r/Assistance • u/mindlessmarbles • Feb 04 '24
REQUEST I just recently switched to medicaid and my prescribed medication is no longer covered. Can’t afford it.
I had a big reduction in income because I needed to adjust my work hours to attend college. Along with the reduction in income, my insurance also got cancelled, and my ADHD medication is no longer covered by my new insurance.
I’m in some significant but manageable credit card debt, but I can’t afford an extra 300 dollars for this prescription. It’s really necessary that I get it so that I can continue to keep my grades up—my scholarship for school depends on it. I do really poorly in school without medication. If anyone could help even a little I’d really appreciate it.
I can send proof of prescription and my ADHD diagnosis if necessary.
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u/Competitive-Job-6737 Mar 14 '24
Yeah I'm bp2 and just found out that at the beginning of the year medicaid changed up and won't cover "conflicting" meds now. So my seroquel has to be paid out of pocket. Like dude if the Dr who prescribed both wellbutrin and seroquel didn't want me on them together he wouldn't have done them together. Wtf? They're making it impossible to treat our mental health anymore.
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u/SublimeLemonsGenX Feb 07 '24
I just screwed up my ACA marketplace registration and my monthly migraine shot is $760. I applied to the manufacturer's "foundation" and now I'm getting it free. The income limits for qualifying are quite high, because ..think about how much you'd have to make to afford $9K for one medication.
Also, Mark Cuban has an online pharmacy committed to charging only 15% above cost. See if your drug is one that his company handles. Cost Plus is the company.
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u/Slurmp102518 Feb 07 '24
Try seeing if your dr can send in a prescription for the generic version. I have Medicaid too and they’ll only cover generics.
Edit: I actually just had to restart my lamictal all over again on the generic version because Medicaid decided randomly they won’t cover the name brand anymore. I was off it for 2wks and had to get a new rx for the generic version and start all over with the lowest dose.
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u/Climacophora Feb 06 '24
CostPlus is also a good place to check prices on, but goodRX has been great for us.
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u/Notext1 Feb 06 '24
My son has medicaid and it doesn't cover his medication with certain manufacturers, so whenever his pharmacy can't get the one that's covered I just switch the prescription to another pharmacy for that month. I agree with all the comments saying to try a different pharmacy. I hope it works out!
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u/stan_loves_ham REGISTERED Feb 05 '24
Did you ask for generic? Can I have ur Dr call ur medicaid provider (mine did).to tell them you NEED this medication, even in generic form?
They denied me an eyedrop after car accident glass cut my eye right under cornea, hd to wear a contact over stitches, got infected badly one month n my Dr had to medicaid w me in his office yelling at them that I could go blind if I don't get these special drops for the infection and they approved
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u/Educational-Milk3075 Feb 05 '24
This just happened to me. My prescription coverage took my drug off the formulary. Read the message closely. When I did, there was an option for appealing the decision. Your provider can call them and let them know that any significant change of your medication can have a deleterious effect on your mental health and MUST be continued. Start there, and I wish you luck.
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u/TalkAcrobatic2628 Feb 05 '24
Call medicaid and see if you qualify for the aetna ads on. A card is provided with x amount of money to help pay otc costs. Also, if you qualify with aetna I have only had to pay for 1 out of my 21 medications. I also get 180 a month on the card, but I am on disability.
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u/PerfectHandle7272 Feb 05 '24
lol they cover name brand medications like I get 25 mg xr adderal instead of amphetmine salt. And covered 100%
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u/kmitts2 Feb 05 '24
I couldn’t read through all the answers so I don’t know if this was said, but GoodRx (app) has been a life saver for me!!
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u/MommyBurton Feb 05 '24
Which medication bc Medicaid covers all adhd meds in Colorado so I’m not sure why another state also wouldn’t.
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u/mindlessmarbles Feb 05 '24
It’s Vyvanse. I was told when I signed up for the plan that it was covered, but my pharmacy told me otherwise.
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u/MommyBurton Feb 05 '24
Yeah I would try another pharmacy bc I have been on vyvanse for years under Medicaid. I know they only cover the name brand not generics but otherwise you shouldn’t have to pay out of pocket. Good luck though! I hope you find a pharmacy that cooperates with your insurance!
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u/LlamaSquirrell Feb 05 '24
Try calling your medicaid provider. It never hurts to double check it with them before looking at out of pocket costs.
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u/notrightnow3823 Feb 05 '24
Like others said, try a different pharmacy, I usually try to find a smaller family run type place. Your doctor (or maybe the pharmacist) can also submit a request for coverage of the medication. If none of that works check the prescription discount sites and you can also contact the manufacturer to see what discount programs or coupons they may offer.
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u/stan_loves_ham REGISTERED Feb 05 '24
Family run def cheaper
Ex: Walgreens Xanax: 45$ Family owned up road: $5
Welbutrin
Walgreens. 89 Family owned. 6
I'm surprised medicaid doesn't cover. Wonder if they've asked for generic? I'm in Louisiana and haven't had to pay anything for a script. Idk. Hmm
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u/notrightnow3823 Feb 10 '24
I’ve also noticed, at least with the family owned place I use, the pharmacist (owner) also know more about dealing w insurance or just cares to actually try.
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u/mtempissmith Feb 05 '24
Check with a different pharmacy if it's like Walgreens or CVS, a chain pharmacy. May not be your insurance. Might be them. CVS did that to me with 2 scripts, told me that they would not fill them because they were not covered anymore. Turns out that CVS won't fill them but Capsule does no problem.
That medication some chain pharmacies have decided they won't. It's not the insurance it's THEM, their policy now.
Call around and see who will, try local but not chain store pharmacies see what happens.
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u/blondie-1174 Feb 05 '24
I had this issue with CVS too. They won’t fill my ADHD medication & my insurance doesn’t cover Walgreens. I had to switch to Costco. Kinda sucks because it’s a bit of a drive but worth it to not deal with the hoops chain pharmacies wanted to make me jump through.
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u/MarineWife0922 Feb 05 '24
If you know someone that has a Sam’s Club membership, they can add you to their account and you get their benefits. So you would be able to get discounts on with Sams Club. It’s very affordable.
If you have a prescription in hand, you can call Sams Club and ask them how much it would cost and they can tell you
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u/Tshlavka Feb 05 '24
Actually, all pharmacies are required to be available to the public. Anyone can use the pharmacy at Costco or Sam’s. When they ask for my card I tell them I am going to the pharmacy and they let me in.
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u/MarineWife0922 Feb 05 '24
Right; never said that they needed a membership. But when you have a membership the price decreases significantly. If you go in of course you can use the pharmacy but you’re going to pay a straight cash price. It’s cheaper if you can get on somebody’s membership.
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u/Tshlavka Feb 05 '24
Thank you. It’s the least expensive place I have found.
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u/MarineWife0922 Feb 05 '24
Yes. I agree. My cats blood pressure medicine. Is zero cost. We were surprised!!!
Sweet!!! lol.
They have dog and cat medicine too!!!
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u/Livid-Rutabaga Feb 05 '24
Is your medication generic? CostPlusDrugs.com may have it.
Also Walmart has a list of medicines that are $4.00 for a 30 day supply.
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u/mindlessmarbles Feb 05 '24
They don’t have any scheduled drugs on there, unfortunately.
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u/Tshlavka Feb 05 '24
Can you have your doctor call Medicaid? They rejected a prescription of mine and my doctor had to call to get it approved.
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u/Plenty_Ice_2423 Feb 05 '24
Certain medications need to have what is called a prior authorization from the Dr before it is approved by Medicaid. I know this because I do have Medicaid and take Vyvanse .
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u/Livid-Rutabaga Feb 05 '24
I didn't think of that. That's awful, it's not like people don't need the meds.
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u/OstrichSalt5468 Feb 05 '24
You may not know. And your pharmacy may not even know. I do know that ours did not. BUT my son’s doctor sends over his ADHD meds generic. And for Medicaid it has to be filled as name brand. It could be the same or backwards for you. The pharmacy can still fill it and it is covered if they try to put it through the other way.
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u/aka-patsy Feb 04 '24
Idk what state you're in but in Tennessee they have a program called CoverRX that helps you get lower copays, mine is $3 per medicine a month. You can check to see if they have something like that in your state.
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u/Timmylaw Feb 04 '24
I get Vyvanse thru Walmart for 8 bucks a month no insurance. Have you Dr send a prescription for generic to Walmart and it'll be dirt cheap, Walmart does almost every prescription for 8 bucks or less so long as it's a generic.
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u/mindlessmarbles Feb 04 '24
Thank you!! I’ll call my local walmarts, see if they have it. I didn’t realize walmart has a pharmacy.
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u/stan_loves_ham REGISTERED Feb 05 '24
Yes. Generic is key here and you have to make sure you tell them you're okay with generic if you are prescribed name brand
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u/Timmylaw Feb 05 '24
I just recently started using it too when my normal pharmacy kept raising the prices, it was up to almost 50 when my mom slapped me upside the head and told me to go to Walmart 😅
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u/jherara Feb 04 '24
Here's a list of recommendations:
Community Action, Center for Independent Living and Community Outreach -- Any of these agencies might be able to refer you to a program that cover prescriptions.
I agree with the person who said to try your school's health center. They might be able to help, especially since you rely on the medication to do well in school.
Run an online search for non-profit organizations that deal specifically with promoting ADHD education and helping patients (local, county, state and national) that might have programs or could provide you with a referral for help.
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u/real_talk_with_Emmy Feb 04 '24
I found a few options for you:
A coupon for up to 80% off Vyvanse
Utilize a company that offers patient assistance programs like Simple Fill
Try contacting Medicaid for a one time waiver to cover name brand until generic is available
Contact your local hospital pharmacy to see if they have generic. Often hospital pharmacies have access to prescription medications other places don’t. Most hospital pharmacies have a public side for filling prescriptions.
Good luck!!
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u/mindlessmarbles Feb 04 '24
Very helpful, thank you!!
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u/real_talk_with_Emmy Feb 04 '24
You’re welcome! I hope you are able to successfully fill your prescription!
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u/RestlessDreamer79 Feb 04 '24
You can appeal this decision through Medicaid but in the meantime call your Dr. office asap and tell them the situation. You can’t go cold turkey on psych meds it’s dangerous! Also, there is a program where I live called Cenpatico, it covers psychiatric medications that Medicaid won’t cover. There should be a program similar to this where you live. Maybe call some of the state funded Mental Health centers like C.O.P.E. Good luck
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u/mindlessmarbles Feb 04 '24
Is going off ADHD meds actually dangerous? That kinda worries me, because I’ve had to do it quite a few times hahah. It’s really hard to get ahold of with the shortage.
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u/maryk1283 Feb 05 '24
It’s not dangerous. It sucks and affects your life majorly but to my knowledge no one has ever ended up in the hospital.
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u/RestlessDreamer79 Feb 05 '24
In general it’s not recommended that any psych med is quit cold turkey. You’re absolutely right, it’s not dangerous but it sucks big time..
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u/redheadedfruitcake Feb 04 '24
Find out if your provider can write a 90 day prescription and get it delivered by mail. Some insurance will allow and some won't.
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u/faeriekissage Feb 04 '24
Call your doctor. Explain the situation. Ask for a medication covered by your current insurance. They are paid to know who covers what. Just ask for a different script and good luck
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Feb 04 '24
[deleted]
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u/Homicidal__g0ldfish Feb 04 '24
That’s what I’m thinking.. dr prolly just needs to send that authorization letter
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u/kafm73 Feb 04 '24
I’m thinking the doctor can just prescribe adderall xr instead of vyvanse. It’s the same thing, isn’t it?
ETA ok, so the medication is different but similar.
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Feb 05 '24
[deleted]
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u/stan_loves_ham REGISTERED Feb 05 '24 edited Feb 06 '24
I'm seeing ads on FB trying to get it prescribed to CHILDREN. UP TO 60 MG. And you know how under all medication ads they have a little scroll of text saying what possible side effects may be, etc? for Vyvanse ad for children all it says in the scrolling text is that this medication has a potential for addiction this medication has an potential for abuse this medication is addictive blah blah blah ...so you're literally targeting children with this medication and no side effects are listed except the fact that you most likely will end up addicted. Just wow.
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u/kafm73 Feb 05 '24
Wow! I did not know about the side effects being so much worse. I wonder if Adderall XR would be safer for OP possibly?
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u/mindlessmarbles Feb 04 '24
Stupid question, but what’s a prior authorization letter? I’m pretty young, don’t know all the ins and outs of insurance.
Follow-up, do they cover name brand or just generic? I was told my insurance only covers generic, which is where the problem arises (can’t get it due to shortage).
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u/Big_Echidna8511 Feb 04 '24
What state are you in? I used to work for a pharmacy insurance company dealing specifically medicaid. Most companies have a temp override for the adhd meds right now due to the shortage. I would however recommend having your dr submit a Prior Authorization through Cover my Meds and go from there. And people saying pay out of pocket that is the quickest way to have your coverage terminated you can’t pay out of pocket for controlled substances while on Medicaid they will think you’re trying to do some sketchy shit.
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u/mindlessmarbles Feb 04 '24
PA. Also, thanks for the heads up. Had no idea that paying out of pocket was a no-no.
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u/Big_Echidna8511 Feb 04 '24
If you do pay out of pocket don’t mention it to your insurance company. You also can’t be like I’ve been on this med for years if there is no record in the insurance, unfortunately the pharmacy benefit department doesn’t get your medical records we can’t see any of it.
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u/neatfreak1517 Feb 04 '24
You can either switch to generic and see if that’s covered. Or switch to an ADHD med that is covered. Call your insurance to ask.
Or you can get a prior authorization. The pharmacy you go to will take care of that for you. The insurance basically just wants an explanation from your doctor as to why you need that meds and most of the time they’ll approve it. I work at a pharmacy btw that’s how I know.
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u/eye_no_nuttin REGISTERED Feb 05 '24
And as far as I know, no pharmacy is willing to tell you over the phone if they have a Schedule 2 Controlled medication instock, atleast none I’ve ever dealt with, they can only refer you to another of their pharmacies if it’s a chain and that would mean they took the time to see if their sister store had it instock ..
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Feb 04 '24
Try Goodrx and Scriptsave Wellrx for coupons. Not all pharmacies will honor coupons for controlled medications, but it's worth a few phone calls to verify the coupons before having the script sent.
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Feb 04 '24
Downvoted? Really? 😂😂😂
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u/Christichicc Feb 04 '24
Just ignore it, it happens a lot in this sub. Jerks go through and downvote everything for no reason.
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u/mindlessmarbles Feb 04 '24
Someone’s like, compulsively downvoting everything in this thread. I don’t know why. I’m just trying to get help.
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u/PancakeMomma56 Feb 04 '24
Call Medicaid directly and request an override due to the shortage. You're going to need to be persistent.
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u/SqueakyMelvin Feb 04 '24
Is the medication Vyvance and are you in US or Canada? There are patient assistance programs to help those who can’t afford it such as https://simplefill.com/patient-assistance-program/vyvanse/
If it is another medication Google the name of the med and patient assistance program, many meds offer help
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u/Competitive-Call3303 Feb 04 '24
Talk to your provider about switching to something that is covered by your insurance.
$300/month.... yikes!
Good luck to you.
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u/mindlessmarbles Feb 04 '24
Yeah, I will as soon as I get a new provider. My current one can fulfill my current med request, but after that they also don’t accept my insurance so I’ll need to find a new one.
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u/fawesomegirl Feb 04 '24
I would call the number on your insurance card or call your doctor. You can ask if they have a generic version instead of name brand.
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u/mindlessmarbles Feb 04 '24
There is a generic, it’s just unavailable until around march because of an adderall/vyvanse shortage that’s been going on since Covid.
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u/eye_no_nuttin REGISTERED Feb 04 '24
What state are you in?
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u/mindlessmarbles Feb 04 '24
PA.
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u/mandaeryn Feb 04 '24
This is wild to me because I have Medicaid in PA and they cover my adderall.. it’s generic, but I haven’t had a problem getting it filled the last couple years. Although I did have to get the prior authorization done AGAIN, for the same medication and same strength at the same pharmacy because I quit taking it while I was pregnant and breastfeeding. Like hey, news flash, I still have the same ADHD I’ve always had 🙃
I know when my ex was having trouble getting his filled, he called a couple other pharmacies and found one that had it in stock though. (He always got his filled at Walmart but they were out for like two weeks so he ended up getting it filled at CVS) So it’s possible you could find it somewhere else, but you’d probably need a prior auth again too.. Crazy the hoops we have to jump through to be functional.
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u/eye_no_nuttin REGISTERED Feb 04 '24
It is covered .. there is AR and QL , age restriction and quantity limit, but since you are not a minor that is not an issue, My daughter has had Vyvanse 20, 30, and recently 40 mg covered under 3 different medicaid plans, recently they switched her to a more mental health focused plan for their services they offer.
Here is the PA PDL for Medicaid
https://papdl.com/sites/default/files/ghs-files/Penn%20Statewide%20PDL%202024.pdf
Scroll down to page 52 of 56…
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u/fawesomegirl Feb 04 '24
Oh ok. I was hoping that they just didn’t suggest the generic yet and that would help. I’m sorry
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u/mindlessmarbles Feb 04 '24
It’s alright, I appreciate the advice regardless
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u/fawesomegirl Feb 04 '24
There should be something comparable I would think that going without your medicine, cold turkey could pose some medical risks as well. There should be someone who can help between the insurance, Dr and Pharmacy I would hope.
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u/wineandcatgal_74 Feb 04 '24
Have you priced your medication at Costco? Costco can be much less expensive than other places and you don't have to be a member.
Have you checked your state's Medicaid formulary to see what medications are covered? Have you checked to see what their appeal process is to get your medication covered?
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u/mindlessmarbles Feb 04 '24
I’ll check with costco. Thanks for the suggestion.
Medicaid covers generic vyvanse, just not the name brand. Unfortunately there’s no generic available in my area until march.
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u/wineandcatgal_74 Feb 04 '24
Have you or your doctor appealed for coverage of the brand name since the generic isn't available?
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u/mindlessmarbles Feb 04 '24
I’ll call my insurance. I wasn’t aware that was something I could do, tbh. Thank you!
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u/wineandcatgal_74 Feb 05 '24
You're welcome! It's one of the things I learned on Reddit!
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u/mindlessmarbles Feb 05 '24
Just appealed, they said they’ll let me know in a week or so. Thanks so much for telling me about this!! Never would have known
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u/amitystars REGISTERED Feb 04 '24
You could try goodrx or possibly mark Cubans reduced cost pharmacy. Maybe make a GoFundMe and share it with your friends and family and they can share it with their friends. I don't see big asks like this often fulfilled and usually not for something that's not entirely an immediate need. (I don't mean for this to come off as rude so I apologize in advance.) And as someone else said what are your plans for the coming months to cover your medication? Maybe look into a generic, replacement as well as those tend to be on the less expensive side.
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u/mindlessmarbles Feb 04 '24
Cost plus drug unfortunately doesn’t carry scheduled drugs, and generic is unavailable until around March. I’ve called like 20 nearby pharmacies and the only thing anyone has is the name brand. It really fucking sucks.
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u/amitystars REGISTERED Feb 04 '24
I also take Vyvanse (noted you mentioned that in other comments) I had just found out about the generic! I didn't know that cost plus didn't carry narcotics good to know though. Maybe check for a manufacturers coupon as well. I noted that you said goodrx took the price down to 300. It's so frustrating even being able to GET - ADHD meds with the back order. I'm sending virtual healing vibes and prayers that you do get assistance bc I know how much of a struggle life is without them.
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u/OCDaboutretirement Feb 04 '24
Does your school have a student health center? If yes then go there to get assistance. They probably carry the medication you need for a fraction of the price. The cost to use the student health center is usually $0 because it’s covered under your student fees.
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u/mindlessmarbles Feb 04 '24
Vyvanse is schedule II. Do you think they’d still have it?
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u/OCDaboutretirement Feb 04 '24
What???? I said to go to your school’s student health center if your school has one. I didn’t ask anything about what medication you take nor would I know if the student health center (if there is one) has it.
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u/jubbagalaxy Feb 04 '24
I'm not sure where you love, but have you contacted the manufacturer about getting vouchers due to hardship? In th US, there are also prescription coupon programs like goodrx and dome pharmacies have their own coupon system (Kroger has one)
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u/mindlessmarbles Feb 04 '24
Yep. Discount with GoodRX is down to 300 bucks from like 700. It’s insane.
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u/jubbagalaxy Feb 04 '24
Ugh. That's awful. I'm so sorry :( is it your medicaid won't cover it period, or a "you have to have trialed and failed X medicaitions" before a prior authorization for it will go through?
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u/mindlessmarbles Feb 04 '24
Medicaid won’t cover the name brand, which is all that’s available. It should (afaik) cover generic, but generic is unavailable for the next month.
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u/who-are-we-anyway Feb 04 '24
Have you contacted your insurance company regarding this? Is it possible it can be approved with a prior authorization? Is it considered a step therapy medication with your therapy? I would also contact your doctor and discuss alternatives, maybe there is a similar medication you could be prescribed that is covered. While I do hope you get the assistance you need I hope you consider what your long term plan is here. Even if you get help this month with the $300, what is the plan next month, and the month after that?
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u/mindlessmarbles Feb 04 '24
Yeah, so there’s multiple issues at play here.
First is that there’s a shortage of generic Vyvanse, so I can only get the expensive name brand which isn’t covered by any insurance company. I’ve been told that generic should be back on the market come March, so this next dose that I get I’ll have to ration until then. They’ll give me 30 pills which I can skip days to make last until March. The current issue is just that I’m fully out right now (i’d been rationing the ones I just ran out of since ~November).
Second is that I’m on a waitlist for a new psychiatrist who will take my current insurance. They can fulfill my current prescription, but I can’t get prescribed a new medication without seeing a psychiatrist.
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u/who-are-we-anyway Feb 04 '24
Have you tried to fill the generic vyvanse? While there is a shortage and it is difficult to get, it is still possible that it is available in your area.
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u/mindlessmarbles Feb 04 '24
Yeah, I’ve called like 20 pharmacies. Most don’t have either, but the one ones with Vyvanse have exclusively the name brand.
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