Help - getting Intuniv (brand) covered by insurance

[Jennifer G]

I am having an awful time with the insurance companies over Intuniv. My two daughters (16 and 11) had been taking Intuniv for years with very good results. Last year, United Healthcare just completely refused to cover it. The prescriptions would have been $400 per month EACH. So we switched to Tenex. It's awful. The girls hate it and it really doesn't work the same way. My older daughter is having a particularly hard time with it but I see big changes in the younger one too. Has anyone had any luck getting their insurance company to cover the brand-name after we can show that we've tried the generic without success? Or alternatively, is there some kind of private supplemental prescription coverage that we could purchase? This is crazy. Here is a medication that they really need and that WORKS and the insurance company just arbitrarily has decided costs too much so they won't cover. Any help would be hugely appreciated.

 

[InsaneCdn]

I'm assuming you are in the US - in which case, others on the board from the US may have some ideas for you.

I'm not from the US. But... I know exactly what you mean. The "rules" around medication coverage are, well, insanity.

 

[GoingNorth]

I was able to get name brand Depakote after the generic came out. My psychiatrist trialed me on the generic and I couldn't maintain proper blood levels. He wrote a letter to CHAMPVA explaining that, and they agreed to provide name brand Depakote.

 

[jal]

I went through the same thing this year with my insurance company. My son has been on Intuniv for a number of years and it works. Under my then insurance through my employer I paid $40 a month. Then Intuniv's patent was up and there is now a generic which is guanfacine ER. New insurance company new employer covered it last year and would not this year. Same insurance co, same medication same dose. Asked the dr's office to fight it. Insurance company gave me a list of things he had to try before they'd approve it. He's been through all of them. So I hunted and was able to find a coupon on goodrx.com. I pay $40.49 a month for 30 days now. Insurance when they covered it before it went off patent was over $100 and down to $70 a month. Go out and get the coupon if you want to try the guanfacine ER. It is the same formulation as Intuniv. He just upped to 4mg after being on 3mg for a number of years and I got a coupon for that dosage too at the same price.

 

[KTMom91]

Been fighting with mine as well, over Victoza. The conversation went downhill when I pointed out they were supposed to SAVE me money.

Saw in the news that Anthem Blue Cross is suing Express Scripts over high prescription drug prices. Wonder if any of that will trickle down to those of us forced to use them.

 

[Tara Brummett]

Following this for answers. I'm US based and there is no option under our insurance (BCBS) to cover Intuniv for our 6 year old. It's the only thing that helps.

 

[Frieda]

Our insurance would not cover the Kapvay (the other non-stimulant ADHD medication besides Intuniv) because they will only cover stimulants for ADHD. We ended up paying out of pocket for 6 month for Clonidine ER (the generic for Kapvay) and then repealing with the insurance company. We listed the stimulants he had tried and the negative results and the positive results we have seen on the non-stimulant. They agreed to cover it for a year and we have had to repeal every year. It's a PIA but worth it.
I have had some health problems of my own and I have had some success with repealing insurances refusal to cover medications before. I get that it is not always successful but it is always worth a try to fight it. I also had some outrageous clinic bills last year that the 'patient advocate' told me had been reviewed and would not be changed but they did get reduced after I filed a complained with the Better Business Bureau. I don't know if the BBB works for insurance complaints but the Office of Attorney General in your state might be another place to try.

 

[HMBgal]

Following this for answers. I'm US based and there is no option under our insurance (BCBS) to cover Intuniv for our 6 year old. It's the only thing that helps.

My grandson takes generic Intuniv, $5 a month. It's called guanfacine. It's been available here in the U.S. for about 6 months.

 

[jal]

Guanfacine ER is the generic form of Intuniv. The Intuniv patent ran out at the end of 2015. It's still a ridiculous amount under my Aetna insurance, but I go out to GoodRx and other sites and get a coupon for it. I am currently using a coupon and it costs about $37 a month. My insurance charges over $100 for a months supply.