{"id":633046,"date":"2025-08-05T17:32:36","date_gmt":"2025-08-05T21:32:36","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=633046"},"modified":"2025-08-05T17:33:35","modified_gmt":"2025-08-05T21:33:35","slug":"does-kaiser-cover-vyvanse","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-kaiser-cover-vyvanse\/","title":{"rendered":"Does Kaiser cover Vyvanse?"},"content":{"rendered":"

Vyvanse<\/span><\/a> (lisdexamfetamine dimesylate) is a brand-name prescription medication approved by the Food and Drug Administration (FDA) as a <\/span>treatment for attention deficit hyperactivity disorder (ADHD)<\/span><\/a> in adults and children over 6 years old. It was first approved in 2007 and is part of a class of medications called <\/span>central nervous system stimulants<\/span><\/a>. It\u2019s also approved to treat adults with moderate to severe binge-eating disorder. Insurance may cover Vyvanse, but there may be specific criteria to meet before it\u2019s covered. Learn about what those are and how to check your coverage below.\u00a0<\/span><\/p>\n

Does Kaiser cover Vyvanse?<\/span><\/h2>\n

Insurance plans from Kaiser Permanente do cover Vyvanse, but not all of them may cover the brand-name. For example, Individual and Family insurance plans from Kaiser Permanente in southern Washington cover brand-name Vyvanse as a preferred brand-name drug, but Kaiser\u2019s Medicare Part D plans in the state only cover the generic lisdexamfetamine dimesylate.\u00a0<\/span><\/p>\n

Kaiser Permanente offers Medicaid plans in California, Colorado, the District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington. Medicaid coverage of Vyvanse varies by state, and some states might cover only some forms of Vyvanse but not others. For example, <\/span>Colorado\u2019s Medicaid preferred drug list<\/span><\/a> as of July 1, 2025, lists <\/span>Vyvanse capsules<\/span><\/a> as a preferred drug, but Vyvanse chewable tablets and generic lisdexamfetamine dimesylate chewable tablets are not preferred.\u00a0<\/span><\/p>\n

It\u2019s important to know that even if your Kaiser Permanente plan covers Vyvanse, many plans often require <\/span>prior authorization<\/span><\/a> for coverage. That means healthcare providers need to work with Kaiser to prove medical necessity before your prescription is covered. \u201cAs the prescriber, I have to submit documentation that shows why those other options didn\u2019t work or weren\u2019t tolerated. It can be a frustrating process for both the prescriber and the client, but unfortunately, it\u2019s become a standard part of getting certain medications covered,\u201d shares <\/span>Logan Kodysz<\/span><\/a>, NP, a board-certified psychiatric nurse practitioner and the co-founder of Desert Clover Psychiatry in Phoenix, Arizona.<\/span><\/p>\n

Does Kaiser cover generic Vyvanse?<\/span><\/h2>\n

If your Kaiser plan doesn\u2019t cover brand-name Vyvanse, it may cover its generic version, which has the same active ingredient, says <\/span>Charles Sweet<\/span><\/a>, MD, psychiatrist and medical adviser at Linear Health. \u201cVyvanse and its generic versions contain the same active ingredient, lisdexamfetamine. The FDA has strict guidelines on the ingredients of <\/span>generic drugs<\/span><\/a>\u2014so strict, in fact, that there is little variance between them and their name-brand counterparts,\u201d he says.\u00a0<\/span><\/p>\n

Many Kaiser Permanente plans cover generic Vyvanse, and some plans cover both the generic and brand-name versions. However, not all plans will cover all forms of generic Vyvanse. As mentioned above, some plans, like Kaiser\u2019s Colorado Medicaid plans, may cover generic Vyvanse capsules, but not its chewable form.\u00a0<\/span><\/p>\n

It\u2019s best to check with your health insurance plan\u2019s <\/span>drug formulary<\/span><\/a> for more information about Vyvanse coverage. A drug formulary is the list of drugs a plan covers.\u00a0<\/span><\/p>\n

How much does Vyvanse cost without insurance?<\/span><\/h2>\n

The average cost of Vyvanse without using insurance is $552 for 30, 30 mg capsules. This could mean that a year\u2019s supply could cost $6,624 without insurance.\u00a0<\/span><\/p>\n

In contrast, generic Vyvanse costs $443 for 30, 30 mg capsules on average without insurance. A year\u2019s supply of generic Vyvanse could be $5,316, about 20% less than the cost of brand-name Vyvanse. If a free <\/span>SingleCare discount card<\/span><\/a> is used at one of the patient\u2019s local pharmacies, the <\/span>price of 30, 30 mg capsules of generic Vyvanse<\/span><\/a> may only be $65.<\/span><\/p>\n

How much does Vyvanse cost with Kaiser?<\/span><\/h2>\n

The cost of Vyvanse can vary depending on your plan\u2019s coverage and formulary. Drugs listed on a formulary are given a coverage tier that determines how much someone can expect to pay for the drug. For example, one of Kaiser Permanente\u2019s Medicare plans offered in Washington covers generic Vyvanse as a Tier 4 drug, which means members can <\/span>expect to pay $90 out-of-pocket per 30-day supply<\/span><\/a> in 2025.\u00a0<\/span><\/p>\n

Some Kaiser plans in the District of Columbia, Maryland, and Virginia cover brand-name Vyvanse as a <\/span>Tier 3 drug<\/span><\/a>. Depending on the type of plan, this could cost <\/span>$80 per prescription<\/span><\/a> or <\/span>50% of the pharmacy\u2019s price<\/span><\/a>.\u00a0\u00a0<\/span><\/p>\n

In the plans we researched, generic and brand-name Vyvanse are typically covered as \u201cnon-preferred\u201d drugs. Non-preferred drugs typically have higher out-of-pocket costs than \u201cpreferred\u201d drugs.\u00a0<\/span><\/p>\n

How to check whether your Kaiser plan covers Vyvanse\u00a0<\/span><\/h2>\n

To check whether your Kaiser plan covers Vyvanse, you can call the Kaiser Member Services line on the back of your insurance card. You can also check online by logging into your account on the Kaiser Permanente website and navigating to the Benefits section.\u00a0<\/span><\/p>\n

On Kaiser\u2019s website, you can find your plan\u2019s drug formulary by visiting the Kaiser site for your region:<\/span><\/p>\n