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Insurance not covering meds- Anyone had this happen too?

Posted by on Mar. 16, 2013 at 7:09 PM
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  Has anyone else had their insurance not cover their ADHD meds?  We are having difficulty with Medi-cal in CA, we just switched plans and I found out that this plan does not cover meds. 

Do you know if it is just the specific meds that my DS is taking? Or meds all together?  Do you know if there are any avenues I can look into to help if I have to pay for the meds?  216.00 a bit hard but know I need to do it if it is a must.

Please contact me with any information will greatly appreciate it.

by on Mar. 16, 2013 at 7:09 PM
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Replies (1-7):
21lisa72
by Member on Mar. 17, 2013 at 3:55 PM

 Our Independent Health requires prior auth and always has the highest copay on the tier-Why it doesnt seem fair these are just as nessesary as heart or blodd pressure meds!

1squishysmom
by on Mar. 17, 2013 at 3:59 PM

 You should call the insurance co. directly. The dr that accepts the insurance should know, though. It could be that they don't cover name brands, but do the generics? We never had this issue, if we did, we would have to change insurance companies, as we would never be able to afford the meds.

lazyd
by Bronze Member on Mar. 17, 2013 at 4:20 PM

We've always gone in with a list of drugs that  my kids' insurance plan will cover.  You can usually look that up online and print a copy before you go in.  Or your doctor should have looked that up or called before he prescribed the certain med.  Now if it is the only med that your child can take, than it sounds like you are out of luck.  But if it isn't than go back to the doctor and tell him that this particular med is not covered by insurance.  The only problem i've had with insurance is that you call them to change one small thing and they accidentally cancelled our insurance so i go to the pharmacy and had to pay over 400 hundred dollars one time!!  

DDDaysh
by Bronze Member on Mar. 17, 2013 at 8:19 PM

You really need to contact the company and get a copy of their coverage policy.  It is crucial to know if they are denying a particular med or medication in general and what the appeals process may be.  

I have had a pre-authorization denied on my son's medication before (IBX Blue Cross is our insurance) and it was a serious hassle to get them to authorize coverage of the drug.  We had to prove other medications were not effective first.  But, eventually we won!  

AMom29
by on Mar. 17, 2013 at 10:28 PM

I had that with Vyvanse.  The dr. wanted to try it instead of Adderall, but the insurance company wouldn't approve it unless we tried Adderall first.

nomadbrat83
by Member on Mar. 20, 2013 at 5:49 PM

 How old is your child?  Some won't cover certain meds or until they reach a certain age.  We had that problem with DD.

CHDMommy3
by on Mar. 24, 2013 at 11:52 PM

Thank you everyone, I actually got it covered.  We just needed a prior authorization.  Thank you everyone.

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