Recently I changed medical insurance companies from Blue Cross Blue Shield (my company's insurance plan) to Aetna (my wife's company's insurance plan). There were a variety of reasons for the switch, but one of the biggest impacts recently - something that I did not anticipate - was a denial of prescription.
I take a daily dose of Ritalin LA for a minor case of ADD. I've been taking 30mg daily for more than 5 years. Under the new plan, the insurance company suggested to the pharmacy that they should fill the order with Vyvanse rather than Ritalin. I think the problem might be cost and the insurance company does not want to pay it.
But here's the thing ... Vyvanse is a different compound. I have serious qualms about switching compounds just because an insurance company doesn't want to pay for another one. Don't get me wrong, Vyvanse might work wonderfully, and maybe even better than Ritalin. Under different circumstances, I might even be willing to try it, but not when I am fresh out of my regular meds. Perhaps, I should have planned ahead more, though I have never had an issue getting it filled. What about quality of life? The insurance company is not my doctor - they're not going to be the ones I call when something is not working right. What if something goes drastically wrong? As far as I am concerned, I would want some supervision before I go changing compounds.
The pharmacy suggested that I have my doctor call the insurance company and tell them that I will only take Ritalin LA and that should do the trick. So I left it in the doctor's hands this morning. I am going into my third day without taking it. Not a big deal, people (especially kids) usually take weekends off, but if it goes much longer, I will start to experience withdrawal symptoms. Hopefully, this is resolved quickly.
Update: I got a new prescription this afternoon from my doctor, but this time she wrote it for Vyvanse, instead of Ritalin! Another receptionist said that she heard the industry was running out of Ritalin. But my pharmacy said they had the Ritalin I needed, it was the insurance company that was refusing to pay. I guess I need more information so I can make an informed decision, so ... I made an appointment for tomorrow to discuss the issue with my doctor. Here's a link to a recent article about the shortage of ADHD drugs: http://www.nytimes.com/2012/01/01/health/policy/fda-is-finding-attention-drugs-in-short-supply.html?_r=2&pagewanted=1
Update (Jan 10): I talked to the doctor this morning about options, given that my regular Ritalin meds are not available. We discussed several alternatives to Ritalin and settled on Concerta. Concerta is a methylphenidate - the same compound as Ritalin - but, due it being a different manufacturer, it has different release times associated with its extended release qualities - 22% immediate and remaining 78% over 10-12 hours. For the record Ritalin was 50% immediate and another 50% after 4 hours. Our decision to go with Concerta is an attempt to minimize the impact to my system and the withdrawal symptoms that I am already beginning to experience from stopping the Ritalin - going into my 4th day off. I am going to monitor this very closely as I am pretty nervous about changing it in the first place.
Update (Jan 11): Trouble sleeping last night. It may have been anxiety or it may have been that I took my first dose of the Concerta at 11am (kinda late in the day) yesterday. Maybe tonight will be better. I am able to focus more on my work today than yesterday. Maybe this will work out after all.
Update (Jan13): Ok. I am now on my fourth dose of Concerta. The release times have been difficult to adjust to, but I think my system is sorting it out. The 1st and 2nd days were pretty rough. This type of drug is a difficult thing to monitor because it is adjusting a brain chemistry that is "not quite right" to begin with, by buffering connections between synapses and neurons. As such, the affects of the drug are difficult to sense. But, I believe I was having an issue about 4 hours after taking the medication because my body was expecting that 50% Ritalin hit and all it was getting was a small portion of the 78% remaining from the Concerta. It left me with a lot of up and down emotional swings. I figured I would give it a week and if I was still feeling the same, I would go back to the doctor.
4 comments:
So sad! Good luck. Keep us posted.
Thanks for keeping us updated. Will your insurance pay for the Concerta? How soon can you get it? I sure hope it works for you, the release times actually sound better to me. Did you think so?
Yes. The insurance paid for it, but the pharmacy filled it with a generic brand. The upside is it only cost me $10. The drug is still methylphenidate and I assume the release times are the same. I took my first dose of it this morning at 11am and while I still feel out of it, I am feeling a lot better. Hopefully tomorrow will be a better day.
I'm glad this seems to be working, maybe it will improve as you get used to the release times. I hope so. Thanks for the update, and continue to keep us posted.
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