Anonymous
Post 01/29/2015 16:09     Subject: United Healthcare not covering certain ADHD meds
Pretty typical for insurance companies, and hardly an ADHD thing exclusively.
Anonymous
Post 01/29/2015 16:05     Subject: Re:United Healthcare not covering certain ADHD meds
Anonymous wrote:I am the end of my rope and maybe someone can help. UHC denied Focalin XR after my daughter being on this for three years and not issue. We tried Focalin, Concerta and Adderall. None of those work. I have had my daughter home for three days because I cant sent her to school. We tried Adderall again and she is Manic per the doctor yesterday and said remove her form the Adderall. WTH do I do? Now UHC says its not in your plan. I pay allot for PPO and this is not in the plan. I have had no issue with BC/BS or Cigna over the years. This is really bad putting my 12 year old through med hell.


Oh they said I could appeal which takes weeks. I asked why put us through this if it was not in the plan to begin with. No real reply other than I don't know. I asked I have a great plan and I assume UHC overall does not cover this Focalin XR. I don't know that answer they say. I said I need to speak with someone who can help me. They put me hold for 8 minutes then I get the automated " You have reached the Pre Authorization Dept.. I have had healthcare since 18 and never had such a difficult time as I have with UHC. also, our DR. noted the past and that this is in fact medically necessary.
Anonymous
Post 01/29/2015 15:59     Subject: Re:United Healthcare not covering certain ADHD meds
I am the end of my rope and maybe someone can help. UHC denied Focalin XR after my daughter being on this for three years and not issue. We tried Focalin, Concerta and Adderall. None of those work. I have had my daughter home for three days because I cant sent her to school. We tried Adderall again and she is Manic per the doctor yesterday and said remove her form the Adderall. WTH do I do? Now UHC says its not in your plan. I pay allot for PPO and this is not in the plan. I have had no issue with BC/BS or Cigna over the years. This is really bad putting my 12 year old through med hell.
Anonymous
Post 11/07/2014 15:08     Subject: United Healthcare not covering certain ADHD meds
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:I found this online, https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Notification_Daytrana.pdf

it seems UHC is concerned with off label prescribing for those over 12 years old?? The pdf documents that Prior Authorization for these ADHD meds going off list.... IF patient is under 12 yrs old, OR if over 12 yrs old also has a diagnosis of ADHD, Depression or Narcolepsy... & that -- authorization will be given for 12 months

Has anyone tried this year?? Our coverage of Focalin XR & Focalin ends Dec 31st...


This might appear new (and I see it has a date of 11/2014), but it has actually been UHC's policy for quite awhile. I had to get prior authorization a year ago for my son's Focalin. My pediatrician takes care of getting it done.


I think this is a separate issue -- the letter over the summer was about taking a whole collection of drugs off the formulary entirely. Not just for off-label use.


The prior authorization requirement has been in effect for quite some time. UHC has made it clear, however, that insurance coverage for these drugs is available only for certain conditions.
Anonymous
Post 11/07/2014 15:06     Subject: Re:United Healthcare not covering certain ADHD meds
also try to see if you can find a coupon online. we found a coupon for vyvanse which reduces the cost by 50% for six months of the year.
Anonymous
Post 11/07/2014 13:51     Subject: United Healthcare not covering certain ADHD meds
Anonymous wrote:
Anonymous wrote:I found this online, https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Notification_Daytrana.pdf

it seems UHC is concerned with off label prescribing for those over 12 years old?? The pdf documents that Prior Authorization for these ADHD meds going off list.... IF patient is under 12 yrs old, OR if over 12 yrs old also has a diagnosis of ADHD, Depression or Narcolepsy... & that -- authorization will be given for 12 months

Has anyone tried this year?? Our coverage of Focalin XR & Focalin ends Dec 31st...


This might appear new (and I see it has a date of 11/2014), but it has actually been UHC's policy for quite awhile. I had to get prior authorization a year ago for my son's Focalin. My pediatrician takes care of getting it done.


I think this is a separate issue -- the letter over the summer was about taking a whole collection of drugs off the formulary entirely. Not just for off-label use.
Anonymous
Post 11/07/2014 13:30     Subject: United Healthcare not covering certain ADHD meds
Anonymous wrote:I found this online, https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Notification_Daytrana.pdf

it seems UHC is concerned with off label prescribing for those over 12 years old?? The pdf documents that Prior Authorization for these ADHD meds going off list.... IF patient is under 12 yrs old, OR if over 12 yrs old also has a diagnosis of ADHD, Depression or Narcolepsy... & that -- authorization will be given for 12 months

Has anyone tried this year?? Our coverage of Focalin XR & Focalin ends Dec 31st...


This might appear new (and I see it has a date of 11/2014), but it has actually been UHC's policy for quite awhile. I had to get prior authorization a year ago for my son's Focalin. My pediatrician takes care of getting it done.
Anonymous
Post 11/06/2014 23:13     Subject: United Healthcare not covering certain ADHD meds
I found this online, https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Notification_Daytrana.pdf

it seems UHC is concerned with off label prescribing for those over 12 years old?? The pdf documents that Prior Authorization for these ADHD meds going off list.... IF patient is under 12 yrs old, OR if over 12 yrs old also has a diagnosis of ADHD, Depression or Narcolepsy... & that -- authorization will be given for 12 months

Has anyone tried this year?? Our coverage of Focalin XR & Focalin ends Dec 31st...
Anonymous
Post 07/21/2014 23:51     Subject: United Healthcare not covering certain ADHD meds
Is this true of all the UHC plans?
Anonymous
Post 07/21/2014 23:29     Subject: Re:United Healthcare not covering certain ADHD meds
UHC covers virtually no brands, so it has nothing to do with anything but it being the worst healthcare plan on the market.
Anonymous
Post 07/21/2014 22:55     Subject: United Healthcare not covering certain ADHD meds
Anonymous wrote:I just found out that UHC is no longer covering Daytrana. My daughter cannot take the pills. Even when she can physically take them which (most of the time she can't) the quick delivery and harsh "comedown" afterwards are difficult for her. I have sent in an appeal letter but I don't know what else to do. They also don't have an appeal format, so you flying blind. When I asked there was no real answer, just make a letter with her insurance ID etc... and state your case. I am heartbroken right now.


I feel for you. But I want to suggest that you make a plan. You are not going to have an outcome to your appeal before you have to refill your prescriptions. So you might want to think about whether you are going to self pay or work on a covered alternative.
Anonymous
Post 07/21/2014 13:45     Subject: United Healthcare not covering certain ADHD meds
I just found out that UHC is no longer covering Daytrana. My daughter cannot take the pills. Even when she can physically take them which (most of the time she can't) the quick delivery and harsh "comedown" afterwards are difficult for her. I have sent in an appeal letter but I don't know what else to do. They also don't have an appeal format, so you flying blind. When I asked there was no real answer, just make a letter with her insurance ID etc... and state your case. I am heartbroken right now.
Anonymous
Post 06/14/2014 08:35     Subject: United Healthcare not covering certain ADHD meds
I saw a report about this. Apparently this is often be case with Costco and maintenance meds.
Anonymous
Post 06/13/2014 21:45     Subject: Re:United Healthcare not covering certain ADHD meds
Not sure if they carry it but check prices at Costco Pharmacy. They can give you options of going through insurance or not.
For my mom's medication, it was cheaper to not even deal with the insurance.
Anonymous
Post 06/13/2014 21:28     Subject: United Healthcare not covering certain ADHD meds
Anonymous wrote:Did anyone else get a letter from UHC the other day indicating that they will not be covering certain ADHD medications after July 1? Both of the meds we use for our son are on the list -- Daytrana and Focalin. Basically they are saying that Metadate, generic Metadate, and Concerta work just as well, so you are supposed to switch. WTH! People spend months/years trying different meds and finally find one that works well with few side effects, and then this happens. I'm particularly concerned about Daytrana, which we switched to a few months ago with huge improvement over the Focalin (we still use Focalin on weekends sometimes and as a booster). The transdermal delivery system makes a huge difference in our case (lasts longer and is much smoother delivery), so saying that we should use a similar medicine that is capsule form seems ridiculous. The other advantage of the patch is that it can be removed whenever, which you can't do with a pill.

Has anyone ever tried to appeal these types of coverage decisions and had any success? I really hate to mess with our system that has been working so well.


You would need to appeal on the basis of medical necessity. Not every plan will let you do this. Find out what the process is from UHC and if your doctor will support the appeal.