I am a Medicaid CW. I have no idea if our state covers Daytrana.....but it sounds like the appeal process has been no use. May I suggest that you, the doctor and the parents contact your State Rep to encourage him/her to perhaps challenge the State's denial of coverage of Daytrana.
Daytrana has been more effective in many children....more so than the other oral medications available with less side effects.
The appeal process, in our state (OH), is really initiated by the Physician. I am also wondering if the state review board (which may only meet once per year), decided to not cover the med due to the cost and that it is so new.
I wish you luck with this as we all know, that if it greatly helps the child, then it is so worth the cost!!!!!
punkin' s mom39133.8885069444* no soliciting *
~ogram~39148.4010416667No, I don't have MA. Have you contacted Shire about their patient assistance program, it can and will pay for meds some of the time.I know several people who use it.Maybe he needs to see a regular psych instead of one within the school system? Insurance companies are strange and sometimes needs 2nd, 3rd opinions before paying for a newer med.
Why can't this child use regular methylphenidate?The same active ingredient in the Daytrana patch?
I never had a problem with my insurance refusing dd's meds.
* no soliciting *
~ogram~39148.4007291667