My youngest daughter was diagnosed ten years ago, at the age of eight, with ADHD. Since her diagnosis, her ADHD has always been managed with medication. As Sydney has grown, we have had to change her medication from time to time because, at some points in her development, certain medications have stopped working. When changing prescriptions we have had to try different treatments as some drugs were not effective for her and she has had adverse reactions to other medications. For the past three years, however, she has been on the same drug, Concerta, which has been working incredibly well for her. As it is a controlled substance, every month either my husband or I venture to the neurologist’s office to get her prescription and then take it to our local pharmacy to have it filled.

On October 1, 2013, my health insurance carrier switched pharmacy plans. On October 2, 2013, I picked up Sydney’s prescription at the neurologist and dropped it off at the pharmacy. About an hour later I received a call from the pharmacy telling me that the insurance carrier was denying coverage as they had decided that Sydney should be on a different (less expensive) medication. Ironically, the medication that the insurance company was “pushing” was a medication to which she had a horrible adverse psychiatric reaction to, Vyvanse. I quickly called Sydney’s neurologist. Her receptionist told me that she had just finished a half hour call with my carrier having gone through Sydney’s entire medical history with them and convinced them that the current medication is the proper medication for her. My neurologist also spoke to my pharmacy and I was assured I would receive the medication the next day.

On Friday, October 3, I received a call from my pharmacist informing me that my carrier was still denying coverage. I contacted the insurance carrier and after several different calls and three hours on the telephone I was finally told that the coverage was denied because I had to use their mail order service. I calmly explained that Sydney was away at school and needed the medication and, thus, there was no time to fill the prescription by mail order. It took four days and countless telephone calls wherein I alternately spoke calmly, reasoned, pleaded, and cried (I am not above crying for my child) before I could get the insurance company to allow me to use my local pharmacy to fill this one prescription using a mail order override. I was specifically told that all future prescriptions for Sydney would have to be filled via mail order.

About two weeks ago, I received a telephone call from my neurologist’s secretary who told me that they had received a letter from my carrier also informing them that, going forward, Sydney’s prescription would have to be filled through mail order. Knowing that I needed time to get the prescription filled and then mailed to Sydney at school we arranged for me to pick up a prescription that day. My husband mailed the prescription out the next day and even paid an additional $12.00 to have the prescription expedited.

About ten days later (you have to wonder what expedited means), my husband received a telephone call informing him that the insurance carrier was denying coverage as 1. The insurance company would only consider Vyvanse for Sydney and 2. The prescription would have to be filled by the local pharmacy. In a two and one-half hour telephone conversation, my husband explained what had occurred the prior month and was able to again get Concerta approved as her medication. During the conversation, however, it was determined that there was a “glitch” in the carrier’s system, one side mandating “mail order only” and the other side mandating “local pharmacy only.” Again explaining that time was an issue as we had to get the medication to Sydney, we were told that they would again issue a mail order override for this month requiring us to get another prescription from the neurologist to be brought to our pharmacy.

Happily, we visited Sydney this past weekend and brought with us her medication. No one at the insurance company, however, can tell us what we have to do next month to get the medication for Sydney.