ADHD medication no longer covered

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This topic contains 7 replies, has 5 voices, and was last updated by  Skypark962 3 weeks, 1 day ago.

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  • #110273


    I learned today, as I tried to process the mail order refill for methylphenidate that the medication is no longer covered for co-pay amount only. Since it is not a preventative medication the deductible must now be met as well. My plan does not define mental health medications as preventative, thus requiring full payment until deductibles are met. For me this is about $675 for 90 day supply against a $3000 deductible. Which also means never meant, always out of pocket since all other medications are considered preventative.
    I am angry, I am appalled. I think it is irresponsible, at best, to not consider medications for mental health preventative.

  • #110275


    I am not able to get my Concerta covered (sounds like that’s what you have too, from that price) because my insurer’s formulary only covers it for kids, but I can’t function nearly as well without it, so it’s important that I have it. My psychiatrist advised me to get a drug coupon from This coupon, which you print or pull up on your phone for the pharmacist, lowered the price for me from whatever obscene price it was to around $110/mo. Not sure how to apply it via mail order, but the internet no doubt knows.

    Be sure to shop around at different pharmacies – I’ve tried to apply the coupons at multiple places, and prices vary wildly. GoodRX shoukd show you estimated prices for your med/dosage at different pharmacies.

    Also, remember that you could always use Ritalin as a fallback. I also take Ritalin to boost the Concerta in the afternoon, and it’s cheap as dirt. Methylphenidate itself is an old cheap drug, so what you’re paying for in the new forms is the release mechanism. Ritalin multiple times a day isn’t nearly as smooth a ride as Concerta (think rickety prop plane instead of luxury zeppelin), but it gets you up in the air and where you need to go in a pinch. If you are unable to get your meds affordably, you could ask your doctor about switching your script to a comparable dosage of Ritalin 2-3x a day.

    Yeah, I feel you. Hate how it’s only covered if you’re a school age child – it’s like they still don’t believe adult ADHD is a real thing.

    • #112728

      Participant will help cover the cost if you live in Canada. Sign up for a free card. Good luck

  • #110283


    Actually it is for a child. Changes to my insurance cover no meds for this diagnosis.
    I did find some great online resources and I am grateful for that. But given the premiums i pay for insurance it should not be needed.

    To anyone using the online coupons, are they consistent or it is cross your fingers and hope that the same med/dose etc has a coupon at refill time?

  • #110284


    Oh whoops, forgot what section I was in! Not even covered for a kid? That’s just horrible.

    Anyhow, I’ve always been able to find and apply a coupon for my dose. Also, you just need to apply it once at your pharmacy. Probably not going to be as good as the covered price, but better than full retail (in my experience, a couple hundred dollars better). Also, pharmacies sometimes have their own discounts they apply to certain drugs, but these come and go. CVS had one for a while, so I was getting a reasonable uncovered price, but one time I went back and the price had doubled. The GoodRX coupon brought it back down, but nowadays I go to Walgreens because they have the right kind of Concerta and the best deal with the coupon. I guess that’s one small silver lining to not being covered – you can go to whatever pharmacy has the best deal/the right generic or whatever.

  • #112726


    To anyone in Canada concerta is covered with a free card. All you need to do is visit and sign up for your free card. It pays the difference between non gereneric and name brand. I pay 39$ a month with this card and I recieved it in the mail and I could use it immediately because my card # was sent directly to my email upon signing up.Saving me approximately 90$ a month. Cheers.

    • This reply was modified 3 weeks, 2 days ago by  Janpet.
  • #112825


    When I wanted to do mail order—it was like $1k. Is this just a mail order thing and the regular way won’t have to be covered by a deductible? Maybe it’s time for a different insurance….this is just awful.

  • #112849

    Dr. Eric

    Talk to your medical office.

    Sometimes, doctors are not thinking about these things when they prescribe.

    It is possible that they can find a nearly identical option that is covered, or they may have folks that deal coverage issues that can help you navigate the bureaucracy better.

    Use the expertise of someone who does this for a living.

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