Does Medicare cover Adderall?
Adderall is a prescription medication that doctors primarily use to treat attention deficit hyperactivity disorder (ADHD). Medicare may cover Adderall or its generic form when it is medically necessary.
Medicare usually covers Adderall under Part D, but Part A may sometimes provide coverage. In some cases, depending on the type of plan, Medicare covers the generic form of Adderall.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Coverage options for Adderall
Share on PinterestUsually, a stand-alone Medicare Part D plan covers Adderall.
Each Part D plan provides a list of the brand name and generic drugs that it covers. This list is known as a formulary.
Part D plans may differ in terms of what their formulary includes, but Medicare dictates that each policy must cover at least two drugs in each of the most commonly prescribed categories.
Medicare plans sometimes cover the brand name drug Adderall, but in other cases, an individual’s plan may only cover the generic version of the medication.
Part D and Adderall
Part D is a prescription drug plan that those with original Medicare can choose.
When a person has a Medicare Advantage plan, they may not enroll in Part D. However, in 2021, 89% of Medicare Advantage plans will include prescription drug coverage, according to the Kaiser Family Foundation.
Private insurance companies that Medicare has approved administer Part D plans. A person’s specific plan might differ depending on the plan provider and where they live, as not all plans are available in all regions.
Each year, Medicare sends a plan annual notice of change document that lets a person know about Medicare changes, including those affecting coverage. A person can check whether the plan provider has changed their formulary by adding or removing a drug, such as Adderall.
Part A and Adderall
Original Medicare Part A occasionally provides coverage for Adderall. Medicare Part A covers inpatient hospital care, including the medication that a person receives while in the hospital.
Usually, Part A covers Adderall if a person takes it during their stay in a hospital or skilled nursing facility. Once the individual leaves the facility, Part A no longer covers the cost, and Part D will take over.
What does Adderall treat?
Adderall primarily treats ADHD.
However, doctors may sometimes prescribe it to treat narcolepsy, which involves an uncontrollable need for sudden deep sleep.
How does it work?
Adderall affects the central nervous system by stimulating chemicals in the brain, such as dopamine and norepinephrine. These chemicals contribute to impulse control and hyperactivity, so Adderall may improve organization and concentration in some people.
Adderall contains two different drugs: dextroamphetamine and amphetamine. It is available in the form of an oral tablet or an extended-release oral capsule.
The dosage for Adderall varies, but the medication is a controlled substance as it has the potential for addiction. Individuals taking Adderall should only take it as their doctor has prescribed.
Costs
For those with a Part D plan, the cost of Adderall may vary depending on the plan’s rules.
If a person does not have prescription drug coverage, they are responsible for the full cost of Adderall.
The price of sixty 20-milligram Adderall tablets can range from $439.21 to $525.02, with generic versions of the medication costing between $29.95 and $33.11.
The generic version of Adderall is known as amphetamine salt combo. Depending on the Part D plan, coverage may only be available for the generic version.
Out-of-pocket expenses
The specific out-of-pocket expenses for Adderall may vary.
As well as a monthly premium, Part D plans may also have copayments that vary among plan providers.
Some Part D plans also have a deductible that a person must pay before their plan covers any costs. Deductible amounts may vary, but in 2021, no Part D plan may have a deductible of more than $445.
Extra Help
If a person with Medicare has trouble paying for their prescription drugs, such as Adderall, they may qualify for the Extra Help program.
Extra Help covers some of the costs associated with Part D prescription drug coverage, such as:
- deductibles
- monthly Part D premiums
- copayments
A person may automatically qualify for Extra Help if they:
- receive both Medicare and Medicaid
- have a Medicare savings program (MSP)
- receive Supplemental Security Income
Those who qualify do not usually need to enroll, and they should receive a notice from the Centers for Medicare & Medicaid Services letting them know that they are eligible.
If someone does not meet the eligibility requirements, they may qualify for Extra Help based on their income, as long as they have Medicare Part A and live in the United States.
According to the Social Security Administration, Extra Help is worth about $5,000 per year. Individuals can apply for Extra Help online or in person through their local Social Security office.
Summary
Medicare covers Adderall as long as the drug is medically necessary for a person’s health or well-being. In most cases, Part D prescription drug plans cover the cost of Adderall.
Depending on the plan, Medicare may only cover the generic version of Adderall. The costs of Part D plans differ, and the out-of-pocket expense related to Adderall may vary.