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.


ADHD medication follow up

Back in June I posted about starting Lexie on ADHD medication to see if that helped her focus (and would confirm that she actually did have ADHD.) At the time, we started her on the lowest dose – 5 mg. After two weeks and very little behavioral changes, we moved her up to a 10 mg dose at the beginning of July.

You could see an immediate change. Lexie was calmer but not doped up or appearing drugged. She would follow directions better and could sit and read a book with me or do some class work. (Yep, I am that mom that has my kids doing school work during the summer, so they don’t lose everything they learned.)

But how would we know if this was the correct dosage? It is one thing to have her at home and focused but totally different to be in a classroom with 20 other students.

When we went back to the doctor, she immediately noticed the change in Lexie’s behavior.  No longer was Lexie rolling across the examine table. She sat there calmly playing on her iPad.

We told the doctor that we would keep her at this dosage and reevaluate at her after school started. The doctor agreed that was the best course of action.

IMG_0226So at the beginning of this year, I sent a note to Lexie’s second-grade teacher. This is nothing new. I always send a note on the first day to give the teacher a head up on her allergies (Epi Pen) and eczema. This year I added a paragraph about the ADHD. I asked her teacher to monitor Lexie’s behavior and let us know if Lexie’s dosage needs to be increased.

Last week, we had our fall parent-teacher conference. Lexie’s teacher marveled on her improvement in reading. Last year, she was behind and had special tutoring. Over the summer, I too had noticed an increase in her reading ability. Both her teacher and I attribute it to the medicine. Finally, we think Lexie is able to pay attention and focus on the story.

Of course, my husband said she had been playing more games on her iPad that required reading and that may have been the extra motivation she needed. Either way, we are thrilled to see she had made such a large jump in her reading.

Her teacher said she thought Lexie’s dosage was at the right level. She can stay focused in class, but she doesn’t seem overly medicated or tired.

I agree. We give her the medication daily and on the weekends, I can see a difference of when she is on the medicine and when she is off it.

The medicine has affected her eating habits some.  There are days when she barely touches her lunch. But she sure makes up for it when she gets home from school, and the medicine’s effect wears off. That happens usually within the hour after returning home from school.

And this means that when we do homework, she is no longer on the medication. Sometimes it is struggle to get her to focus but I like that she has that time to try without the benefits of the medication. We are allowing her to work on her self-control at home where we have the time for it and the medication is allowing her to focus at school. I think it is the perfect blend to manage her ADHD.




Starting ADD medication  

Lexie at her Fiesta parade in April.

Lexie at her Fiesta parade in April.

I wrote back in March that Lexie’s teacher was concerned that she might have an attention or focus problem. I brought it up to Lexie’s pediatrician at her 7-year-old checkup in April. After a few basic questions, she gave us the paperwork to have her assessed for ADD or ADHD.

Basically this included a questionnaire for both parents and her teacher. They like to have four assessments so we had Lexie’s reading teacher also fill out a form. The pediatrician then scored the questionnaires. We met with her at the end of April to go over the results.

Both my questionnaire and Lexie’s primary teacher indicated that Lexie might have a focus problem. But the one from my husband and her reading teacher didn’t. Since all four questionnaire were not in sync with each other, there was no definite diagnosis of ADD or ADHD.

As we discussed this, Lexie is rolling across the exam table and even though she had my husband’s phone to play with, she can’t sit still.

The doctor talked briefly about our options – trying therapy to redirect Lexie or trying some medication to see if that helped her focus. If the medicine worked, we would then have our ADD diagnosis. If it didn’t then we would need to look at other methods for redirecting her.

I think because we are already frustrated with her, medication seemed the easier solution to at least get a definitive diagnosis. The doctor went over the side effects – decreased appetite, sleep problems or even possibly heart palpitations.

One thing I didn’t realize is that most ADD medications are stimulants. As such, since Lexie was born with a congenitive heart defect (which resolved itself before 9 months old), the doctor ordered an EKG that would be evaluated by her pediatric cardiologist (who we hadn’t seen in almost 6 years).

Well, her cardiologist had since changed offices and he didn’t have access to her old records. If he had, we probably would have been saved from having to make an appointment to see him. As it was, we got a call that he had noted something unusual on her EKG and we needed to follow up with him.

After a second EKG, an echocardiogram and refreshing his memory about Lexie’s medical history, he pronounced her heart strong and saw no problem with her taking ADD medicine. (He did note that he could see why she might need the medication as she again could hardly sit still during the exam.)

So after one last appointment to again go over the side effects, we were given a prescription for Focalin. We were to start her with the lowest dosage of 5 mg and then if after two weeks that didn’t seem to help, we were to move her to a 10 mg dosage.

After a few days delay of getting the insurance company to understand the dosage instructions so they would cover her medication, we tried to start Lexie on the medication on June 12th. I say try because the medicine came in a pill format and Lexie has never taken a pill.

My husband thought it would be no trouble as he has never had problems swallowing pills. I on the other hand remember struggling with it as a child. Lexie takes after me and had trouble swallowing the capsule.

The instructions indicated that we could open the capsule and add it to a spoonful of applesauce which we didn’t have since neither kid eats it. So we decided to open a capsule and add the contents to some water and administer it by a syringe as we do all of Lexie’s other medications. Lexie however panicked and the most of the meds dribbled down her front side.

Admitting defeat for the day, we tried again the next day. This time we sprinkled it on a spoonful of yogurt and she had no problem taking it. She has now been taking it for a little over a week and there has been very little change in her behavior. We will probably try the higher dosage in the coming week and then meet with her doctor next month to check her weight and discuss if the medication is helping her.