Does Aetna cover Vyvanse?

In this article:

• Does Aetna cover Vyvanse?
• Does Aetna cover generic Vyvanse (lisdexamfetamine)?
• How much does Vyvanse cost?
• How much does Vyvanse cost with Aetna?
• How to check whether your Aetna plan covers Vyvanse
• How to save on Vyvanse

In this article

• Does Aetna cover Vyvanse?
• Does Aetna cover generic Vyvanse (lisdexamfetamine)?
• How much does Vyvanse cost?
• How much does Vyvanse cost with Aetna?
• How to check whether your Aetna plan covers Vyvanse
• How to save on Vyvanse

Vyvanse (lisdexamfetamine dimesylate) is a prescription drug approved by the Food and Drug Administration (FDA) for ADHD in adults and children 6 years and older and for moderate to severe binge eating disorder in adults. It belongs to a class of medications called stimulants—specifically, central nervous system stimulants. Like other brand-name drugs, Vyvanse can be expensive without coupons or insurance. The brand-name version costs an average of $553 for 30, 30 mg capsules. 

Does Aetna cover Vyvanse?

Some Aetna plans may cover Vyvanse, but as is often the case with health insurance, it depends on the specific plan’s formulary, the prior authorization requirements, and the reason it’s prescribed.

Formularies

Formularies are drug lists that insurance companies use to show which medications they cover and which they don’t. They may also list the plan’s coinsurance and copay policies, which can vary between plans.

A portion of Aetna’s plans label Vyvanse as a “non-preferred” drug, meaning it’s typically not covered or minimally covered, preferring generic lisdexamfetamine dimesylate instead. Other plans list Vyvanse as a preferred brand, which means they’ll likely provide some coverage. The only way to know for sure is to check your specific formulary or contact the insurance company directly.

Some plans may also place quantity limits on Vyvanse, since it’s a stimulant and a controlled substance, similar to Adderall (amphetamine/dextroamphetamine). If so, it means they will only cover a certain number of capsules per month.

Prior authorization

Insurance companies sometimes want to verify that a specific drug is, in fact, medically necessary. They do this through a process called prior authorization. In these cases, they may require the healthcare provider to submit additional documentation of treatments, symptoms, or side effects from other drugs tried. They could also require step therapy—the process of trying other, similar drugs before moving to Vyvanse.

“Prior authorization is often required and typically involves documentation from the healthcare provider showing that the patient has tried and failed other medications or that Vyvanse is medically necessary,” says Charles Sweet, MD, medical adviser at Linear Health. “Delays and denials are, unfortunately, common.” Not all plans require prior authorization, but some may. 

Reason for taking Vyvanse

Vyvanse is only FDA approved for ADHD and binge eating disorder, but some doctors may prescribe it “off-label” for depression or narcolepsy. Usually, insurance will only cover a drug for its approved purposes, so if your health care provider prescribes it for something other than ADHD or binge eating disorder, Aetna may deny coverage.

Does Aetna cover generic Vyvanse (lisdexamfetamine)?

“As of now, multiple approved generic options offer a more accessible, affordable option for many patients,” Dr. Sweet says. Many Aetna plans will cover generic Vyvanse when it’s prescribed for an FDA-approved condition. Whenever there’s an available generic drug, insurance plans often prefer it to the brand-name alternative—and it appears that Aetna is no different.

Even when their formularies list Vyvanse as a non-preferred drug, they typically cover the generic version as a preferred drug. Of course, this also depends on your specific plan. Just like with brand-name Vyvanse, some may require prior authorization, and how much they’ll cover may vary as well.

How much does Vyvanse cost?

Many people rely on drug coverage because prescription drugs can be expensive if you’re paying out of pocket. Without health insurance with prescription drug coverage, Vyvanse costs an average of $553 for 30, 30 mg capsules (a 30-day supply). That’s around $18 per dose and over $6,600 per year.

Those costs aren’t set in stone, though. They can vary based on the dosage and quantity prescribed, your location, and even the pharmacy you choose.

How much does Vyvanse cost with Aetna?

It’s difficult to put an exact price tag on how much Aetna copays are for Vyvanse since there are so many different Aetna plans. Some Aetna plans might cover the entire cost, while others might require their members to pay copays or coinsurance. It typically depends on which drug tier Vyvanse falls into. Each formulary organizes drugs into tiers. Some use numbered tiers, but many Aetna plans classify medications as either generic, preferred brand, non-preferred brand, preferred specialty, non-preferred specialty, or non-formulary (not covered at all).

If your plan classifies Vyvanse as a preferred brand, you’ll likely receive thorough coverage. If it classifies it as a non-preferred brand, you may need prior authorization first, or you might have to pay more out of pocket. Either way, you may have better coverage for generic lisdexamfetamine.

How to check whether your Aetna plan covers Vyvanse 

Aetna makes it fairly easy to check your formulary online. On its “Find a Medication” page, you can select your specific plan, and it’ll take you to a page where you can search for Vyvanse or look over a PDF of the full drug list. This will tell you the tier and may also state whether prior authorization is necessary.

If you’d rather talk to someone instead, you’ll need to log into your member account, then call the number listed under “Support.” 

How to save on Vyvanse

There are ways to save on Vyvanse if you don’t have health insurance or if your copay or coinsurance is too high. 

For example, SingleCare offers free coupons and a discount card you can use for your medication at pharmacies across the country. With a Vyvanse coupon, you could pay $386 for 30, 30 mg capsules of brand-name Vyvanse instead of $553. Or, you could ask your healthcare provider to prescribe generic Vyvanse and pay $65 for 30, 30 mg capsules with a lisdexamfetamine dimesylate coupon instead of $443. You can use these coupons even if you have insurance, but you can’t use them on top of insurance coverage, so you’ll need to determine which provides the best discount.