Craig.

I live in Alberta, is there a “Section 8″ application process for Strattera?

If not what current drug plans cover Strattera?

Thanks…..

but the downside:
- difficulty falling asleep
- significant loss of appetite to the point where his pediatrician is wondering if he’s anorexic

In Quebec, Biphentin 30 costs $71.20 for 30 capsules. 80% is reimbursed by my health coverage from work.

Due to the drug card I am now on Ritalin SR. It’s horrid. Does nothing except give me headaches, “drop” and dry mouth.

The diagnosing psych stated that if I had access to Strattera–he would have considerably increased the dosage to see the results. Due to the expense he suggested Concerta.

I’m so desperate for relief that I am considering paying out of pocket on my meager ODSP income. I cannot tolerate any SSRI’s or Wellbutrin which is cutting down my options.

Also, I have PTSD as well. Due to working ‘in the field’ for years, my options for psychiatric intervention are limited for privacy reasons.

If anyone knows of a *private* psych who is OHIP covered, and has openings, who can help me with some of the emotional aspects as well as medication, I would be truly grateful.

I really want to thank you for taking so much time to share your experience with insurance coverage of Strattera in the US.

Having your input, as well as all of the other great comments that we get on this blog contributes so much to people learning more about ADHD. Keep up the great work!

A couple of comments:

1) It doesn’t surprise me that your insurer created a similar process to get coverage for the newer medicines. While I applaud your efforts to enter into a discussion of the ethical issues, my experience is also that it is about getting the cheaper costs of the treatment.

I will let you know that on one occassion, I had a patient that I wanted to get coverage for Concerta. To follow the protocol, I started him on Dexedrine – which he had never been on. To my surprise – he actually did better with this medicine, and continued on it, and thus the Ontario Government plan got off on a cheaper medicine. This is the only experience of this type that I can think of in my practice.

2) Regarding a doctor’s perspective – there are two issues that you have written here – 1) one doctor didn’t want to fill out the insurance papers so you had to get a new doctor; 2) your doctor decided to lie to the insurance to get your medicine covered.

The doctor who didn’t want to fill out your papers – this is very unfortunate. It is my belief that a doctor’s role includes being an advocate for patients – and that means filling out frustrating forms now and again. Hopefully this means that you now have a doctor who is more willing to ‘go to bat’ for you and your treatment.

With respect to honesty and the insurance form – this is a very tricky one, and certainly one of ethics. This is something that I have never done, and don’t imagine that I would.

Although I want to advocate for my patients as much as possible, if there is a system which needs to be followed, I follow it. I wouldn’t want to jeopardize my licence to practice medicine with a problem with my honesty. I am not trying to criticize your doctor, however the ‘standard of medical care’ is defined as what the doctor’s peers would do. It is my belief that if you asked 10 doctors if they would lie to get insurance coverage for their patient’s medicine, I would guess that only a very small percentage would say yes (if any).

That said, in Canada, us doctors have to deal a lot less with the insurance issues than the American doctors – so I can’t really comment on their experience.

That said, I have given prescriptions to patients and asked them to take it for a week and then let me know how it was. So, I have tried to limit the exposure to make it easier on my patients.

Thanks again, and I hope that we get other great comments from people all over the world.

I was given samples of Strattera by my doctor to get started. I applied to my insurer right away. After responding really well to the medication my doctor recommended, I was disappointed to discover my insurer wanted me to jump through the hoops you describe in this post of your blog.

I had recourse to appeal with my insurer so that I would not have to begin another medication when I was doing well on the one I was taking. I knew the alternative medication, Concerta, worked quite differently. My doctor didn’t want to appeal.

I found another doctor. He said if I was doing well on Strattera he would not recommend I try Ritalin or Concerta. He also said he would usually begin trying people on Strattera, not the stimulants such as Ritalin, Concerta, etc. as insurers recommend due to costs. He and I agreed this was purely and simply about costs to insurers, and not what was in the best interest of the patient.

The sad conclusion of my story makes it a story of ethics. My doctor concluded the only way to deal with the insurance industry, in this case, was to lie to them. He told me he would write out a prescription for Ritalin. He told me to not take it. He told me to get in touch with his office in a few weeks. His office would write a letter stating I had negative side affects with Ritalin and would appeal my need to take Strattera. This was to avoid my body needlessly going through predictable negative adjustments to new medication when the one I was on was working so well.

The side story: Since the black box warning came out on Strattera my insurer has changed their policy. They now will cover Strattera without preconditions. Growing up in a medical family, I believe this is about profit margins, not what is in the best interest of the patient to receive the best therapy. I also don’t believe this a reasonable way to keep down the high costs of medications. I believe this is about the ethics of greed on many levels, and the ethics of providing optimum therapy for patients for a reasonable cost.

My sad conclusion: I wrote to my insurer, using the appeals process in place with them, to attempt to engage them in a discussion about the ethics of the process of “step-therapy” – trying something cheaper first. Because I found them unwilling to be engaged in a discussion of ethics, and only willing to discuss dollars per treatment, I have concluded the thing to do is to tell them that the advice being passed around by doctors is to simply lie to them about their step-therapy process. Perhaps, this will give them incentive to want to enter a discussion about ethics and the cost of treatment, and allowing doctors to prescribe optimum therapy that is not simply based on profit margins.

I commend you, Dr. Handelman, for your efforts to get out good information about ADHD through your audio newsletters and your blog. Your succinct summaries of information on different aspects of ADHD are very helpful. I have benefited greatly. Thank you very much.

Tedd