Me vs. the HMO | ADHD Information

So I go to have my son's Focalin XR refilled and it was .  In the past is has been half of that.  So I call my insurance company and they tell me that is not a "preferred" drug.  That I could go to Aderral or another drug.  They told me that most of these drugs have the same ingredients and my son should react the same on any of them.  OMG.  So now my choice is to pay for something that I know works great for my 6 year old or mess with the presciption (for ).  Any thoughts on that?

Wow............my kids are on Focalin XR and very stable.  I would freak out if that happened to me.  How can they have so much control?  UGHHH......

HEALTH CARE IN AMERICA IS A CRIME!

twirly1

I pay full price for DD's Concerta( 9 a month) because it is not on the "preferred med list", short acting Ritalin is.

You have to do what's best for you and your child, and weigh the finainces to see which is best overall.

Good luck.

They usually win.

I'm forced to take zolpidem since it came generic.

I can pay the balance, if I want the Ambien.

Ask your doctor, maybe he knows how to deal with insurance companies.

I'M A VICTIM!

(again)

Your doctor knows how to deal with this.  He needs to fill out a form stating that you've tried drugs A and B, and they did not work, therefore Focalin XR is being prescribed. It's a game. BTW, Strattera is 0 a month. Our Psych filled out zillions of pages of paperwork, and they still refused. I gave up fighting, m cancelling the insurance( not paying for what costs me a fortune) and going without...we will just pay out of pocket from now on. Been doing it anyway..

Like everyone else has said, there are forms for your doctor / psychiatrist to fill out, I believe they are called "Medical Necessity" forms, that can be submitted to your insurance company that might bring you back to your former price with Focalin. Try calling the pharmacy number on your insurance card and asking them to fax or mail you these forms for your insurance carrier.

On a more realistic note, if you still have problems with the company, another alternative that might be helpful as far as regulating the costs over the period of a year is a Flex spending account, if one is available to you. Another option that might be available is the mail order program, where you get multiple months for just one copay. Most insurances now have these special programs available, but you just have to ask about them. (I know this really doesn't help the REAL problem -- that this should be completely illegal because the insurance company should have no right to interfere with your trial and error process with your doctor and what works for your son.) But, I thought it might be worth mentioning in the meantime.

Good luck with the fight, I think we are all fighting the HMOs for something or another...

[QUOTE=iamsamz]

If you were paying less in the past why the change?

 

[/QUOTE]

 

Insurance companies can change their formularies every 6 months in January and July.  Some insurance companies wont even allow you to have non formulary meds with a prior auth and some will just charge you a higher copay. T

I love you guys.  Thank you so much for your ideas.  I am so pissed at the insurance companies.  Kris

If you were paying less in the past why the change?