Adderall Quantity Limits Or Not Covered By Insurance Now?

I tried to run my script through my Cigna Medicare health insurance plan like I always do and it comes out to be around $10 or $20 a month. I received a partial fill with a promise that the remainder would be in the following week (which they were). A few days later, I received a letter in the mail stating that Cigna either is not covering it anymore in 2023 or they put a quantity limit on it. I'm not sure which as I am having difficulty getting through on their phone. Has anyone heard of this? I take 60 mg daily IR. It was floating around that the DEA decided that it was a 'new, universal rule' that 40 mg is the max to be dispensed to anyone in a month. Help! Can someone explain these changes to me to the best of your ability?

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Hmmm, I’m interested in this answer too because I just switched to Cigna and I take generic IR as well although only 30mg p/day

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Not sure about the laws in your state but in Louisiana, where I'm from..... If you, for any reason partially fill your ADHD medication, you lose the remainder. It's happened to me before. They wouldn't even allow me to pay cash for the remainder, I simply lost half of that prescription due to a partial fill.

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I have the cigna medicare for tennessee and I can't find Adderall or any generic on the list for 2023. If they stopped covering it your doctor can get what's called an exception from cigna so they will pay for it.

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I forget to mention that it wasn't a remainder of a partial fill, it was a new fill when the date of the old script was done. Does anyone know of these quantity limits in 2023 with Cigna or perhaps other insurance companies? I think they stopped covering it. Also, in the letter they indicated they gave me enough to get me by... I'm thinking that's what they meant because of their tricky wording. I will indeed ask for an exception for Cigna as a poster suggested. Now paying $53 is much different than the Cigna cost of $10 - $20 makes a lot of difference! Thanks!

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Medicare Part D Plans do have quantity limits of Schedule II drugs. You should be able to go to your plans website, put the drug info in and find out.

Your doctor may or may not have a Prior Authorization approved for the additional tablets

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Re: Kf3355705 (# 2)

In Louisiana you have only 72 hours to get the remainder filled. But it is up to each pharmacy if they want to do it

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Re: BlessedLady (# 6)

In Michigan you can't get the remainder filled. You must have a new script... even if it's not time yet. Allergies, lost scripts, and stolen scripts are a few reasons doctors are allowed to do this.

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Re: BlessedLady (# 5)

Thank you! I'll also call too. Is it true that many, many plans are restricting the amount to 40 mgs daily? Is that the new, magic amount?

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Re: abiggers80 (# 3)

It is up to each plan if they cover a drug. Asking for a exception does not guarantee they will cover it. It seems more and more doctors are no longer comfortable prescribing stimulants for ADHD to seniors. Medicare sends doctors messages about the drugs they prescribe. More and more doctors are receiving these messages from Part D Plans

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Re: BlessedLady (# 9)

Oh no. I'm going to try for an override if that's what you call it. I'm on disability, not a senior. Thanks for the info.

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Re: Jeno71 (# 10)

Let us know how it goes. It will be useful to others that have Medicare Part D. Good Luck

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Yeah, January 1st new formularies would have come in to play, usually get these in the mail or by email ahead of time so you can be ready, they usually will process one so you can prepare which is why you got January’s and then you got a letter.

You can appeal it as if it was denied and ask for an exception. The last time my provider wanted to give me three a day instead of two she had to do that and it was approved. If they approve it you’re just going to have to try to remember to renew it every year because they usually only approve a year at a time.

If they are not cool with that maybe your provider can give you a higher dose and instruct you to take half the pill? When I had to pay cash for my medication and I took 10 mg twice a day they would give me (30) 20 mg and I would take half 2x a day because that was a lot less expensive than buying (60) 10 mg.

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I also wanted to say that if it turns out you need to pay cash for them if you have AAA you can get a pretty good discount at chain pharmacies. Back when I had to pay cash they were $90 by AAA made them $30 at CVS. I think Costco does it to you and I know Wallgreens does.

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Re: BlessedLady (# 11)

I have part D through silver scripts and they are fine with my quantity, the only difference is that my co-pay went up about a dollar. I can live with that though.

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Re: Jeno71 (# 8)

I don’t think this is happening, my friend takes 90 mg total per day and she’s not having a problem except for whatever issues we run into because of the shortage of medication. Maybe it’s a state thing?

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Re: BlessedLady (# 6)

Yeah in NH with controlled substances you actually have to forfeit the remainder if you accept a partial fill, but it’s pretty easy to just get a new prescription from your doctor that would start whenever your partial fill would run out.

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Re: BlessedLady (# 5)

Yes and your doctor can ask for an exception, silver scripts gave me an exception for a quantity limit a couple years ago.

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Re: Optimistic (# 15)

It depends on the state. State laws can be stricter than federal law. Most pharmacies will not do partial fills because there are no guarantees the medication will come in before the time frame is reached. Some states have a 24-72 hours time frame. If you want to know exactly what your state laws are. Put, Your State Name Laws Governing Partial Schedule II Fills in Google. Unfortunately some doctors and pharmacists lie.

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Re: Optimistic (# 16)

Yeah, that's what I've been doing when for example they only had nine days worth of 20s and then I would simply get a new script hoping more 20s would come in by day ten or get a script of 10s and wind up with a thousand pills. Uggggh.

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Re: Trina (# 1)

I finally got an answer from Cigna. It's on their formulary, so you can get it. It's a tier three drug, so it's kinda expensive (it may have been a tier one or two last year and they may have moved it. But, I just know that my $10 and $20 co-pays are now like $45). What you first have to do is call them (not on the number on the back of the card, but at their coverage determination deptartment 877-813-5595 and ask to put in a request for a 'tier override'. They will probably ask for your docctor's info so they can ask him a few questions. Don't get your hopes up on this though because this med is already on it's lowest tier, so I don't get why I even did that part, probably to get to the appeals portion (this takes about 72 hours). That is when you get a 'no' on a tier override and you want to appeal it. So, call appeals 866-845-6962 and the person will ask you verification questions of who you are and just poof! put in a request for an appeal to that tier override decision. This also takes about 72 hours. I'm in the waiting process now - about 36 hours I'd say. For some reason, I think that I'm going to be stuck either paying their $45 co-pay and dig myself closer to the donut hole or using Goodrx and getting it from Costco for $50 and pay out of pocket and not having it effect my donut hole. This is not typically an expensive medication. PS - I got a fill and then the letter came saying that, 'here's a fill for now to get you through, but don't expect it to be a regular thing because of it maybe not being on the formulary (which it is)or quantity rules.' That the story. Hope the info helpls because I hate being turned around and around and on hold endlessly.

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Re: Kf3355705 (# 2)

I have had the same issue but if you call your treating doctor he/she should be able to get you the remaining script but have to write a new script for the missing pills.

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Re: Jeno712003 (# 22)

Unfortunately, Medicare Advantage Plans are famous for denials, restrictions and limitations.

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Re: Jeno71 (# 21)

I fugured it out. Cigna already has me at the cheapest generic Adderall rate, but it's expensive because it's a tier 3 drug. There's nothing lower. I've been paying out of pocket and that actually proves cheaper!

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Re: Optimistic (# 13)

Yup, I use Goodrx at Costco. Runs me about $45.

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