My health insurance keeps denying me coverage for ADHD meds – Please, anyone help

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I’m 30 years old and have just been diagnosed with ADHD about 2 weeks ago. I’m a high school teacher in Arkansas. My insurance is ARBenefits – I’m on the “classic plan,” which is a middle-of-the-road HDHP option. You can see all the info here. My plan’s benefits PDF is here, and the preferred drug list is found here. The insurance company’s explanation of reference pricing can be found here.

Here’s the rundown on what’s been happening so far:

  • Wednesday, 12-2:
  1. Got ADHD diagnosis from my counseling therapist, scheduled an appointment with Dr. for the next Wednesday afternoon. Life is good and things make sense. I feel hopeful for the first time in a while.

  • Wednesday 12-9:
  1. Saw Dr., he agreed that I had ADHD, wrote me a prescription for Vyvanse 20mg and cancelled my old prescription for Bupropion, which I’ve been on for a while as an antidepressant because I was diagnosed as depressed before we figured out I had ADHD, but bupropion in higher doses makes me feel awful and wouldn’t play well with other ADHD meds. I still had 14 days worth of it. Made me a little uncomfortable to cut that lifeline, but I was excited to try to actually treat the problem of ADHD rather than the symptom of depression.
  2. I went to Walgreen’s, only to be told that my insurance is refusing to cover my medication because I’m too old. I freak out and have a little meltdown and leave, embarrassed, with the knowledge that they may cover the medication if they got a preauthorization, whatever the crap that is. Without insurance the medication is $400/month, which is about 15% of my income. Uh, nope. Unfortunately, I learned about the preauthorization mere minutes after the clinic was closed for the day, so I couldn’t do anything but wait.
  3. I also picked up my regular prescription for fluoxetine (my other antidepressant that I’m staying on), and once I get home I realize that they screwed up my prescription and only gave me 30 days’ worth instead of 90 days’ worth. I call and ask what to do, and I end up having to drive back up to Walgreen’s and wait in their drive-thru for 15 minutes to get the rest of my prescription filled. Grand.

  • Thursday 12-10:
  1. Spent hours on the phone with my insurance, doctor’s office, pharmacy, and lord knows who else trying to figure out what was wrong. Had multiple meltdowns and lost my temper. Eventually I manage to get the message through to my doctor that they need to send a preauthorization to the pharmacy. They also tell me to come get a Vyvanse discount card from the doctor’s office.
  2. I go to the clinic and get the discount card. They’re still working on the preauthorization, but the card is supposed to be good for the first month for free, so I figure I’ll go get the first month filled and start my new medication and get the ball rolling, and figure out the payment later.
  3. I go to the pharmacy and give them the discount card, asking them to run it as secondary insurance as I’ve been told to do. I end up getting told that they can’t fill it because, according to my insurance company, “the medication is only for people 26 and under, they won’t cover anything otherwise.” Okay, so now I know that my insurance is saying that adult ADHD doesn’t exist. Great. Nice to know what I’m working with. I go home and cry, because it’s already too late in the day to do anything else.

  • Friday 12-11:
  1. Got a phone call midmorning that my preauthorization had been denied. So, for reasons that I am forbidden to know, the medication that my doctor says would be best for me is not allowed by my insurance. Great. The nurse who called talks me through finding the document that lists which medications ARE covered by my insurance, and I send it to her so she and my doctor can go over it.
  2. After lunch I get a call saying that they have written me a new prescription for Adderall, with the option to fill it generic. I have to go pick it up in person at the clinic because evidently having ADHD is like the pharmaceutical equivalent of having swear words tattooed on your face.
  3. I pick my prescription up at the clinic, and get out as fast as I can. No problems. It’s a good clinic.
  4. I go to the pharmacy again, and they tell me the exact same crap: Over 26, not covered. The pharmacist on duty is awesome and calls my insurance and harasses them for a drug that WILL be covered, and comes up with a generic version of Focalin XR, dexmethylphenidate XR 20mg.
  5. I stand there in the pharmacy and call the clinic and they say they can get me that prescription today, so I haul butt across town to get the new prescription. Before leaving Walgreen’s I buy some Reese’s candy to give to the nurse at the clinic who has been dealing with all of this because she’s handling everything WAY better than I am.
  6. I get to the clinic and have to wait a bit to get the prescription, but no big deal. Reese’s delivered without a hitch, too.
  7. I get back to the pharmacy and find out that my prescription doesn’t matter anyway, because they don’t even have the freaking medication I’ve been prescribed, and they won’t have any more until freaking January.
  8. They call other pharmacies and nobody has it.
  9. I leave and call CVS, because I guess Walgreens policy says never to call CVS, I dunno. I get put on hold and start driving that way, because I am picking up dinner from a restaurant next door to the CVS anyway.
  10. Twenty minutes later, they answer the stupid phone as I pull into the parking lot. I tell them what happened with having been on hold for 20 minutes and tell them I’ll just come talk to them inside.
  11. They also don’t have it, and won’t fill the prescription. I have yet another meltdown. I apologize for my moral failures that have led me to not be rich, and explain that clearly becoming a teacher was wrong of me and I should have pursued the higher calling of being a crack dealer. (In hindsight, that might have been interpreted to be an attack on pharmacists, which it in no way was meant to be. Whoops.)
  12. Now it’s late and I have no prescription filled and am stressed and sad and feeling worthless and I am pretty much just ready to give up and say “f*** me for having ever tried to better myself” and just give up. I just give up.

  • Saturday & Sunday 12-11 & 12-13: Everyone is closed over the weekend, so I just try not to worry about any of it.

  • Monday 12-14:
  1. Called clinic first thing to let them know about how none of the pharmacies have the medication. Still waiting to hear back as of lunchtime. Who knows what comes next. Ugh.

Can anyone please help me figure out what the crap to do? I am NOT at all comfortable or fluent in any of this mess. Bureaucracies are the cancer of society, but we have to navigate them from time to time. Unfortunately, my unmedicated ADHD makes navigating a bureaucracy rather difficult. Please, anyone, please help.

submitted by /u/Arrdenet
[link] [comments]
I’m 30 years old and have just been diagnosed with ADHD about 2 weeks ago. I’m a high school teacher in Arkansas. My insurance is ARBenefits – I’m on the “classic plan,” which is a middle-of-the-road HDHP option. You can see all the info here. My plan’s benefits PDF is here, and the preferred drug list is found here. The insurance company’s explanation of reference pricing can be found here. ​ Here’s the rundown on what’s been happening so far:
Wednesday, 12-2:

Got ADHD diagnosis from my counseling therapist, scheduled an appointment with Dr. for the next Wednesday afternoon. Life is good and things make sense. I feel hopeful for the first time in a while.

Wednesday 12-9:

Saw Dr., he agreed that I had ADHD, wrote me a prescription for Vyvanse 20mg and cancelled my old prescription for Bupropion, which I’ve been on for a while as an antidepressant because I was diagnosed as depressed before we figured out I had ADHD, but bupropion in higher doses makes me feel awful and wouldn’t play well with other ADHD meds. I still had 14 days worth of it. Made me a little uncomfortable to cut that lifeline, but I was excited to try to actually treat the problem of ADHD rather than the symptom of depression. I went to Walgreen’s, only to be told that my insurance is refusing to cover my medication because I’m too old. I freak out and have a little meltdown and leave, embarrassed, with the knowledge that they may cover the medication if they got a preauthorization, whatever the crap that is. Without insurance the medication is $400/month, which is about 15% of my income. Uh, nope. Unfortunately, I learned about the preauthorization mere minutes after the clinic was closed for the day, so I couldn’t do anything but wait. I also picked up my regular prescription for fluoxetine (my other antidepressant that I’m staying on), and once I get home I realize that they screwed up my prescription and only gave me 30 days’ worth instead of 90 days’ worth. I call and ask what to do, and I end up having to drive back up to Walgreen’s and wait in their drive-thru for 15 minutes to get the rest of my prescription filled. Grand.

Thursday 12-10:

Spent hours on the phone with my insurance, doctor’s office, pharmacy, and lord knows who else trying to figure out what was wrong. Had multiple meltdowns and lost my temper. Eventually I manage to get the message through to my doctor that they need to send a preauthorization to the pharmacy. They also tell me to come get a Vyvanse discount card from the doctor’s office. I go to the clinic and get the discount card. They’re still working on the preauthorization, but the card is supposed to be good for the first month for free, so I figure I’ll go get the first month filled and start my new medication and get the ball rolling, and figure out the payment later. I go to the pharmacy and give them the discount card, asking them to run it as secondary insurance as I’ve been told to do. I end up getting told that they can’t fill it because, according to my insurance company, “the medication is only for people 26 and under, they won’t cover anything otherwise.” Okay, so now I know that my insurance is saying that adult ADHD doesn’t exist. Great. Nice to know what I’m working with. I go home and cry, because it’s already too late in the day to do anything else.

Friday 12-11:

Got a phone call midmorning that my preauthorization had been denied. So, for reasons that I am forbidden to know, the medication that my doctor says would be best for me is not allowed by my insurance. Great. The nurse who called talks me through finding the document that lists which medications ARE covered by my insurance, and I send it to her so she and my doctor can go over it. After lunch I get a call saying that they have written me a new prescription for Adderall, with the option to fill it generic. I have to go pick it up in person at the clinic because evidently having ADHD is like the pharmaceutical equivalent of having swear words tattooed on your face.
I pick my prescription up at the clinic, and get out as fast as I can. No problems. It’s a good clinic. I go to the pharmacy again, and they tell me the exact same crap: Over 26, not covered. The pharmacist on duty is awesome and calls my insurance and harasses them for a drug that WILL be covered, and comes up with a generic version of Focalin XR, dexmethylphenidate XR 20mg. I stand there in the pharmacy and call the clinic and they say they can get me that prescription today, so I haul butt across town to get the new prescription. Before leaving Walgreen’s I buy some Reese’s candy to give to the nurse at the clinic who has been dealing with all of this because she’s handling everything WAY better than I am. I get to the clinic and have to wait a bit to get the prescription, but no big deal. Reese’s delivered without a hitch, too. I get back to the pharmacy and find out that my prescription doesn’t matter anyway, because they don’t even have the freaking medication I’ve been prescribed, and they won’t have any more until freaking January. They call other pharmacies and nobody has it. I leave and call CVS, because I guess Walgreens policy says never to call CVS, I dunno. I get put on hold and start driving that way, because I am picking up dinner from a restaurant next door to the CVS anyway. Twenty minutes later, they answer the stupid phone as I pull into the parking lot. I tell them what happened with having been on hold for 20 minutes and tell them I’ll just come talk to them inside. They also don’t have it, and won’t fill the prescription. I have yet another meltdown. I apologize for my moral failures that have led me to not be rich, and explain that clearly becoming a teacher was wrong of me and I should have pursued the higher calling of being a crack dealer. (In hindsight, that might have been interpreted to be an attack on pharmacists, which it in no way was meant to be. Whoops.) Now it’s late and I have no prescription filled and am stressed and sad and feeling worthless and I am pretty much just ready to give up and say “f*** me for having ever tried to better myself” and just give up. I just give up.

Saturday & Sunday 12-11 & 12-13: Everyone is closed over the weekend, so I just try not to worry about any of it.

Monday 12-14:

Called clinic first thing to let them know about how none of the pharmacies have the medication. Still waiting to hear back as of lunchtime. Who knows what comes next. Ugh.
Can anyone please help me figure out what the crap to do? I am NOT at all comfortable or fluent in any of this mess. Bureaucracies are the cancer of society, but we have to navigate them from time to time. Unfortunately, my unmedicated ADHD makes navigating a bureaucracy rather difficult. Please, anyone, please help.
submitted by /u/Arrdenet [link] [comments]Read Morer/HealthInsurance

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