Changing my daughter’s ADHD medicine due to insurance

Last June, my daughter began taking a generic version of Focalin to help her focus in school after she was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). By July, we had increased the strength. We thought her behavior was much improved. Even the doctor noticed a difference at a follow-up appointment. We decided to wait for school to start to see if it was the correct dosage to help her with her classroom learning.

When we met with Lexie’s teacher for a parent-teacher conference in November, we learned that she was doing great in school and that even her reading scores had risen from last year. Her teacher said her dosage was perfect.

That was all well and fine until we received a letter that the Lexie’s medical insurance plan was being discontinued, and we would need to select a new one. When we looked at the plans out there, we were left with two choices – either select an insurance that had her pediatrician on the plan and NOT her specialists (ophthalmologist and allergist) or pick one that had the specialists but would cause us to lose the doctor she has had since birth.

If you have been following my blog, you will know that Lexie has had a variety of medical issues (situs inverses, eczema, allergies, polysplenia). Things have been going well, and I was eager to keep the pediatricians we knew and who knew her.

capsuleBefore choosing our new health insurance, I made sure Lexie’s meds were on their approved list. She takes two antihistamines as well as the ADHD medication. I checked, and they were on the list. Yeah!

January hit and when I went to fill Lexie’s ADHD medication, the pharmacy said that the insurance wouldn’t cover that drug. They wanted her switched to Adderall.

It seems I had missed something very important when looking up coverage of her drug. Her medication had an “ER” at the end of it. That is for Extended Release.

Her new insurance would cover the generic Focalin but not the Extended Release version. They requested we switch her to Adderall Extended Release. Her pediatrician petitioned them to allow her to stay on the Focalin, but the insurance denied the request. While waiting for the decision, we had no choice but to put her on Adderall.

I warned her teacher about the change, so she could watch for any side effects and to let us know if the medicine wasn’t working as well as the previous one. Her awesome teacher sent me an email every day for the first couple of days. She noticed no side effects, and it seemed to be working fine.

That is good news and bad news. Good that she is responding to the new medicine but bad that we will no longer go back to the medication her doctor prefers. I guess all that really matters is that the medicine is working, and Lexie is able to focus during school.

 

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