Guest Author - Megan Dlugokinski

I had the most bizarre experience this week. I went to pick up my ADHD medications at the pharmacy and they told me that my insurance company refused to pay for my medicines because I was “too old to have ADHD.” I was flabbergasted!!

I have heard of some crazy things happening in this world but this takes the cake. I am anything but ‘too old’ in anybody’s book. That is age discrimination pure and simple! Not to mention the fact that this particular medicine is only rated for adults. Therefore they have a conflict in their statements.

How can they have a medicine that is rated only for adults and yet an adult is too old? So basically they are telling me that no one is allowed to take this medicine?? At what age do you become “too old” to have ADHD?
The ironic thing is that I’ve been taking this medicine for several years. I get the usual runaround every few months or so when they need some pre-authorization forms filled out. Why they need this when they know I have been taking it for a while and will continue to be taking it indefinitely is beyond me.

The insurance company just doesn’t want to pay the outrageous prices. The cost without insurance is nearly $300 vs. the $50 fee with insurance. So the price per pill went from 85 cents each to $5.00 per pill!! That is extortion in my book. I realize that the pharmaceutical companies have lots of costs involved and have legal risks but that is still way too much.

The way I see it I need to have my medicine to function so that I can take care of myself, my three daughters and earn a living. So if I pay for the $250 price increase I have less money to support my family. Yet if I don’t pay it I won’t have any medicine and therefore will not function at the capacity I need in order to be able to take care of my family. What a catch-22 they put me in. I was outraged that they could arbitrarily change the rules out of nowhere without ‘prior notification’ to me or any chance to dispute their decision.  

So not only am I upset at the huge cost difference but I’m even more outraged that I’m supposed to pay this extra money because I’m too old to have ADHD?! There has been a huge rise in Adult ADHD diagnoses over the last few years. So how can the insurance companies say that there is a specific age in which you can no longer have ADHD or be medicated for it? If a doctor says someone has ADHD and there is scientific research showing evidence that ADHD does not go away with age, how can an insurance company dispute that?

I will not take this lying down! Age discrimination is illegal and they can not just arbitrarily change the rules because they want to. If the insurance companies need to cut costs then they need to find some other way. It is time we all stood up and made these insurance companies accountable for their actions.  If anyone else has encountered this problem, please send me an e-mail with the details of your experience. In addition to a possible age discrimination lawsuit, I will be reviewing the insurance policy for possible breach of contract. I suggest you do the same.
 
Update on Black Box Warning issue: (see prior article "Are ADD Medications Safe?" listed below)
For now it seems that the recommendation that the FDA impose a black box warning on stimulant medicines has been rejected. They are still trying to decide the best method of explaining the risks without alarming anyone.
 
Check out this Teleclass:  
ADD expert Dr. Ned Hallowell is giving a one-time teleseminar about how to help kids with ADD succeed in school. If you have elementary or middle school children with ADD, this teleseminar will provide the latest on ADD and how to help kids take best advantage of their school years. The seminar will be held via a toll-free number on Saturday, April 29th from 10am - 12pm. There is a fee of $69 for the session, which will include both live lecture and Q&A with Dr. Hallowell. To sign up, visit Dr. Hallowell's educational website at www.allaboutminds.com.