Adderall & New Heath Insurance Nightmare

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    • #91388

      I’m going to try and make this brief because I am (yet again) doing everything possible EXCEPT winding down to (hope hope) be asleep by 4 am. Okay, I have been on Adderall (not XR) for years and years. I am prescribed 20mg 4 times a day. I have been taking it this way for about 9 years now. Whenever I change my health insurance, I always have to jump through some crazy fill out this form, this authorization, blah blah blah in order to get my medication covered. I have never been denied before until now. I recently switched to Blue Cross and Blue Shield of Florida because I am getting health benefits through my place of employment now which I thought was good, but I am having the worst time. They cover the generic only version, which is fine because I take that, but they only cover 90 pills at a time. So my doctor filled out the Quantity Limit authorization form. First, it was denied because he didn’t write it for the generic. So, after I called to check on this, they told me it wouldn’t go through like this and to have the doctor call them and tell them the generic is okay. A week later I called back, and they said it was denied because they don’t cover Adderal, only the generic. They said that they need the doctor to fax something in writing saying that generic is okay. I have no idea why a week earlier they took my doctors phone call and told him it was being processed. Why they didn’t tell him this then is beyond me. So, a week later I called back (I have already paid full price for my meds but I can always submit a claim later I think). Now they are telling me it is denied because they don’t authorize more than 90 pills at a time. I thought that was what the Quantity form was?! Isn’t that the whole reason my doctor filled that out in the first place?! I called my doctor, and he said he just got off of the phone with them and he isn’t sure what they need either, but we will file an appeal. Four weeks later I get an appeal letter saying my appeal was denied because they do not cover the name brand Adderall.

      I’m so confused. Has anyone else had any similar thing happen and managed to get through it? Is it because it’s Florida healthcare? Up until this point I have had insurance through Blue Cross and Blue Shield of Maryland and Alliance Healthcare also in Maryland.

      Hopefully I am making sense. Sorry I rambled, and hopefully someone understands what I’m trying to say.

    • #91398
      JBoom
      Participant

      Hmm, I have BC&BS and they cover my brand name Adderall (I know that isn’t your request, but it sounds like that’s the reason they’re denying you).

      Have you just called to talk to a customer server person there? I know when I needed permission for something (in my case, it was the need for name brand), they had a process, but I had to keep calling to ensure it was in motion. It sounds to me like they are confused about what the request even is, since they keep mentioning name brand even though your request is for dosage beyond the FDA recommended dose. 80mg a day is pretty high, even higher then the recommended dose for narcolepsy, so there is going to be hoops to jump through because they don’t want to be sued over it.

    • #91491
      AKBW
      Participant

      I was on 20 mg. of Ritalin four times a day for years and years. That’s 120 pills as per month. Well, all of a sudden the insurance company limited it to 90 pills per month. I was furious. The doctor said her hands were tied. The insurance companies are running the doctors. P.S. I turned 65 and my psychiatrist took me off the Ritalin completely because of “my age”. She hinted that it was the decision of the insurance company. She gave me a synthetic called Nuvigil. It’s approved for narcolepsy. One pill a day wasn’t working. The insurance company only covered one pill per day. So now the doctor gives me an RX that I pay out of my pocket for. And it’s very costly – one hundred twenty two dollars for 60 pills. To make matters worse, to me the Nuvigil isn’t working but I keep taking them hoping they will.

    • #91581
      yolagnes
      Participant

      This is happening with all ADHD meds, not just Adderall. They don’t want to pay out, so they are putting limitations on the meds based on what the “maximum recommended dose” is. Now, we all know that some of us need more than the maximum recommended dose, obviously. Something that I discovered quite by accident is that if the doctor write scripts for different doses of prescriptions, sometimes they will fill them, even though it’s in total over the recommended maximum dose for the month. So, let’s say for example the maximum they dispense on the Adderall or the generic is 90 pills of 20 mgs, and let’s say you needed 120 pills of 20, have him write out a script of 90 pills of 20 and then 60 pills of 10 or whatever works. The point is to get two scripts. Two different scripts that will give you the coverage you need might work. I have tried submitting scripts first a week apart from each other and then later on two scripts at the same time and they got filled. And like I said, it was an accident that I discovered this and it was because my son’s dosage kept getting changed because he was being titrated and we had to keep on adjusting the dose weekly. Remember it’s a computer turning you down when the script gets submitted. There’s no live person on the other end when that script goes through checking to see, oh is this total going over the maximum? It gets blocked the moment it hits the maximum for the script submitted is what I believe is happening. Give it a try and also use the generic. Many insurance companies will no longer cover brand if a generic is available.

    • #104622
      ryanme
      Participant

      i take 10mg 2 to 3 times a day of amphetimine salts and have no problem getting to sleep before 4am. ( after 14 years of experimenting, i found this lower amount rather than the doctors impulsive recomendation of 20 is better and been doing it for 10 years now.)

      Yes there is a lot of bad communication and likely corperate abuse, but i had aflac i think it was for a while and paid $5 a month for my meds. Ive dropped insurance outright for years and pay 80 to 120 month to month now, but am finding coupons and am considering getting my employers insurance… feel the pain but hope people keep asking questions.

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