What is "sufficient documentation" for an ADD medication?
August 17, 2014 1:06 PM Subscribe
I've been taking Adderall XR for about a half a year, and it has made a tremendous difference in my life. The med, however, was recently put on the Prior Authorization list - which means that I now need to receive approval from my insurance before they cover it. My doc submitted an application, which I just found out was denied on the grounds that I don't have sufficient documentation of ADD. I took a test with my doc, and was denied again. What exactly do they want from me?
posted by CottonCandyCapers to Health & Fitness (19 answers total) 6 users marked this as a favorite
The first rejection document I received states that anyone 18 and older who starts on a stimulant needs an ADHD screening before starting on the medication. I had had a screening back in college, but that was many years ago and I couldn't find it - so I took a short test with my psych. She handed me a questionnaire, I filled it out, then she looked at it and said "yup, you have ADD." It was pretty bare-bones. I was denied again.
(The test was the ASRS, found on this site: http://www.help4adhd.org/documents/adultadhdselfreportscale-asrs-v1-1.pdf)
I called to ask and their answer was very noncommittal - along the lines of "Well, we can't say what kind of documentation you would need that might help, anything else would certainly help but the PA request could go either way..."
I get the feeling that my insurance just doesn't want to pay for stims. My psych was pretty dejected as well, and seems to want to give up. I can go on without the med, but without it I'm back to being my usual head-in-the-clouds self who can't focus on any one thing a a time. Its made such a positive impact on my life, and I'd like to get back on if possible. So, I'm wondering... what else could they want from me? Maybe a more comprehensive test? If so, would I ask my psych for it, or if not where would I take it? Is there another solution that I might be missing?
PS: I am planning on switching from Adderall XR to Vyvanse. Also, I was taking a booster of IR Adderall in the afternoon - combined, a daily total of 25mg.