Insider tips on lowering ADHD costs (Link works) by getting your insurance company to pay for medication, treatment, and other therapies by Jane Lehto
Reduce ADHD Costs with Patient Assistant Programs by Kimberly Holland Find retail prices for the brand name and generic versions of Adderall and other popular ADHD medications. (Be sure to compare costs with your local pharmacies.) Try other cost-saving techniques, such as mail-order prescriptions and coupons.
A comprehensive collection of sources for help with medication costs – Post on Psych Central Forums. (Link doesn’t work, but copy and pasting the URL does) – Repeats some of the sources listed below but provides additional ideas especially about generic medications. (URL: https://psychcentralforums.com/insurance-and-finances/153805-free-low-price-prescriptions.html#post1481620)
Help from Pharmaceutical Companies – Patient Assistance Programs
Eligibility varies program by program. Generally, individuals must have incomes under 200% of the Federal Poverty Level, cannot have prescription coverage from any public or private source and must be a U.S. resident or citizen. Some companies also require that the patient has no health insurance (including Medicare).
Note: These are non-profit sites and do not charge you for their help.
RX Hope has program descriptions and downloadable applications for prescription assistance programs for specific medications including psychotropic medications
Needy Meds – Just enter the name of your medication in the Drug Search box in the upper right corner.
RxAssist – Offers access to PHARMA programs for both doctors and consumers (877) 844-8442 – Copy and paste: https://www.rxassist.org/
Note: IF you need Vyvanse or Intuniv, Shire Care’s income criteria is significantly higher than the less than the 2x the poverty level required by most Pharma programs. You still need to provide proof of hardship however. Each application will be considered on a case by case basis. See Shire Care for more information and to apply.
Monthly paperwork for stimulant medications too much for you to deal with? For a small fee, The Medicine Program.com will help you with applying for PHARMA programs and enlisting your physician’s help. – P.O. Box 520 – Doniphan, MO 63935-0520 – (573) 996-7300
Money Matters – The Affordable Health Care Act and Mental Health – Find Health Insurance – Low-Income Help – Social Security Income and Social Security Disability
The Cost of Not Treating ADHD by Steven Kurtz – “We’re already paying the cost, and our kids are too.” “Many kids with ADHD, and other conditions, just find their problems compounding as they get older. And they are less and less responsive to treatment. Kids with untreated ADHD often become adults with untreated ADHD, and with that comes a whole host of adult-sized problems.”
How much does it cost to test for ADHD? Consumer Reports – $700 to $1600 was the average assessment cost. – “About one-third of the parents in the survey reported that the costs of treating their child for ADHD were covered completely by their child’s health plan, with two-thirds of respondents reporting half to all treatment costs were covered by insurance.”
The Affordable Care Act has new regulations to make sure that mental health treatment is covered to the same extent as physical care. Therapies for depression, anxiety, and substance abuse — which often come along with ADHD — are among a core set of 10 services called “essential health benefits” that must be covered with no out-of-pocket limit. Included in these are prescription medications, which are usually a major component of ADHD treatment. Knowing that a pre-existing condition won’t exclude you from getting affordable insurance is also a bonus. So is the option of keeping children on their parents’ policies until they’re 26. (1)
Before health reform, one out of five people who bought their own insurance had no mental health benefits. This change is long overdue. One drawback may be that by placing the primary care physician is at the center of treatment, Doctors may decide to treat ADHD themselves by just prescribing medication, rather than referring to a specialist. With the high rate of mental health issues and Learning Disabilities so commonly associated with ADHD, however, a complete diagnosis and a holistic treatment plan may be beyond the expertise of primary providers. (2) They may not appreciate the value of parent training to managing behavior or family therapy to educate and help all members of the family.
The news for low-income families is not as good. “In 2012, the Supreme Court gave states the choice of whether to join the Medicaid expansion or not. Unfortunately, almost half of the states have decided not to do so. That means that 6 to 7 million Americans won’t enjoy this enhanced access.”(3) Even with Medicaid, finding a physician will be difficult. “Under the present Medicaid reimbursement rates, physicians are paid only about $45.00 for a basic visit, while $75 per visit is the break-even point for most private practices. So the physician has to take a $30 loss for every Medicaid patient that he or she sees and has increased paperwork to even get the reimbursement.” (4) Find Health Insurance
Alternatively, let your fingers do the walking. Check the Community Pages in your local phone book under Mental Health for local federally funded clinics. They accept Medicaid, Medicare, most insurances and will adjust their rate according to your income. (Note: Some areas do not consider adults with ADHD (alone) as qualified for treatment. Others will treat if it’s in combination with another mental disease or disorder). Children’s clinics, however, deal with ADHD concerns on a regular basis.
Or, use Google. I had good results using the words community mental health with city, county, and/or state
The Department of Vocational Rehabilitation is another possible way to go. You do, however, have to prove you are not employable or under-employed due to your ADHD or combination of disabilities. I know quite a few people who got a lot of help through DVR a number of years ago (including paying for a diagnosis for ADHD,) but their funding has been hit. – Find your state’s Voc-Rehab services
Clinical trials don’t cost a thing and you may even be reimbursed for your time. (There’s no guarantee you’ll get the drug being tested, but you can often get a free evaluation for ADHD.) For a listing of current studies, see the National Institute of Mental Health.
2-1-1 is an Information and Referral service to help people connect with important community services and help them find help in their community more easily. Call 2-1-1 or Search for a 2-1-1 Call Center. Available in many states, 2-1-1 can help you find organizations that may assist with a broad range of needs. You may find help paying for medications or financial assistance with other essential needs such as food, clothing, rent and utility assistance, child care, employment supports, services for older adults, etc.
Social Security Income and Social Security Disability Income
Supplemental Security Income, or SSI, provides monthly income for those who cannot work due to a disability such as depression, bipolar disorder or other mental disorders. You must meet strict eligibility criteria to qualify.
The basics of SSDI – “Social Security Disability Insurance (SSDI) is available to any worker who has a “disability” as defined by the federal government and who has paid into the Social Security system for a specified amount of time, depending on their age. In order to qualify as “disabled,” an SSDI applicant must show that he is almost completely unable to work at any job whatsoever.”
Social Security Disability and ADHD (link works) – This article focuses primarily on children. – They need to show a MARKED inability to succeed in school and strong documentation is required. For adults: Adults must be unable to earn more than $960 per month gross (with that inability also caused by MARKED impairments. Most importantly, to win disability benefits from the Social Security Administration based on attention deficit, or ADHD, a person must have measurable functional deficits, in the context of school or work performance. (URL: https://www.disabilitysecrets.com/adhd-attention-deficit-social-security-disability.html)
SSI / SSDI Outreach, Access and Recovery – SOAR Help for the homeless with mental illnesses, a process where eligible individuals can have their disability case expedited. SOAR’s online training course (Link works – Or copy and paste) https://soarworks.samhsa.gov/ is about 16 hours long, but it leads you through all the steps to help clients apply for SSI or SSDI. – To be eligible you must be at least 18, diagnosed with a serious mental illness as well as homeless or at risk of becoming homeless. The SOAR process is designed to have a decision for disability claims within 90 days.
• “Image courtesy of Luigi/FreeDigitalPhotos.net” Modified on Canva.com
References
(1) “The Affordable Care Act: Good for ADHDers” by Katherine Ellison – www.additudemag.com/adhdblogs/19/10545.html (2) “An Update on How the U.S. Affordable Care Act Impacts Mental Health Care” By John M. Grohol, PSY.D. – http://psychcentral.com/blog/archives/2013/11/01/an-update-on-how-the-u-s-affordable-care-act-impacts-mental-health-care/ (3) “Affordable Care Act : Will It Impact Your ADHD Child’s Treatment?” http://newideas.net/adhd-affordable-care-act-impact (4) “One of the Best Things to Happen to People With ADHD? Obamacare” by Dennis Thompson Jr. http://www.everydayhealth.com/news/obamacare-best-thing-happen-people-with-adhd/
