Adderall Quantity Limits Or Not Covered By Insurance Now? (Page 2) (Top voted first)

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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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: Optimistic (# 13)

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

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Re: Jeno712003 (# 22)

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

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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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