Ask the Experts

Insurance Doesn’t Cover My Daughter’s ADHD Medication

“Our daughter was recently diagnosed with ADHD, and her doctor prescribed Vyvanse. Our insurance covers only Adderall or Focalin. From the doctor’s description, it doesn’t seem like these two medications would work as well for our daughter. Can insurance companies cover only certain types of medication?”

Your problem with medication coverage is not uncommon. Many insurance companies cover only generic forms of ADHD medications, since they are less expensive. Vyvanse works like Adderall, but each drug is released into the body in a different way.

Ask your physician to contact your insurance provider and explain why Vyvanse is essential for your daughter. The insurance company might approve its use on appeal, but I would not count on it. You may need to pay out-of-pocket for it, or choose another form of the medication. Note that Vyvanse has a savings offer that may help cover the cost, in part, of your daughter’s prescription.