposite.>>
Sorry for the long story, obviously meds aren't working properly. My thoughts are all jumbled and I am very snappy.

Another reason why I think IR might work better is sometimes I have a hard time getting to sleep and have to take klonopin, it sucks because the next morning I am all groggy.

Another suggestion is Dexidrine spansules SR(sustained release). I never had a problem out of the the generic XR either. I am with Kaiser so the have a deal with Shire where they sell the brand XR for the generic price. Dexidrine is the same type of med as adderral. If u do decide to go with the IR thgh I would ask the pharamacy who makes the generic IR before u pay for it. I hve seen on here that the Sandoz/Eon version seems to work the best. I take 3XR's a day totally 45mg. Xr usually only last arnd 5hrs or so. Sme people its 4hrs. When u go back to your PDoc ask them abput it.

[greylochdruid]

Fogot to make my other suggestion. Take 2-3 XRs a day. If u take 1 30mg xr have your PDoc break it down into 3 10mg XRs or 2 15mg XRs. My spouse takes 2 15mg XRs a day My suggestion is take your other dose at the 3 1/2 to 4 1/2 hour mrk after u take your 1st one. Its what we do and it works well for us. U will probably have to get a authorization from your Pdoc bfre ins will cover it but I had no problem they just fax it to pharmacist.

[KADD1011]

Thanks for your replies.

SG- I was on the phone with Cigna and they just stated what I wrote. I will have to get my doc to call a number to get a prior authorization to get the generic (which is fine by me as long as they cover it).

A light went on this morning. I did a lot of research yesterday (mostly on here) and figured maybe it was something that I was changing, not the drug change. I have become sluggish for the past two weeks, not really on the onset of the drug change.

I figured it out! I have been popping my Prenatal (no I am not pregnant, but I have some left over) with my ADD each morning. The vitamin has 200% Vitamin C! That explains the 4 hour then crash effect. Also, I just looked and I have been consuming more power/gatorade (Citric acid!) BINGO. Took me a while, but I don't think I will need a drug holiday after all.

I still might switch to the IR due to my inability to sleep, or just drink OJ or powerade. Or taking my Multi at night might just help with that. I will experiment, I have about 3.5 weeks to do so.

[MomfromMN]

Wow, I'm surprised a large health insurance company like Cigna would take such a hard line on this. I have them too and was hoping that I would be able to try a generic XR because just my 14 day starter dose of 10mg was $27+ with insurance!

About your reaction to XR, I can't say too much about it since this is my first week, but the last two days I've had little to no effect from it except for what feels like sinus pain and pressure and tooth pain which is really pretty bad. It also wears off really fast for me, although you seem to think it's related to the Vit C. I've been taking it on a totally empty stomach (hours before and at least 2 hours after).

[OnlyMe]

My insurance is the same way, only the brand name for adderall.

[ShredderGirl]

Hmmm...

Insurance companies refusing to cover GENERIC (CHEAPER) Adderall XR, citing lack of therapeudic equivalency...

Combine that with numerous complaints from patients about the recent quality of their Adderall...

Something is definitely going on because that makes absolutely NO sense.

[KADD1011]

Originally Posted by ShredderGirl

Hmmm...

Insurance companies refusing to cover GENERIC (CHEAPER) Adderall XR, citing lack of therapeudic equivalency...

Combine that with numerous complaints from patients about the recent quality of their Adderall...

Something is definitely going on because that makes absolutely NO sense.

I totally agree. After reading about the generic scandal with the mixed bottles, maybe that is why Cigna is denying it? They did tell me how to get the generic if I want it though.

Now I am not entirelly sure if it was the Vit C. I didn't take anything today and I am sort of tired already, was by noon. Then again I did take it at 530 today.

[Trooper Keith]

Originally Posted by ShredderGirl

Hmmm...

Insurance companies refusing to cover GENERIC (CHEAPER) Adderall XR, citing lack of therapeudic equivalency...

First of all, "generic" Adderall XR is only about 5 dollars cheaper than the brand.

It is not bioequivalent, meaning it does not work the same way, it does not do the same things, etc. It's not Adderall XR, it's something similar to Adderall XR, but not similar enough to be considered a generic. It makes a lot of sense for them not to cover this drug. They want to pay for something that will work as intended.

Combine that with numerous complaints from patients about the recent quality of their Adderall...

This I know nothing about, I have heard rumors about Shire changing their formulation, but it makes no ******* sense for them to change the formulation of their core product.

[CignaChick]

Hi everyone,
I wanted to post my opinion since I work for Cigna. They won't cover my adderall at a generic level either and our coverage is so bad that I paid $210 last month for 30 days of 25 mg adderall XR. Now the the dept I work in has absolutely no relation to our pharmacy dept and my boss has tried to fight this with Cigna b/c she has the same problem with her son. Even as employees we can't get a real answer as to why we pay so much. It's ridiculous. I'm actually looking up a supplemental Rx coverage online right now. I'd rather pay $50 for additional insurance and have a $25 copay than pay $210 a month. I love where I work, for the most part Cigna is fair and they reimburse providers well so I don't know what the problem is behind the scenes..Just wanted to let you know even the employees suffer (if not more). Best wishes! Keep me posted if you find a good option!

[Tabbycat]

I'm debating whether to use COBRA (out of job) or find a different insurance policy (if I can).
I had Catalyst for prescriptions, United HC for insurance.

I was taking generic Adderall, & my co-pay was still $75/month!!!

I've been off the Adderall for a few weeks now, & realize every day how much I need it, how much it helps me.

Where's the prescription assistance program for this med? Oh yes - I forgot, ADD isn't a "real" disease/disorder...

[Spacemaster]

I've seen this happen with other drugs, like cholesterol meds, not just stims. Sometimes when a drug becomes generic, some insurance companies cut deals with the drug manufacturers. They get a kickback from the name brand manufacturer if they agree to only cover the name brand. Sick, isn't it? I know someone whose insurance will not cover generic Lipitor. They will only cover the name brand. Nevermind the fact that the generic is under $20 and the name brand is over $200.

I'm sorry I don't have any references for this, unless you count the conversations with my boss/pharmacist.

[lawyered]

Hey guys. I apologize for bumping an old thread, but I wanted to let you know that I fixed this.

When I ran into this problem for the first time, I basically had no choice but to pay or not get my medication on time. So I paid, disputed Cigna's denial of coverage, and fought for reimbursement. Cigna told me the reason they were denying coverage was because the generic brand my pharmacy dispenses (Global Pharmaceuticals) isn't FDA-approved to treat ADD, and only Actavis is approved by the FDA as a generic equivalent to Adderall XR.

I knew this was stupid, because my old insurer covered the same generic, and nobody would cover an unapproved medication so easily. I'm also a lawyer (disclaimer: not yet licensed to practice in your state, this post is purely for informational purposes and not legal advice) and I work on health care mergers and acquisitions, so I know a little about FDA regulations. So I dug in.

It turns out Cigna was right: Global and Teva were never approved by the FDA as generic equivalents to Adderall XR. But there's a reason for that: Both companies resell drugs made by Shire, maker of the name brand, from the same plant and using the same process. The FDA waived approval in both cases because the generics are an already-approved drug. They're literally name-brand capsules with generic labels printed on them. (This is not true of Actavis, which makes its own generic and needed independent FDA approval.)

During my dispute I bombed Cigna with a bunch of documentation on this stuff. Earlier this week, I tried refilling the generic again and it rang up approved. Now I just have to pay the co-pay.

I don't know if they fixed it for Teva generics, so you may still have to fight them there. But the Global generic is covered now. Just FYI.