Saturday, May 18, 2013

Thursday, January 01, 2009 JOESmommy asks

Q: Insurance coverage changed. What is the best alternative to the Concerta my son was on?

Our insurance recently stooped covering my son's Concerta (he was on 54 mg) The insurance company listed Adderal xr and Vyvanse as alternatives or Methylphendiate (Ritilin). The doctor has opted for the ritlin, administered twice a day where the Concerta was once a day and he is down to a 5mg dose. It is just like life before medication and I am terrified the fifthe grade will swallow him whole once he goes back to school. Should I insist the doctor try the Adderall or just try to ride it out with the Ritlin? What is the closest to the Concerta?

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Answers (2)
1/ 1/09 9:51pm

Before you consider changing, I think you should appeal to the insurance company to continue to cover the Concerta at the old rate.  Asking you to change is not medically prudent if your son is doing well on Concerta.  Although Concerta and methylphenidate are the same active ingredient, they get to your brain at completely different rates in the two different preparations. 

I saw this happen several years ago when BC/BS in NY added Conceta to their formulary. At that time, they bumped Adderall XR and suggested that people change to Concerta.  Now they're suggesting a change in the opposite direction just because they got a better deal from one company than from another.

I don't think we should let them do that to us again without a fight.

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3/26/09 12:04pm

i agree. insurance companies do this all the time. have your doctor call the insurance company. its worth a shot.

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By JOESmommy— Last Modified: 12/23/10, First Published: 01/01/09