Insurance givin me trouble, man

Community
#1

Well, anyone who’s ever been prescribed a stimulant medication probably knows how much of a hassle it can be to get it filled, but boy was I unprepared for this all-American mess.

I’ve been waiting a week for my insurance to authorize coverage on my newly prescribed Ritalin, so today, I finally decided they had enough time to get it together and gave them a call. Typically, this is not a covered medication, but a doctor can call and have it approved. Unsurprisingly I ran into trouble right away. My insurance does not even have a request on file, meaning one of two things: One, the doctor has not yet requested the medication be covered, and two, insurance denied coverage immediately and they notified neither myself nor my pharmacy.

I’m waiting on a call from my doctor to ask them whether they’ve made their appeal yet, but I suspect they have and my insurance just denied them. In that case, I’m not really sure what to ask or say to my insurance provider in order to increase the chances of it being covered. Could anyone with experience tackling this beast of a medical system give me some pointers on how to talk to my insurance about this issue? I’m definitely not paying $300 a month out of pocket for the stuff. Why is adhd treatment so adhd unfriendly?

1 Like
#2

I would definitely lean on the doctor to help with this. In my experience doctors have been able to get the prior authorization, but they sometimes forget or get behind. Calling the office and asking them to facilitate it is never a bad idea. If the insurance denies, there may be a customer service line where you can call and make an appeal for coverage. It’s usually a frustrating process, but it’s an option. There may also be discounted vouchers for Ritalin through the manufacturer or a site like GoodRx.

3 Likes
#3

I just got off the phone with her and she said it was time for some phone calls on her end of things too, so I hope she can put the hammer down on it, otherwise imma have a rough time.

3 Likes
#4

It looks like with GoodRx, the price for a generic near me is around $20 for 60 tablets at 20mg. The brand name is around $90 for the same.

I don’t know if you need the brand name or if a generic would work, but if your insurance doesn’t approve it, you can look into GoodRx, and similar things like singlecare (I think?). They make agreements with pharmacies and it doesn’t cost you anything.

About generics, I’m on a generic of adderall XR, and it’s great, but when I was on a purportedly identical generic from a different pharmacy, it didn’t work at all, gave me headaches, and made me anxious. So if the first one doesn’t work out, idk if it’s the same with Ritalin, but you could talk to your doctor about trying a different generic or the brand name one.

2 Likes
#5

That’s all excellent to know honestly. I looked into good rx, and they’re wanting between $60 and $80 for a 30 day supply of what I’ve been prescribed, which is way better than no discount but still fairly pricey. Now I know to be on the look out for side effect differences in the generics tho so it’s a good start.

2 Likes
#6

:slightly_smiling_face: I hope the insurance comes through!

1 Like