Adderall instant release will always be on an insurance company’s formulary with the extended release however it can vary and this is because the extended release is slightly more expensive than the instant release adderall extended release is designed to mimic taking a comparable dose of the instant release four hours apart so if you look at the concentration of an
Fetta mean in someone’s blood if you take a comparable dose of adderall instant release four hours apart the extended release is designed to mimic that concentration exactly so that’s generally why they don’t cover the extended release in favor of the instant release just in case you’re ever wondering but y’all don’t care about that you just want it try to get this
Stuff approved so let’s have a look and see how to do that so there are two situations as i mentioned before it can either be on the formulary in which case is going to need a prior authorization or it won’t be on the formulary in which case you need to start the non-formula medication process if it’s on the formulary it’s basically gonna have the same criteria
As the instant release so it’ll look something like this you can see well let me go back we can see that this company is just like that situation i described earlier trying to encourage people to take the adderall twice daily as opposed to the extended release so here it says non formally and feta meaned extra and feta mean er and feta mean dextroamphetamine
That’s the generic name for adderall sometimes you will see it written as in vet amine salts it’s the same thing that’s non-formulary instant releases formulary well let’s have a look at the criteria if it is on your plan formulary the criteria will be the same for the instant release as the extended release required medical information statement of fda-approved
Diagnosis of narcolepsy or attention deficit disorder so in order to get this approved if it’s on the formulary all you need is just a diagnosis of attention deficit disorder or narcolepsy so when you go to the submission all you need to write for the die no sis’s adhd or narcolepsy and it’ll be approved that’s it if it’s not on formulary and there’s just a little
Bit extra information we got ad for a non formulary medication we have to do an extra we have to add a little bit of extra information for non formular medications we have to try and fail to formulary alternatives so we click on the medication click on alternate medicines and here it’s got four medications that are listed we’re not to try all of them just to i would
Recommend picking adderall instant release and feta mean dextroamphetamine and methylphenidate here it’s got methylphenidate er but doesn’t really matter this right adderall instant release a methylphenidate now that we’ve got our two formulary alternatives we’re gonna proceed to step 3 and this hypothetical example i’m going to be taking adderall extended-release
20 milligrams daily so i can fill in this rubric beginning with the drug name adderall extended-release make sure to include that the generic is okay if a generic is available unless you plan on using the generic name which would be feta mean dextroamphetamine or you can put in feta mean salts as usual i would just recommend using the brand name plus stating
That the generic is okay if available the drug strength 20 milligrams drug quantity 30 frequency 1 daily doctor’s name doctors facts the diagnosis i chose to use adhd the diagnosis code is 314 point zero one i used adhd because it’s far more common than narcolepsy if you need the diagnosis code for narcolepsy although it’s absolutely 100% not necessary you can
Just search it on google or use the cms idc 9 code search tool if the adderall extender release was on your formulary then you can stop here there’s no need to include the criteria because as we saw earlier for the instant release the only criteria for the prior authorization was just the fda approved diagnosis of attention deficit disorder or narcolepsy since we
Provided attention deficit disorder it will be approved if it’s non-formulary then we’ll have to include this information of course if you include this information and it’s on the formulary it’s not gonna hurt you so you may as well include it anyways tried and failed adderall instant release and methylphenidate it doesn’t matter if you use the brand names or
Generic names it’s all fine after i’ve got all this information i’m going to call the insurance company asked to file prior authorization as usual doesn’t matter if it’s technically non formally or prior authorization you just say prior authorization i know what you’re talking about they’ll collect this information from you and that’s it you hang up the phone and
You’re done oh yes and don’t forget to ask for a stat decision that way that approval will be given to you within 24 hours and then 24 hours this will definitely be approved this is gonna be approved 10 times out of 10 if you have any questions feel free to ask hope this was helpful and i’ll see you next time you
Transcribed from video
How to Get Adderall XR Approved By ONEEZE
