“Last January, I went to fill my son’s ADHD prescription and was handed a bag with an unfamiliar drug name on it. No mistake, the pharmacist tech said, it was just the generic version,” Craig Idlebrook writes over at Stat. “I had a sinking feeling. As a former editor for diabetes publications, I knew that insurance companies regularly switched people from one brand of insulin to another, or from a name brand of insulin to a generic. I’ve heard stories from people with diabetes who said the switch completely upended their blood sugar management. However, I had used generic medicine for my blood pressure without a problem, so I hoped for the best…. The first day that my son took the generic, he was OK. The second, he was irritable. The third, he was sobbing. His pediatrician wasn’t surprised. Before we had landed on an ADHD medication that worked, we had cycled through several others that failed spectacularly. Some children are extremely sensitive to the variations in ADHD medications, and my son was one of them. I filled his prescription for the name-brand medication with my credit card, and started the process to appeal the insurance company’s decision. What followed was a frustrating and costly process that took a couple of months and several dozen hours on hold…. By the time I convinced the insurance company to cover the name-brand medication, I had switched jobs and insurances, so I had to start the process over again. The mind-boggling experience lasted a full year…. According to recent reports, that process has become more automated than in the past. For example, a 2023 ProPublica report found that Cigna created an algorithmic process that allowed a single physician to issue 60,000 denials in a month.” Craig Idlebrook, “I went on a mind-boggling journey to get my son’s ADHD medication covered by insurance — twice,” Stat.
