Does Medicaid Cover Adderall XR?

Medicare Benefits Solutions
Sep 24, 2021

If you have been diagnosed with Attention-Deficit/Hyperactivity Disorder or narcolepsy, you might have concerns as to whether common prescriptions, such as Adderall XR, are covered under your Medicare coverage.

TIP: view our helpful video guide on Medicare prescription drug coverage.

Medicaid vs Medicare Adderall Coverage

Due to Adderall XR being a medically necessary prescription for ADHD and narcolepsy treatment, it is typically covered under most Medicaid programs. Depending on the source of the prescription, the drug can be covered under select programs.

For instance, Medicare Part A solely covers prescriptions administered while a patient is living in a nursing facility and Part B only covers prescriptions that are provided in outpatient clinical settings. If your prescription is provided by a physician, your Medicare Part D coverage may help cover the medications.

If you are a Medicare beneficiary and unsure of whether your prescription is covered under Medicare Part D benefits, it is best to talk with your insurance provider before attempting to receive your medications. While your Medicare Part D Prescription Drug Plan or Medicare Advantage plan with prescription drug coverage will most likely cover your expenses, the controversial nature of Adderall XR makes it difficult to predict whether your provider will allow for full coverage.

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Do I Qualify for Medicare or Medicaid?

It is important to note that while Medicare and Medicaid have similar coverages, the two programs are differentiated based on income and state regulations. In states that allow both Medicaid and Medicare, low-income individuals may qualify as dual-eligibles, a title that refers to being eligible for both programs.

There are two types of dual-eligibles: full-benefit and partial duals. Full-benefit duals receive all benefits that are offered under both Medicare and Medicaid coverages, while partial duals may receive partial coverages from the two programs. Partial coverages include assistance paying premiums, cost-sharing, and more.

TIP: check our Medicare essentials article and discover the differences between Medicare vs. Medicaid.

What is Adderall XR Used For?

As mentioned, Adderall XR is typically used as a combination treatment for disorders with no cure. This drug is classified as a stimulant due to its ability to increase alertness, energy, and focus. Individuals diagnosed with ADHD can benefit from frequent use of Adderall XR because this treatment not only improves clarity but prevents sudden impulse-triggered actions.

Adderall is typically used to:

  • Help you stay focused on an activity
  • Increase your ability to pay attention
  • Reduce impulsivity
  • Enhance concentration
  • Improve listening skills

When there is a prominent increase of dopamine levels, Adderall XR may be used to restore hormone imbalances and control symptoms. While medications are not typically the first course of treatment for ADHD or related conditions, they are administered once therapy is proven unsuccessful. Adderall XR can be used to improve symptoms throughout the day if used as recommended.

When ingested in the form of capsules, it may slowly release within the body over the course of a day. There is a variation in the effectiveness between Adderall and Adderall XR, but you should only use the prescription that works for you. Adderall XR is thought to have stronger and more long-lasting effects, while Adderall can be taken in small doses each day.

TIP: Find out which plans offer the best prescription drug benefits and compare them against your existing Medicare coverage.

Is Adderall XR Prescription Coverage Guaranteed?

Since Adderall XR presents a high risk of both addiction and substance abuse, it is heavily regulated by state officials. Consequently, you may have to meet a few requirements before you become eligible for Adderall XR coverage under Medicaid or Medicare. If you are seeking Adderall XR prescriptions as a treatment for ADHD or narcolepsy, you must have first undergone behavioral modification therapy before resorting to medications.

The largest concern lies within children diagnosed with ADHD using Adderall XR as a form of treatment. Our brains are typically fully developed at age 25, meaning that the ingestion of such substances could interfere with development. Regardless, if you have previously undergone the mentioned therapy, your physician can attest that you require medicinal treatment. This will not only expedite your request to have Adderall XR covered by your insurance company but ensure that it is covered. The same process is used to determine if your Medicare benefits can cover the prescription.

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