Posted by Zeke on January 10, 2000, at 2:03:30
In reply to Re: Ritalin Coverage--more, posted by Noa on January 9, 2000, at 10:09:53
I ponder the psychostimulant issue from several angles:
One could say that the HMOs place special controls because it's a controlled substance. But I doubt that they demand preauthorization from having a script for Percodan or other schedule 2 opiates filled. (Do they?) An exception may be that they would review high doses or ongoing prescriptions as would be given to a person with cancer. Of course, we have (had) undermedication or even lack of medication for such persons with narcotics just as with stimulants. Granted, doctors need to use special care with these substances because of abuse potential and persons becoming dependent on them. And in practice doctors fear state medical boards' critical oversight: investigations and potential discipline. But the conservatism creates craziness where doctors fear 'addiction' (dependence) by using appropriate (high) doses in terminal cancer patients. More in our perspective, this means using stimulants -- even if some dependence develops -- because they more importantly allow a person to be functional and have a better quality of life.
The thing that really strikes me about what was said, is that the companies demand preauthorization for stimulants in adults -- but not in children. This implies that they are inappropriately prescribed for adults? Consider that Ritalin and amphetamines are a first line medication for Narcolepsy, a condition that typically presents itself in young adults.
Now certainly there are many more people with ADD and depression than narcolepsy. And also the stimulants have been used primarily for childhood ADD -- not long ago ADD was thought to be just a childhood condition. But research and practice has shown that ADD symptoms continue into adulthood, and that adult ADD and often depression can be treated (find relief) with stimulants. So here come the insurance companies and HMOs who say, you need our approval, not just your doctor's approval (prescription)!
Do these companies similarly demand preapproval for adults for say Retin-A? Retin-A is an acne medication, and acne is largely a teenage condition. There are probably even better examples than this. But I doubt the companies demand reapproval in these cases?
I even wonder if they require approval for Cylert(pemoline) to be covered for adults? Cylert is a schedule 4 drug, with minimal abuse potential compared to Ritalin or amphetamines. JohnL and Noa, you might ask your pharmacy about this. I'm curious about the response. Given, Renee's experience that Ritalin is OK but amphetamine needing approval, I rather doubt they would be so critical towards Cylert. This again would point to schedule 2 drugs being the main issue. This is why claim morality is a big motivation behind the policy (excuse the pun)!
This irritates me because eight years ago I had a somewhat similar experience. When I was first treated for ADD, I had a doctor that used rather high doses of Ritalin. The pharmacy refused to fill the Rx because it exceeds 60mg/day. They didn't have any similar policy about other meds. (They also wouldn't stock Dexedrine -- though they did dispense Percodan etc., which makes little sense to me.)
Again, they thing that strikes me here is that the preauthorization is limited to adults.
What my doctors have sometimes done and can eliminate some problems, is to write 'for ADD' or 'for depression' etc. on the scripts.
I have a friend at CHADD and may inquire if this is a widespread problem. I'll keep you posted.
Back to the crazy world!!!
poster:Zeke
thread:17987
URL: http://www.dr-bob.org/babble/20000101/msgs/18516.html