:x
My friend just changed insurance policies and found out the Dexedrine that her son takes is not covered under her insurance so she has to pay $35 each month to keep him on it. Changing meds is not an option because finding one that worked initially was a nightmare. Dexedrine works. Adderall and Concerta are covered, so she is confused why the Dexedrine isn’t covered. Has anyone else experienced something like this? Can her pediatrician call the insurance company and override the drug for him? Please help!
Re: Insurance coverage of Dexedrine
Hmm. Probably your friend has PPO or HMO insurance that has a list of drugs that are preferred for particular prescriptions, probably because they can negotiate a cheap price with the manufacturer. If you go outside this list, you have to pay extra. In my PPO, generic drugs on the formulary list are a maximum $10 co-pay, while off-list name brands will cost me a $35 co-pay.
my prescription coverage wouldn't cover it either.
I would go to Costco and pay their price which was about $100 for 90 pills because our PPO wouldn’t cover Dexedrine. Perhaps he can switch to Adderall, it is a formulation of dexedrine. My son swtiched to when he quit taking Dexedrine. Adderall also seemed a better mix for him than just the Dexedrine alone.
Re: Insurance coverage of Dexedrine
I am curious whether Al is here to make a legitimate point (Ritalin has not been properly studied, adverse reactions are under-reported, ADHD is overdiagnosed, etc.) which are appropriate if unpleasant topics, or if he is just here to harangue parents who already have enough on their plates.
If he wishes to express discomfort with the US medical community’s reliance on medication to fix all problems, trial and error use of controlled substances or less than professional diagnostic techniques it is not helpful to suggest a parent who is having trouble with getting insurance coverage to see the neighborhood junkie instead.
It is difficult to tell from his posting whether Al is expressing himself poorly or deliberately trying to incite, hence my question.
[quote=”amywesty”]:x
My friend just changed insurance policies and found out the Dexedrine that her son takes is not covered under her insurance so she has to pay $35 each month to keep him on it. Changing meds is not an option because finding one that worked initially was a nightmare. Dexedrine works. Adderall and Concerta are covered, so she is confused why the Dexedrine isn’t covered. Has anyone else experienced something like this? Can her pediatrician call the insurance company and override the drug for him? Please help![/quote]
The doctor can call the insurance company and put in the paper work for an appeal . If the insurance co. still refuses, then your friend can call the insurance company herself and appeal the decision. I have done so for my son’s medication (Strattera), and my doctor has just recently appealed for me to get a medication for my asthma.