starting ADHD *before* a full psych/neuropsych eval for an adult?

[Noreen Claire]

I had my annual physical last week, and spoke to my doc about getting a psych and/or neuropsych eval to rule in/out OCD, anxiety, and ADHD. He referred me to the practice's social worker, who contacted me a few days later with a half-dozen names. He also stated that, because not all insurances will cover the evaluations and because there is usually a long wait time, that he could just prescribe me an ADHD med (vyvanse) to start now. 

I'm not sure how I feel about this. I've done a lot of searching online, and I'm even more conflicted/confused now than I was before I started googling. If you started ADHD meds as an adult, how would you feel about this? Should I wait for an eval before starting any meds? Should I give the meds a try now, while I wait for evals that could take months to complete? (As a side note, I've had the names to call for consults for three days now and I cannot bring myself to sit down and call any of them. Uuugghhhhhh.)

 

[prairiewindmomma]

Personally, I’d try the meds. You’re peeling an onion. Taking off layers of issues will lighten the load of the rest and give you better info. 
 

In my family, vyvanse has been life changing. It was very clear very early on that it was helpful.

[Lecka]

I think — this is what you are pursuing, and this is the situation.

I would also go for it.

I don’t want to minimize this, but I don’t think this is a really big deal.  It’s not a medication that I would think — hey, that’s messed up.  There are medications where I would have that opinion, but this isn’t one for me.  

Edit:  I hope it is helpful, and if it’s not, that is informational, too.  But I hope it goes well and is helpful.

I also think it’s a totally valid decision to hold off for now.  It is what you are going to feel comfortable with, that is really what matters.  
 

Edit:  if this comes across way too casual, I think that is fair, it is not something where you can go off of someone else’s casual attitude, if it does not seem that way to you.  
 

I have had things where I did not feel casual while other people did, and I did not do things the casual way.  And I don’t regret that at all, even if sometimes later I think I could have been more casual.  But it has to be what makes sense at the time.  

Edited March 25, 2022 by Lecka

[Lecka]

You could also see if your insurance covers the evaluation, and what waiting lists are like.

Sometimes if you ask about the cancellation list you can get in sooner.

Sometimes it takes even longer than the original estimated wait time.  

Edit:  I think if it feels weird now, it will still feel weird after an evaluation.  Maybe it will feel less weird, more official, maybe the evaluator will be someone awesome to talk to about things.

But at a certain level it will still feel weird.  I don’t know if it’s moving faster than you were mentally prepared for — that is something that happens with me sometimes.  

Edited March 25, 2022 by Lecka

[Soror]

I've not dealt with treatment or testing as an adult but my kid is on Vyvanse. - Fyi it is expensive- $320 a month- although they have a $60 coupon. There are other less expensive meds to try. I'd call to check prices with your insurance in your area (you can also download GoodRx to get a general idea of prices).

[Carrie12345]

For adults who know themselves, can communicate well with their care professionals, and can be aware and insightful of the differences (or lack thereof) I’m all for it.

My dx came from a combo of my regular doctor and therapist, not a PhD or PsyD full eval.  I have an adult kid with a different dx on meds through their regular doctor and therapist, not a full eval.  While another kid did get a completely different kind of dx from a pediatrician, I did have a full eval done because of their very young age and way too much room for error.

It is very hard to get full evaluations in many (most?) places, and usually quite expensive.  For something that depends so much on self-reporting, like an adult adhd dx, I do think the “shortcut” is both safe and worth it. Not all doctors are willing to go that route, often due to the way health care systems are set up to send you to 8 different people for 1 issue, or sometimes due to not keeping up with advances (like dh’s dr.), so having one that is is a pretty awesome thing.

[scholastica]

3 hours ago, Soror said:

I've not dealt with treatment or testing as an adult but my kid is on Vyvanse. - Fyi it is expensive- $320 a month- although they have a $60 coupon. There are other less expensive meds to try. I'd call to check prices with your insurance in your area (you can also download GoodRx to get a general idea of prices).

And some insurances won’t cover it until you’ve tried other meds. 

[kristin0713]

Regarding ADHD, when I took my DS for a full eval, ADHD was diagnosed based on screening questions. There was not a test for it. He did take several tests for intelligence, reading, language, and math. I have wondered if his scores would be higher now after being on meds but they were very high to begin with and it doesn’t matter. It wouldn’t change his diagnosis. There is a definite improvement in focusing on the meds. 

Re: OCD and anxiety, which my daughter has — again there is not a test for this. It’s a screening. I’d make a list of everything you notice now and pay attention to any differences if you start meds. I don’t know anything about vyvanse but I haven’t heard of it helping anxiety and OCD. Pay very close attention to whether it seems to make those symptoms worse . 

 

[Toocrazy!!]

My young adult son was tested for ADHD last fall. It is really just a screening. And a very expensive one at that. I think an adult could make the same type of decision regarding that diagnosis. It’s a very reflective type test. 

Just from his experience- I would try to actually write out all the things you consider are complicated by adhd and reflect on them as you try the meds. DS was looking for a magic type feeling and I think missed out on the progress he was making. Try to be very specific with the challenges you have now so you can evaluate as you go. You start on a low dose and work up, and the improvement might be subtle as you progress. 

[Katy]

It’s fine. If your insurance will cover it, try it. Just watch out for your moods & attitudes. It makes DH angry. 

[Noreen Claire]

Thanks, everyone, for your input. As always, you're the best.

I didn't realize that vyvanse would be so expensive! It looks like their patent runs out next year, so hopefully there will be a generic soon.

I sent a message to my doc to fill the prescription. 

[Toocrazy!!]

There are coupons online. From the manufacturer. 
Watch for how low they start the dose and how quickly they want you to move up. You can only use a coupon once a month. Try to fill 2 weeks worth if they might increase your dose that often. We couldn’t do that with vyvanse. DS ended up combing lower doses to try higher doses as they were prescribed so he didn’t have to fill a new prescription. Not sure if that’s legit, but his dr was ok with it. 

[Janeway]

ADHD meds can increase anxiety and likely will not reduce it..unless the adhd is what is causing your anxiety. For me, I have anxiety from trying to get ready for my grandma to arrive, and my ADD (what they called it when I was a child) is interfering with my ability to organize my house. I might go on meds. 

Edited March 25, 2022 by Janeway

[KSera]

1 hour ago, Janeway said:

 

ADHD meds can increase anxiety and likely will not reduce it..unless the adhd is what is causing your anxiety.

 

They can increase it but it’s also not unusual for them to decrease it. My adult kid who started meds noticed an immediate decrease in anxiety before anything else. They felt like it was due to having their brain not so revved up, with thoughts all over the place. It also helps with some compulsive behavior, probably due to decreasing impulsiveness. 

[Janeway]

42 minutes ago, KSera said:

They can increase it but it’s also not unusual for them to decrease it. My adult kid who started meds noticed an immediate decrease in anxiety before anything else. They felt like it was due to having their brain not so revved up, with thoughts all over the place. It also helps with some compulsive behavior, probably due to decreasing impulsiveness. 

Do you have an opinion about Vyvanse vs Adderall? My one son is on Adderall and the other, Vyvanse. Then I heard some parents last night at a soccer game comparing the two and they seem to think Vyvanse is better. Wondering what people here think? 

[scholastica]

Adderall had bad side effects for my kid. The Vyvanse is time-released so one pill works for pretty much the whole day. Since it is time released, it’s less likely to be abused, sold to or stolen by others. 

[Kanin]

8 hours ago, kristin0713 said:

Regarding ADHD, when I took my DS for a full eval, ADHD was diagnosed based on screening questions. There was not a test for it.

Good point. There's no test for ADHD that's a 100% definitive test... like a blood test for a vitamin deficiency, for example. You fill out rating scales and it's very subjective. At least with kids, they have multiple people do the scales so they can see if the raters agree with each other, which gives more confidence in the ratings. 

OCD and anxiety are strongly correlated with ADHD, so my opinion is that it would be worth trying the meds to see if those other issues improve at all. It'll give you some more information to go on. 

[JumpyTheFrog]

Adderall and its generics are also available in time released. They are pretty cheap. The Good RX price near me for them is about $37.

Before we started DS 16 on meds last fall, I read a book on ADHD that had multiple chapters about all the drugs options. The doctor usually recommends starting on either Ritalin or Adderall first (two different types of stimulants) because they are cheaper before moving on to the more expensive stimulants (or the non-stimulants).

[kbutton]

8 hours ago, KSera said:

They can increase it but it’s also not unusual for them to decrease it. My adult kid who started meds noticed an immediate decrease in anxiety before anything else. They felt like it was due to having their brain not so revved up, with thoughts all over the place. It also helps with some compulsive behavior, probably due to decreasing impulsiveness. 

This.

Also, it can sometimes be dosage, a different generic, a different mechanism of action, etc.

My son will get some anxiety if he has enough dosage to make him feel different but not enough to make him able to effectively organize himself--there can sometimes be a sweet spot. Or if he gets a generic that doesn't work for him (he takes a generic normally). 

[KSera]

6 hours ago, Kanin said:

Good point. There's no test for ADHD that's a 100% definitive test... like a blood test for a vitamin deficiency, for example. You fill out rating scales and it's very subjective. At least with kids, they have multiple people do the scales so they can see if the raters agree with each other, which gives more confidence in the ratings. 

 

Fwiw, my kids who have been diagnosed have taken various computer based tests in addition to  the rating scales. They have had different measures for auditory attention vs visual attention from that, such that some of them were more impaired in one than the other. They are scaled scores and my kids with ADHD have scored very low compared to age mates (like single digit percentile performance on those subtests). 

[ktgrok]

My only hesitation on trying the meds is that for some people, if the true problem is anxiety, not ADHD, than it can make it worse. So, be prepared for that. Also, know that you will need at least a week -10 days to know if the dosage is right, so don't judge based on the first few doses. I was SURE it was too strong the first few days, but by the end of the week my brain adapted to the sudden increase in dopamine it had been missing, and everything evened out. I was actually feeling euphoric/high at first, and had a headache in the front of my head - that totally went away as well. 

But yeah, anxiety can cause ADHD type symptoms, but ADHD can cause anxiety. For me it was obviously that the ADHD came first, I had symptoms from a young child. Others have the opposite. And OCD is a whole other thing entirely. 

But if it doesn't help, or makes things worse, you can certainly stop the meds after giving it a good 10 day trial. Most adults never do a full neuropsych workup. 

[Kanin]

10 hours ago, KSera said:

Fwiw, my kids who have been diagnosed have taken various computer based tests in addition to  the rating scales. They have had different measures for auditory attention vs visual attention from that, such that some of them were more impaired in one than the other. They are scaled scores and my kids with ADHD have scored very low compared to age mates (like single digit percentile performance on those subtests). 

That is pretty cool! I've only known one psych who was willing to do that for a school eval. I wish everyone could do that.... very neat. 

[ktgrok]

21 hours ago, Janeway said:

Do you have an opinion about Vyvanse vs Adderall? My one son is on Adderall and the other, Vyvanse. Then I heard some parents last night at a soccer game comparing the two and they seem to think Vyvanse is better. Wondering what people here think? 

They are sort of the same thing, but not. Basically, Adderall comes in short acting and time release. The time release is controlled by little beads of medicine that dissolve at different rates. Some people's digestive system makes that type of system work less ideally than it should. 

Vyvanse is a "pro drug" in that it is converted by the liver into Adderall. The time release mechanism is via the liver metabolism, vs the stomach/intestines. It's a bit more gradual release for most people, versus the way Adderall XR (the time release one) releases in the system. So for some who are sensitive to the ups and downs it can feel better. It is also not able to be crushed and snorted to get a fast high/overdose, as no matter how it gets in the body it has to pass through the liver to be metabolized - so time release no matter what. That's the main reason it was made - so that it couldn't be abused like that. 

I take vyvanse, as does my 22 yr old. My husband takes short acting adderal, twice a day. I also, depending on what dose of vyvanse I'm on at the time, take a top off dose of short acting adderall in the afternoon. For a while i was prescribed 30mg vyvanse in the morning, with 10 mg adderall in the afternoon, but I kept forgetting to take the adderall so now I take 40mg vyvanse in the morning, with no top off. 

[ktgrok]

Oh, and regarding anxiety, my social anxiety got SO MUCH BETTER on ADHD meds. Mostly because I could actually remember people's names! I had no idea how much that was effecting my anxiety until I went to a work even with DH and realized I'd met 5 new people and could remember all their names an hour later! usually, people introduce themselves and my brain just hears "blah blah blah" and then I feel like an idiot so I get anxious and avoid everyone. I even posted here, I think, the day that happened as it was SO incredible. 

I also lose my temper WAY less on meds. I can think before I speak  yell. 

[TechWife]

Can you consult with a psychiatrist instead? That might be faster, but it will depend on availability where you live.  
 

Do ask  them why vyvanse? There are a lot of options out there and that’s an expensive starting point. There are a lot of generics on the market and one might work for you. It’s just something to think about. 

[Noreen Claire]

Welp. I quit.

I emailed him back and said yes, please prescribe (the drug that you told me aallllllll about would be perfect for me). He replied this morning... That I would need to make *another* appointment to review WHICH DRUG WOULD BE APPROPRIATE and SIDE EFFECTS and ABUSE and whether medication is EVEN APPROPRIATE IN MY CASE. He says, "I don't just prescribe via email."

I can't. I just can't. It has taken me YEARS to admit that I was struggling and ask for help. His email was patronizing and snarky, the underlying tone was that I was drug-seeking for nefarious reasons. 

I quit.

[KSera]

9 minutes ago, Noreen Claire said:

Welp. I quit.

I emailed him back and said yes, please prescribe (the drug that you told me aallllllll about would be perfect for me). He replied this morning... That I would need to make *another* appointment to review WHICH DRUG WOULD BE APPROPRIATE and SIDE EFFECTS and ABUSE and whether medication is EVEN APPROPRIATE IN MY CASE. He says, "I don't just prescribe via email."

I can't. I just can't. It has taken me YEARS to admit that I was struggling and ask for help. His email was patronizing and snarky, the underlying tone was that I was drug-seeking for nefarious reasons. 

I quit.

I’m so sorry. That is cruddy, thoughtless behavior on his part. He may be a doctor who doesn’t remember his patients well and doesn’t recall that he specifically suggested and offered it to you. Can you follow up with a psychiatrist instead?

[katilac]

5 hours ago, Noreen Claire said:

Welp. I quit.

I emailed him back and said yes, please prescribe (the drug that you told me aallllllll about would be perfect for me). He replied this morning... That I would need to make *another* appointment to review WHICH DRUG WOULD BE APPROPRIATE and SIDE EFFECTS and ABUSE and whether medication is EVEN APPROPRIATE IN MY CASE. He says, "I don't just prescribe via email."

I can't. I just can't. It has taken me YEARS to admit that I was struggling and ask for help. His email was patronizing and snarky, the underlying tone was that I was drug-seeking for nefarious reasons. 

I quit.

I wouldn't do that based on this email. Because of the type of medication, I think most doctors do make you go in for a physical appointment at the time of writing the scrip, and you have to go back to the office to get it refilled every single month. He's not necessarily saying "I don't just prescribe via email" to be snarky or cast shade upon your request, but because it's actually his ongoing policy or even the law where you live. There are definitely very specific laws related to stimulant medication. 

That's not to say you're wrong about thinking the email had a patronizing tone, but honestly most doctors slide into that patronizing tone on the regular. Don't let that keep you from getting something that might help you. That's not going to hurt him. The sad fact is that you remember the visit well, but he is just reading his notes that probably say "disc s/s add, med poss" or the like. 

Any doctor you go to is almost certainly going to have the same requirements. I feel your frustration, because he probably made it sound like he was agreeing to prescribe, and didn't mention that another specific visit would be needed. That's hella annoying, but don't throw away all the hard work you've done to get to this point. I rant and rave about doctors all the time, but I try to be practical about it as well. I want to try a certain medication, I'm an established patient here, and I know he's at least open to the idea of prescribing it? I might as well go see him, if that's going to save time, and keep looking for a doctor I like better. 

Don't let his lack of communication skills stymie your efforts to find helpful medication. 

I'm sorry he was jerky about it. 

[kristin0713]

I would call the office and ask him to call you. Since you *just* had a physical last week, and he already offered to prescribe you this med, maybe a phone call would suffice. These meds are considered a controlled substance though and like a PP said, there are different laws regarding prescribing and filling them. I don't have to take my DS in every month, but I need to call and talk to the nurse practitioner every month to get it refilled. 

[Janeway]

On 3/26/2022 at 8:05 AM, ktgrok said:

They are sort of the same thing, but not. Basically, Adderall comes in short acting and time release. The time release is controlled by little beads of medicine that dissolve at different rates. Some people's digestive system makes that type of system work less ideally than it should. 

Vyvanse is a "pro drug" in that it is converted by the liver into Adderall. The time release mechanism is via the liver metabolism, vs the stomach/intestines. It's a bit more gradual release for most people, versus the way Adderall XR (the time release one) releases in the system. So for some who are sensitive to the ups and downs it can feel better. It is also not able to be crushed and snorted to get a fast high/overdose, as no matter how it gets in the body it has to pass through the liver to be metabolized - so time release no matter what. That's the main reason it was made - so that it couldn't be abused like that. 

I take vyvanse, as does my 22 yr old. My husband takes short acting adderal, twice a day. I also, depending on what dose of vyvanse I'm on at the time, take a top off dose of short acting adderall in the afternoon. For a while i was prescribed 30mg vyvanse in the morning, with 10 mg adderall in the afternoon, but I kept forgetting to take the adderall so now I take 40mg vyvanse in the morning, with no top off. 

That is very good to know about the not being able to abuse it like that. I have a son who has ADHD who has also been abusing substances. He is clean now, but "relapse is a part of recovery." He is supposed to leave for college in the fall and keeps insisting that he be prescribed adderall, and not the XR version. With his specific request and his history, it has thrown up red flags and no one has prescribed it.

[Katy]

I think DH had to go in every 3 months for that one. It’s a legal requirement, not snark. I’m sorry it came off that way. 

[Lecka]

That email just looked like a form letter to me?

I think it’s not cool to do the bait and switch, and sounds like poor communication, but I don’t find this to be a horrible email, *given* I do not assume it is personal in any way.  
 

If I thought a doctor sat down and composed this letter with a certain person in mind, I would feel very differently.  
 

I was in the hospital with someone recently who was admitted and they only had a room in the ICU, and she had to take a suicide assessment.  Then she transferred rooms when a regular room opened up, and the nurse there did the same assessment, because they have a policy to do it when they have someone new in their department.  
 

It was something that did not go over well with the person AT ALL, but I think it’s just part of healthcare sometimes.  It’s not personal.  
 

Anyway — I hope you can figure something out.  I don’t know if it’s something to just put up with, or look for another doctor, but to me I think I would roll my eyes and go on, assuming it wasn’t personal and this is just part of the bureaucracy we have to participate in sometimes whether anyone on either side wants to or not.  
 

 

Edited March 28, 2022 by Lecka

[ktgrok]

10 hours ago, Janeway said:

That is very good to know about the not being able to abuse it like that. I have a son who has ADHD who has also been abusing substances. He is clean now, but "relapse is a part of recovery." He is supposed to leave for college in the fall and keeps insisting that he be prescribed adderall, and not the XR version. With his specific request and his history, it has thrown up red flags and no one has prescribed it.

Definitely, with a history of abuse should only get Vyvanse. It is more expensive, but there is a manufacturer discount card you can get from the website that lowers the cost significantly. Without the card I would pay $75 per month, after insurance. With the card I pay $30 a month. 

[Soror]

1 hour ago, ktgrok said:

Definitely, with a history of abuse should only get Vyvanse. It is more expensive, but there is a manufacturer discount card you can get from the website that lowers the cost significantly. Without the card I would pay $75 per month, after insurance. With the card I pay $30 a month. 

Depends heavily on your insurance. On my insurance I paid 100% until I met deductible- it was $258 after the coupon (I called around to different pharmacies fwiw). After I met deductible it was $33. We switched plans this year and I'm supposed to be capped at $250 for name brands- hoping the coupon is after that but haven't filled it yet. 

re: dr's visit- I'm sorry they made you fill like crap. I understand all the anxiety with finally bringing things up. There are always a lot of hoops with ADHD meds since they are controlled substances. I would guess a good part of his reply was because of that--- but his phrasing was crappy and insensitive.

[Toocrazy!!]

I deal with the same drs office for my parents and now for my son’s ADHD meds. It’s like dealing with two entirely different offices. Because of the type of drug, it does seem like my son is always being accused of something. Until he can get on the right drug and right strength, it’s monthly appointments, biweekly phone calls defending his need to try the next strength, lagging insurance approvals. It’s hard for a person with ADHD not to give up. It’s a pretty intense process. 

[ktgrok]

3 hours ago, Toocrazy!! said:

I deal with the same drs office for my parents and now for my son’s ADHD meds. It’s like dealing with two entirely different offices. Because of the type of drug, it does seem like my son is always being accused of something. Until he can get on the right drug and right strength, it’s monthly appointments, biweekly phone calls defending his need to try the next strength, lagging insurance approvals. It’s hard for a person with ADHD not to give up. It’s a pretty intense process. 

Yup. And the irony is that people with ADHD are least able to handle all the hoop jumping. My son is currently unmedicated because it is such a PIA. 

[prairiewindmomma]

Vyvanse has a manufacturer's coupon. Depending on how your rx insurance is set up, if you have a standard tiered plan the copay drops to $40/month.

Methylphenidate ER/Concerta runs at about $52/month with a goodrx coupon.

Regular Methylphenidate/Ritalin is about $30/month with a goodrx coupon, a bit cheaper at Costco.

Adderall is usually cheapest, somewhere in the $20 range.

So, Vyvanse isn't necessarily way more expensive than the other ADHD drugs.

 

[Noreen Claire]

On 3/28/2022 at 4:50 PM, prairiewindmomma said:

Vyvanse has a manufacturer's coupon. Depending on how your rx insurance is set up, if you have a standard tiered plan the copay drops to $40/month.

Methylphenidate ER/Concerta runs at about $52/month with a goodrx coupon.

Regular Methylphenidate/Ritalin is about $30/month with a goodrx coupon, a bit cheaper at Costco.

Adderall is usually cheapest, somewhere in the $20 range.

So, Vyvanse isn't necessarily way more expensive than the other ADHD drugs.

 

Looks like vyvanse isn't covered by my insurance at all. I will find the space in my budget if it's the best option, but it will be tricky.

I spent all my energy yesterday and today contacting the names on the list the office sent me for evals... most of them got back to me that they either "don't do adults" or that they are "too busy" to fit me in, or even put me on their waiting list. So, that's been unhelpful.

I emailed the doc back to say, basically, "WTF?" He replied that I need to schedule a zoom visit because we didn't discuss everything that was "germane to prescribing adhd meds". I have so much other stuff to try and get through this week that I hope maybe to have the bandwidth to get around to it next week. We'll see.

[ktgrok]

4 hours ago, Noreen Claire said:

Looks like vyvanse isn't covered by my insurance at all. I will find the space in my budget if it's the best option, but it will be tricky.

I spent all my energy yesterday and today contacting the names on the list the office sent me for evals... most of them got back to me that they either "don't do adults" or that they are "too busy" to fit me in, or even put me on their waiting list. So, that's been unhelpful.

I emailed the doc back to say, basically, "WTF?" He replied that I need to schedule a zoom visit because we didn't discuss everything that was "germane to prescribing adhd meds". I have so much other stuff to try and get through this week that I hope maybe to have the bandwidth to get around to it next week. We'll see.

Honestly, for most people there is very little difference between Adderall extended and vyvanse. 

[scholastica]

On 3/28/2022 at 3:50 PM, prairiewindmomma said:

Vyvanse has a manufacturer's coupon. Depending on how your rx insurance is set up, if you have a standard tiered plan the copay drops to $40/month.

Methylphenidate ER/Concerta runs at about $52/month with a goodrx coupon.

Regular Methylphenidate/Ritalin is about $30/month with a goodrx coupon, a bit cheaper at Costco.

Adderall is usually cheapest, somewhere in the $20 range.

So, Vyvanse isn't necessarily way more expensive than the other ADHD drugs.

 

For those who don’t have tiered plans, just a deductible, the coupon maxes out at a $60 discount on the over $300 list price. For example, we paid $280 this month for it for my ds. When he first went on it, we had to get pre-authorization for it. Luckily it goes off patent next year.

[ktgrok]

1 hour ago, scholastica said:

For those who don’t have tiered plans, just a deductible, the coupon maxes out at a $60 discount on the over $300 list price. For example, we paid $280 this month for it for my ds. When he first went on it, we had to get pre-authorization for it. Luckily it goes off patent next year.

Yikes!

for an adult like OP then, who has no concerns about abuse or selling it on the street, I'd definitely stick to Adderall, either short or long acting. The "crash" coming off can be a bit more abrupt, but I found that some coffee timed properly eased that. And I didn't have any issues after the first few months I was on meds. 

[Soror]

1 hour ago, scholastica said:

For those who don’t have tiered plans, just a deductible, the coupon maxes out at a $60 discount on the over $300 list price. For example, we paid $280 this month for it for my ds. When he first went on it, we had to get pre-authorization for it. Luckily it goes off patent next year.

Yes, similar here.

Ritalin (methylphenidate) was less than $20 a month

Adderal around $100 (only did that one a month and didn't shop around as we were under extreme stress)

Vyvanse $260 ish

I hadn't heard the patent is running out next year, that is very good news.

[TechWife]

On 3/28/2022 at 4:50 PM, prairiewindmomma said:

Vyvanse has a manufacturer's coupon. Depending on how your rx insurance is set up, if you have a standard tiered plan the copay drops to $40/month.

Methylphenidate ER/Concerta runs at about $52/month with a goodrx coupon.

Regular Methylphenidate/Ritalin is about $30/month with a goodrx coupon, a bit cheaper at Costco.

Adderall is usually cheapest, somewhere in the $20 range.

So, Vyvanse isn't necessarily way more expensive than the other ADHD drugs.

 

Pricing  is entirely dependent on insurance and the PBA. There are huge price differences between plans for the same medication. My ds’ Vyvanse is nearly $300 per month until he meets his $5K annual deductible. He has an excellent insurance plan other than the high deductible. The Vyvanse manufacturer’s coupon is only $60.

OP - FWIW, many doctors have no idea what the meds they prescribe cost. A doctor who starts with Vyvanse right out of the gate almost certainly doesn’t know. Also, it’s not usually the first drug that is tried, which makes me wonder about both expertise and susceptibility to sales pitches. Many providers don’t read charts before they respond to patient questions, not even for medically complex patients. It’s sad and scary for the patient. I’ve had a lot of medical encounters over the past several months and boy do I have stories. 

[TechWife]

I’ll throw this into the thread - family experience has taught me that behavioral health patients are often treated with suspicion at the pharmacy and by the medical practice staff at non-psychiatric practices. For some it’s because they have been burned and are jaded. For others it’s because they are arrogant and judgmental. Then there is a certain percentage that are just uneducated. It’s a sad way to approach a patient population that already has difficulty accessing appropriate treatment and sticking to treatment plans for a variety of legitimate reasons. 

[Soror]

59 minutes ago, TechWife said:

Pricing  is entirely dependent on insurance and the PBA. There are huge price differences between plans for the same medication. My ds’ Vyvanse is nearly $300 per month until he meets his $5K annual deductible. He has an excellent insurance plan other than the high deductible. The Vyvanse manufacturer’s coupon is only $60.

OP - FWIW, many doctors have no idea what the meds they prescribe cost. A doctor who starts with Vyvanse right out of the gate almost certainly doesn’t know. Also, it’s not usually the first drug that is tried, which makes me wonder about both expertise and susceptibility to sales pitches. Many providers don’t read charts before they respond to patient questions, not even for medically complex patients. It’s sad and scary for the patient. I’ve had a lot of medical encounters over the past several months and boy do I have stories. 

AFter the dr. prescribed Vyvanse and I figured out it was going to be 260 with the coupon I called the dr back. I'm not sure if he didn't know or didn't think it was worth mentioning (which is ridiculous-high ded plans are pretty common these days). Maybe he will remember next time he prescribes it that for many families that is a good chunk out of the monthly budget. We ended up going with it as we'd already tried other meds in different strengths and were desperate. 

51 minutes ago, TechWife said:

I’ll throw this into the thread - family experience has taught me that behavioral health patients are often treated with suspicion at the pharmacy and by the medical practice staff at non-psychiatric practices. For some it’s because they have been burned and are jaded. For others it’s because they are arrogant and judgmental. Then there is a certain percentage that are just uneducated. It’s a sad way to approach a patient population that already has difficulty accessing appropriate treatment and sticking to treatment plans for a variety of legitimate reasons. 

I had a very fun time finding ds a new dr after the old practice went to NP only and the GP moved away. They made me feel like a drug seeker for my son. REally the ped we ended up with sucks but I haven't got the nerve to go through it all again.

[ktgrok]

55 minutes ago, TechWife said:

I’ll throw this into the thread - family experience has taught me that behavioral health patients are often treated with suspicion at the pharmacy and by the medical practice staff at non-psychiatric practices. For some it’s because they have been burned and are jaded. For others it’s because they are arrogant and judgmental. Then there is a certain percentage that are just uneducated. It’s a sad way to approach a patient population that already has difficulty accessing appropriate treatment and sticking to treatment plans for a variety of legitimate reasons. 

Pretty sure this is why, despite Vyvanse not being a first line drug, it was advised to my 19 yr old son, who also had depression/anxiety. To be fair, I get it - something that our insurance covered that wasn't likely to be abused or sold in a college age kid makes sense. Then I went on it as my first choice since it worked so well for him, and we have similar drug metabolism. My sister's insurance will cover it but only if she tries and fails cheaper drugs first. So she just sticks with Adderall XR (or whatever the extended release is). Adderall and Vyvanse are similar, Ritalin is a different medication. 

[katilac]

On 3/28/2022 at 12:26 PM, Toocrazy!! said:

  Until he can get on the right drug and right strength, it’s monthly appointments 

He should prepare himself for the fact that it might still be monthly appointments after they settle on a certain medication. That's not unusual at all.