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Key takeaways
Most Cigna plans will cover Vyvanse, though they may prefer the generic (lisdexamfetamine) to brand-name Vyvanse.
Cigna often asks you to try other similar medications before they cover Vyvanse. They may also require your healthcare provider to provide a documented diagnosis and explain why Vyvanse is best for you.
Since each Cigna healthcare plan is a little different, it’s best to contact your health insurance plan directly to ask whether Vyvanse is covered and what steps you may need to take to ensure coverage.
Vyvanse is the brand name for lisdexamfetamine, an extended-release central nervous system stimulant (CNS) that’s FDA-approved to treat attention-deficit hyperactivity disorder (ADHD) in adults, as well as kids aged six years and up. Vyvanse is also indicated in the treatment of moderate to severe binge eating disorder (BED) in adults. Vyvanse is considered a Schedule II controlled substance because of its potential to cause addiction and substance use issues.
Without health insurance coverage, Vyvanse’s out-of-pocket costs can be steep. If you are considering taking Vyvanse and have Cigna health insurance, you probably want to know: Does Cigna cover Vyvanse? While most Cigna plans will cover Vyvanse, insurance coverage for Vyvanse is not always straightforward and may require pre-authorization procedures like prior authorization or step therapy.
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Does Cigna cover Vyvanse?
Yes, Cigna Healthcare typically will cover Vyvanse. “Cigna generally includes Vyvanse (lisdexamfetamine) and its generic equivalent on its formulary, but coverage specifics can vary by plan and region,” explains Sharon Batista, MD, assistant clinical professor of psychiatry at Mount Sinai Hospital and psychiatrist at Balanced Psychiatry.
However, since a generic version of Vyvanse—known as lisdexamfetamine — arrived on the market in 2023, Dr. Batista says, Cigna and other insurance companies have been more likely to cover the generic drug than the brand-name product. Not only that, but often, the patient has to meet certain requirements before Cigna will cover either brand-name Vyvanse or generic Vyvanse.
Prior authorization
Prior authorization is a process where a health insurance company makes sure that a prescription medication is medically necessary for you. This is typically done in conjunction with your healthcare provider. “In my experience, Cigna almost always requires prior authorization for brand-name Vyvanse, and this also often applies to the generic medication,” Dr. Batista says.
Documented diagnosis
In order to complete the prior authorization process, your healthcare provider will have to prove to the health insurance company that Vyvanse is medically necessary for you. Most insurance companies will only cover Vyvanse for its FDA-approved indications, which are ADHD in adults and children over six years, and moderate to severe binge eating disorder in adults. Insurance health benefit plans like Cigna usually “require a formal diagnosis documented in the patient’s medical record to meet coverage criteria, and sometimes medical records have to be sent over to the plan,” Dr. Batista describes.
Step therapy
Another action Cigna and other similar insurance companies often require is step therapy, which is when the insurance company requires the patient to try several similar prescription medications before approving coverage for a particular medication. “Your prescribing physician needs to document that you’ve tried at least two other ADHD medications without success, or that you have specific medical reasons why Vyvanse is necessary over alternatives,” says Erika Frieze, PsyD, clinical psychologist at Bridges of the Mind. When it comes to Vyvanse, this usually means trying generic Adderall XR(amphetamine-dextroamphetamine) or Ritalin (methylphenidate HCl) first, according to Dr. Frieze. Some Cigna plans may require you to try ADHD medications like Concerta (methylphenidate) or Strattera (atomoxetine).
Quality limits
Another hurdle you may encounter when you try to get Cigna to cover Vyvanse is the limit on how many tablets you can have at once. According to Dr. Batista, Cigna may restrict the prescription to 30 pills per 30-day supply per fill.
Copays and deductibles
Finally, you may have to pay a copayment or meet a deductible before your Vyvanse prescription is covered. “Copays depend on the specific plan’s formulary tier; the generic version of lisdexamfetamine is usually placed on a lower tier than the brand-name Vyvanse, resulting in a lower copay and easier access,” Dr. Batista says.
How much does Vyvanse cost?
Without insurance, Vyvanse can be expensive. Currently, it costs about $557 for 30, 30 mg capsules of Vyvanse if you pay out-of-pocket. This can add up quickly, with Vyvanse costing as much as $6,684 for a full year’s supply.
Even if your insurance covers Vyvanse, you may owe a copayment. This amount will vary from one Cigna health benefit plan to another. “Most of my clients end up paying $30-60 copays for brand-name tier medications [like Vyvanse], but I’ve seen some plans require 20% coinsurance, which can mean $200+ monthly costs,” Dr. Frieze shares.
How much does Vyvanse cost with Cigna?
Again, without insurance, Vyvanse can cost up to $557 for a 30-day supply. Each Cigna plan is different, and copayments may come into play. How much you pay may depend on your formulary, which is a prescription drug list that insurance companies keep of which medications they prefer to cover.
“The most reliable way to determine coverage is to check the patient’s specific plan formulary, which is usually available online through the insurer’s member portal or by contacting Cigna’s pharmacy benefits line,” Dr. Batista says. “Cigna’s coverage of ADHD medications is generally robust, but there is a clear preference for generic medications, including generic lisdexamfetamine and other stimulant and non-stimulant options.”
How to check whether your Cigna plan covers Vyvanse
You may prefer to check the web or ask your friends whether their health insurance company covers Vyvanse. But insurance drug coverage can be complicated. Insurance policies can differ for each individual, even within the same insurance company. That’s why your best bet is to contact Cigna directly to discuss pharmacy benefits or carefully consult your plan documents.
“Here’s what I tell my patients,” Dr. Frieze says. “Call Cigna‘s member services and ask specifically about your plan’s ‘formulary tier’ for Vyvanse.” When you call, make sure you have your health insurance information handy, most of which is included on your health insurance card. You may also want to have your healthcare provider’s info, a copy of your prescription, and any official notation of your diagnosis.
How to save on Vyvanse
You can use a SingleCare coupon to reduce the cost of Vyvanse. These coupons are completely free and can be used more than once—each time you fill or refill your Vyvanse prescription. SingleCare coupons can be used by any U.S. resident at a participating pharmacy. SingleCare coupons don’t expire.
How do SingleCare coupons work? Simply search the SingleCare database for Vyvanse. Check the SingleCare savings card. If it beats the price your insurance expects you to pay, take it to the pharmacy when you fill or refill your next Vyvanse prescription. Make sure you bring both your Vyvanse prescription and the SingleCare saving card.
SingleCare coupons aren’t the only way to save. Other options can be found here: 5 ways to save money on Vyvanse.
- Label: Vyvanse-lisdexamfetamine dimesylate capsule, Vyvanse-lisdexamfetamine dimesylate tablet, chewable, DailyMed (2023)
- FDA approves multiple generics of ADHD and BED treatment, U.S. Food and Drug Administration (2023)