Ask the Experts

Insurance Coverage for Adderall

Now that the mental-health parity law has been passed by Congress, will my insurance company have to cover the cost of my Adderall? It is very expensive. Please say yes.

If your current HMO provides mental-health coverage, it can’t prohibit or restrict your access to medication for your ADHD, under the recently passed Mental Health Parity and Addiction Equity Act of 2008.

This legislation prohibits health insurance plans sponsored by businesses with 50 or more employees from imposing visit limits or applying different deductibles, co-payments, out-of-network charges, and other financial obstacles to mental-health treatment. According to this law, if you have mental-health coverage with your HMO, it would have to cover the cost of your Adderall, or at least a generic version, if one exists.

It may take your HMO some time to understand the full scope of the law and to change its policies. Still, that should not deter you from educating your HMO and asserting your rights. One other thought: Each state has its own parity legislation, which may offer more protection than the national law to individuals with mental-health conditions, such as ADHD. Check with your state’s legislature and/or department of insurance.