Life with the Wild Things

Just another mom of 2 boys in a house full of energy!

ADHD and precertification for insurance November 27, 2014


Dear insurance company, government, and who ever else it may concern,

Thank you for your letter received by household Monday, Nov. 24.  Thank you for your response that did not help me at all on Tuesday, Nov. 25.  Here is my understanding of the current situation we are in…

Someone somewhere has decided that Daytrana (methylphenidate transdermal patches) will require precertification as of January 1, 2015.  In order for my son to continue using Daytrana to control his ADHD, our pediatrician must do the following.

1. Step therapy to prove that Daytrana is the best medication for my son.  If someone somewhere who made this decision agrees with our pediatrician, then we can continue to use the medication.

2. My pediatrician can write a justification and ask for an exemption to the step therapy.  Then someone somewhere will decide if my son can continue using Daytrana.  If said someone somewhere decides an exemption is not allowed then we must return to number 1 on the list.

So, please confirm that I understand this correctly.

Said someone somewhere knows my son and his needs how exactly?  See I didn’t know that said someone somewhere referred to as “invisible person” had been with me since my son was born.  I didn’t know that “invisible person” had watched my son suffer in second grade with his behavior problems.  I don’t recall “invisible person” sitting with me in the principal’s office discussing my son’s behavior.  I don’t remember seeing “invisible person” in the meeting to work on the behavior chart.  I don’t remember “invisible person” holding my hand in the pediatrician’s office while we discussed the medication options for my 7 year old.

You see I am having trouble understanding where “invisible person” was during all this.  I am fairly certain “invisible person” didn’t have any issues taking the money out of our check to pay the premium for my insurance.  But, I just don’t remember seeing “invisible person”.

Where were you when I realized that I would have to give my son a schedule 2 narcotic every day to help him succeed in school?  Where are you every month when I have to call in to the doctor’s office, travel to the doctor’s office to pick up the written Rx, go to the pharmacy and have it filled because schedule 2 narcotics require a new Rx every month?  I’m getting older so maybe memory is failing about where you have been during this process with me.

When “invisible person” decided that Daytrana requires all this extra work, did “invisible person” realize that my now 11 year old has excelled with his current medication?  My 11 year old has used Daytrana for 4 years.  He is an honor roll student, in Beta Club, on the science Olympiad team, a member of the first robotics team at his school, a first degree red belt in tae kwon do, and a member of the 6th grade boys basketball team.

My son is at a really good place in his life.  And you want me to take him off his current medication that is obviously working well and try other ADHD meds that you deem cheaper and work “just as well”.  Do you think that we didn’t try this already?  My son has a problem swallowing pills.  In addition, Daytrana patches allow my son to feel like he controls his medicine.  Which gives him a lot more confidence.

So someone somewhere, thanks for putting yourself in the middle of my son’s treatment.  I am sure you can understand my frustration.

Sincerely, Mom doing the best she can

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