Looking for guidance: Cost of ADHD medication
Hi All, I've just been prescribed the generic version of Vyvanse and had a bit of sticker shock when I was rung up at my local pharmacy. Even with insurance it was nearly $300 for a months worth pills. I realize this is a problem likely unique to the United States, but I'm wondering how other folks are navigating the costs. While I can afford the medication, the idea of taking on a car sized monthly payment for the pills is really unpalatable. Do folks have any tricks or tips for getting the medication at a lower rate, switching to different medications (i.e. adderall or ritalin), or finding a secondary to cover prescriptions? I've read about Goodrx or SingleCare may be more affordable. Does anyone have experience with those providers?
As a side note, I oversee selection of our company health plan/insurance. While I'd rather not change for the sake of co-workers who have established their primary care physicians with our current offering, I have the ability to change it for 2026. If there folks have providers who cover more of the costs I'm open to hearing it.
Beyond the costs, does anyone have any advice or guidance for things to watch out for as I start taking the medication? Tomorrow is my first day and I'm a combination of excited and anxious.
Thanks!
I had insurance at one point that barely put a dent in reducing the high costs of extended release Ritalin, so the pharmacist used GoodRx instead of my insurance for it. I don't recall the exact numbers (this was several years ago), but it was the only way I could reasonably afford it at the time. If nothing else, it's definitely worth having the pharmacist check how much it would be with GoodRx (or SingleCard) vs insurance.
The only issue there is that your payments won't count towards your deductible. If anyone is concerned, they should look into how much of their medication cost counts towards deductible and whether it's something you're willing to do or not. I know there's no right answer since you're essentially taking the gamble of expecting serious medical payments that year or not, and whether the extra savings you might get from another service is worth the additional risk.
Awesome, thanks for the feedback! I'll definitely have them check
IR methylphenidate (Ritalin) is dirt cheap, and that was one of my primary drivers for picking it. It's been a huge benefit for me, and it's all of $25 for a month's supply, without insurance chipping in at all. Yes, I do need to take a pill a few times a day, but that's hardly a bother.
Wow, that is a marked difference, I'll keep it in mind. Is there a noticeable difference is experience between the two other than needing multiple pills?
It works better for some people, worse for others. I'm not sure we really understand why, because at the end of the day they're all pretty similar stimulants.
Adderall used to be the only thing that worked for me. Vyvanse didn't work at all and just made me feel off. Then I went many years with no ADHD meds. Got back on Adderall and it was making me crash. Now, Vyvanse works wonders with no issues. Why? Who can say.
My advice is to try and find the ADHD med that works for you and figure out a way to get it cheaper. Use services like goodrx, see if the manufacturer has any coupons or even call them directly, talk to your insurance company and be a (polite) pain in the ass.
If none of these pan out for you, then start looking at alternative meds. I think the hassle is worth it because when you find a good dose of a good ADHD medication, it can be life changing.
Other generic advice: start on a very low dose and give it time. The crashes (if you experience them) do subside as you kind of stabilize on the meds. Your appetite will stabilize in time. Sleep disturbances will subside. Avoid caffeine - I stick to one single cup of coffee in the morning and almost never have more during the day. I used to chug it all day - don't do that on the meds. You don't need to.
Be aware that the meds will provide a stark and noticable "high" for the first several weeks. This will not and cannot last. Don't keep chasing higher doses. ADHD meds, when they're working properly, don't feel super different in your moment-to-moment life. You just kind of notice in retrospect that you're more focused, you're doing more stuff than you were before, and you're generally doing better. Watch out for cravings and the desire to double dose. If you do it, you Rob Peter to pay Paul. You will adjust to any dose.
I was lucky. My main addiction back in the day was painkillers but I abused my ADHD meds (and any other drug I could get) as a side effect of this. After getting several years clean from opiates, I was able to get back on ADHD meds without any problems. But just be aware. People who start these meds as adults have the freedom to dispense them to themselves freely, as opposed to children who do not. I think this is a good PSA, but I don't want to scare-monger either. They're life-changing and amazing when all goes well.
While I agree with the advice you gave in the rest of this paragraph, this first sentence definitely needs a "might" instead of a "will." I've been on several of the major players (currently on Vyvanse) and I have not experienced this with any of them.
I definitely agree with your advice though -- take the dose you're prescribed orally and your risk of addiction to ADHD meds is almost non-existent, but when you start taking extra on a whim (or taking it any way but by mouth), that story changes fast.
So weighing in after my first hour, I definitely felt it kick in. It's not exactly what I was expecting or hoping for, it feels definitively like a stimulant. I'm hoping the initial buzz fades as it's a bit distracting.
It's probably a little bit different for everyone, but I expect that at minimum that feeling will go away as your tolerance increases.
Something to consider is that the pH of the fillers may vary, and absorption can vary based on stomach pH. I have had one generic where taking an antacid made no difference, then I had a 2nd where taking an antacid before it has made it about as effective for me as the other generic was. It is also worth trying removing the contents from the pill casing and taking with/without food (do not crush).
It doesn't always help, some people literally do not respond to stimulants. But it is worth a shot, and also keeping a "cheat sheet" of your findings for what works for each generic you get.
Vyvanse specifically is also definitely different insofar as it's a prodrug rather than the stimulant itself, which changes a lot of factors -- for instance, I know some of the other extended release pills you can't split at all because it can interfere with the mechanism, whereas splitting the powder inside my Vyvanse capsule was something my psychiatrist instructed me to do under some circumstances.
Like @wolf_359 says, it varies from person to person, and we don't always know why. For me, if I wasn't told that the slow-release and instant-release were, in fact, the exact same chemical, I would have thought them completely different. The slow release felt grindy, sandy, uncomfortable in my brain. IR more sharp and effervescent, but nice and clean.
One of my friends, same age, same sex (male) feels almost exactly the opposite- slow release for him is smooth sailing, while the IR is punchy and nauseating.
Wish I could give a clearer answer, but at least you know going in that you have to listen to your own body, first and foremost.
I will say, don't be afraid to break up your IR pills in to even smaller doses. I take 40mg/day (a relatively high dose), but literally 10mg in the morning, then 5mg every hour or so. This doesn't bother me at all, some might find it dreadfully fiddly, it's all up to you. But that is the nice thing about IR- you don't have to worry about breaking them up, as you aren't damaging any special coatings or the like, so you're a lot freer to find a dose schedule that works for you.
I open my Vyvanse and put it into a water bottle. I usually drink half in the morning, then have one or two more sips later in the day. Sometimes they're big sips because I'm feeling unfocused or just generally have a busy/long day. Many other days, I take little sips and have leftover for the next day.
Works for me! And has saved me before when the pharmacy doesn't have any in stock and I need to dig into my extra for a couple days. Learned early on not to take any more Vyvanse after 3pm though. Even when I have a long night ahead of me. Even a small amount that late will make me have vivid, repetitive dreams that prevent me from feeling rested in the morning.
Yeah my doctor has pretty much instructed me to do this with my Vyvanse on some days!
Yes. To the point methylphenidate didn't work for me while Vyvanse/Elvanse/Tentin does.
Adderall is also much cheaper in my experience. I pay about 30 bucks a month, except when my plan rolls over. So it's worth checking if it will always be that expensive or if you're hitting your OOP for the year due to it being Jan/Feb.
Also worth checking the formulary for whether for weird reasons a different dosage or even the name brand is cheaper.
You can look up the Good Rx coupons online for comparison, they may not help a lot, depending on the med, but I don't know about Vyvanse specifically.
Yeah, it turns out my OOP is very, very high. Which is nuts considering everyone at the company has their Platinum plan as a base. More reasons to thank Luigi I suppose.
To elaborate on what DefinitelyNotAFae said, there are a few different terms here.
note, I'm not a professional in this area and I'm just talking from memory, so please verify independently, I'm a lot healthier now than I was in the past which is great but also means I've paid a bit less attention to my insurance plan numbers
edit, removed my speculation on numbers cos i did a brief search and this seems to vary enormously. Also HMOs are different from PPOs, and generally are slightly worse plans although they may make more sense for healthy people with very good primary care doctors.
In case it’s a helpful resource to folks, Brian David Gilbert wrote a good, comedic overview of a lot of this terminology.
Also to add, it's not unusual to have to pay your deductible on your first prescription of the year. (I don't have one for visits just medication). This is annoying and common, especially in July for me because it's a weird timing when most are January ish.
So it's definitely worth checking OP as it might just be a much smaller copay for the rest of the year. You should get an explanation of benefits monthly from your insurer that would tell you what you paid, what they paid and would specify if the deductible was part of that.
For what it’s worth, this depends on the plan. For the plans I have had in the past, copay and coinsurance are different.
Copay: This is the price you pay, period. It has nothing to do with a deductible. The only exception is if you hit your out of pocket max, in which case it is free.
Coinsurance: These are the things that have a deductible. If you have a $500 deductible and 40/60 coinsurance, and get a $600 procedure, you pay $500 + $40
I really appreciate the write up!
I'm pretty well versed on OOP vs deductible vs copay. My insurance switched with ACA was implemented back in 2013/14 and I ended up paying $6500 for an MRI I scheduled in December when I had a PPO and received in Jan when I had switched to an HMO without being notified that didn't cover it. Learning it didn't apply towards my OOP or deductible was just additional salt in the wound. All great points though!!
We have a PPO - specifically because of the incident above - and my deductible is $1000 and OOP limit is $9,150. I can't even find info on my deductible for prescriptions.
It's crazy that we all need to get secondary eduction in insurance payments for us to navigate this system!
Is that your initial yearly deductible or your total OOP? I don't usually hit my OOP, but I still have a hundred bucks or so at the beginning of the insurance year (mine runs on fiscal years) that I have to pay
My wife is in the same situation with her insurance, and GoodRx should get the cost down to ~$100/month. The downside is that the cost doesn't apply towards your insurance deductible/out of pocket max.
Other medications are definitely going to be cheaper, but the extended release—and more importantly the smooth release duration—is pretty much unmatched by any other medications because of its unique release mechanism (i.e., Vyvanse being a pro-drug vs other extended releases just having physical coatings to delay release). With other IR/XR medications, there are far more noticable peaks and crashes, while Vyvanse is a really smooth ramp-up and ramp-down.
As for tips:
Keep in mind that medications aren't a cure for ADHD; they are just another tool and you need to apply it correctly and use it to build good habits and systems in order to really thrive.
The medication will likely suppress your appetite, so don't forget to keep your blood sugar up. Protein is your friend. Don't forget to stay hydrated, either.
Avoid or limit caffeine until you know how your Vyvanse will interact with it.
Good luck!
FWIW the peaks and crashes don't feel nearly as noticeable after being on it for quite some time. Early days I felt the Adderall XR "releasing" every hour-ish... but now I don't really notice after it kicks in because i'm actually focused on other things (and not eating lunch or drinking water, another thing to keep in mind)
What does the release feel like?
When I first take the med after a long break i could feel the physical "up" feeling - more anxious, heart rate up, feeling a bit manic - come and go throughout the day.
The food you eat and hydrating and other things impact it, so I definitely wouldn't claim its an hourly period intentionally. But once I'm used to the med again it's a weird day when j can "feel" the physical anxiety symptoms and I never feel that "meds have kicked back in" feeling anymore
Ah, I ended up getting that. It's pretty jarring. I am definitely excited for the feeling to subside with time.
If it doesn't, definitely discuss with the doc. I get side effects but very rarely that keyed up feeling
It's curious that you would experience that, since Adderall XR—and almost all of the other XR medications—only contain two stages: instant release beads and coated beads, with the coating taking ~4 hours to break down before they release the contents. (There are some newer medications that have 3 stages, and I believe there's also Dyanavel XR that has an assortment of coatings to provide a much smoother release gradient similar to Vyvanse but without the pro-drug component.)
The more pronounced peaks and crashes I experienced may be due, in part, to being a fast metabolizer and because I require an overall higher dose. I've been on stimulant meds for over 20 years (all of my adult life), and took IR at 5 different intervals throughout the day to maximize duration and minimize the peaks and valleys that I felt with XR.
Despite being somewhat tedious, it was a system that worked really well, but I ended up switching to Vyvanse after the Great Amphetamine Shortages of 2022 began. While the 70mg lisdexamfetamine isn't quite as effective as my old 5xIR regime, it's pretty dang close (though I swear the 50mg brand-name Vyvanse was about as effective as the generic 70mg is) and it's great not having to keep my meds on me all day.
Still, it's just further reason why there are so many different medication options out there: there really isn't a one-size-fits-all solution.
Personally I suspect it had to do with not eating before taking it which can speed absorption and the adjustment period to getting used to the meds as I stepped up on them initially. Could even be all in my head. But my guess is it was something about how my body was reacting to it and I understand eating protein/fat before taking it slows down and evens out absorption rates now, but that wasn't a thing I was told by a doctor.
I don't experience that anymore, even if I'm off them for a week, so I can't really recreate it
Thanks for the tips! I'll have snacks at the ready!
I'm not planning for it to be a catch all, I have some pretty good coping mechanisms as is. Honestly, I'd really like to experience what a "normal" brain feels like, if you know what I mean. I know I probably won't experience that, but I'm really interested to see what it does feel like. Nice to know Vyvanse doesn't have the peaks and crashes.
I've used GoodRx before. It's easy to use and when it provides discounts they're enormous.
Lisdexamfetamine (generic Vyvanse) I is a medication I take. It is excellent; far smoother and longer lasting than amphetamine salts (Adderall). 1 Vyvanse/Lisdexamfetamine can mostly get me through the day. With Adderall, I have to take another dose after 5.5 hours.
$300 is insane. You almost certainly can do better.
CVS for $81
I've found that Vyvanse plus coffee make me irritable as hell. Adderall doesn't interact with coffee that way for me.
If you've not taken this class of medication before, pay attention to how your body feels through the day as well as your thoughts. When I had too high of a dose, my chest felt tight, my thoughts raced, and I was irritable.
The right dose makes it much easier for me to take action, makes the world more interesting, and takes me out of my otherwise chronically irritable mood. I just feel... more ease.
The first time I took Adderall, I had the best nap I'd had in years. That was a good thing. The stimulants should make you more at ease and comfortable and not overstimulated, fidgety, and edgy.
Sign me up. It's so interesting hearing everyone talk about it. Very excited, and nervous, to start tomorrow!
Weirdly I purchased the Vyvanse at CVS.
Be aware that the first couple of weeks may feel especially wonderful. The honeymoon phase passes. The meds are still incredibly helpful but they stop feeling magical.
FWIW, ADHD meds work for about 80% of the ADHD populace. 1 in 5 don't have luck with the medication.
I'm feeling like I'm on a stimulant, but I wouldn't call it wonderful. Maybe jarring?
Sounds like you may have too high a dose. I suggest talking to your doctor about it.
Will do! Sorry for the flippant comment, it's been a bit of a strange morning. My doctor had us setup a checkin plan for 10 days out and started me on 10mg. Honestly I think I'm just feeling like my ADHD tendencies have been turbo charged. I just forgot about rice I had on the stove and burnt it. I've been sending emails in parts - like following up with additional information I forgot to put in the first one. Spacing out with the farmer's market vendors. It's been weird, like being on the tail end of party drugs but in my day to day life.
Give it a few days to settle in (and don't skip it on the weekend) so your body can adjust. It's hard because it can help you focus, but the physical stimulant bit (if applicable) can also be distracting and trigger/stoke anxiety which worsens focus, etc.
But if its not helping, definitely tell the doctor
What is your deductible for prescription drugs? Given you're spending this much on 1 prescription my guess is that it's relatively high, but if you will hit your deductible and then it changes to a copay system, you may need to consider this $300 amortized over the entire year. It's possible that using GoodRx and not using your insurance will actually cost you money in the long run, and you need to check your plan details before making that decision.
(For example, I've had years where I was guaranteed to hit my out-of-pocket max because I had surgery planned, so there would be 0 point to try and save money on anything insurance covered, since I was going to pay precisely the out-of-pocket max that year on medical care (as covered by insurance) and no more. This kind of situation is unlikely but you should be aware of it.)
If you have a good pharmacist, they might be able to help answer some of these questions for you, because they have your insurance information. Otherwise my recommendation is to read the plan benefits as best as you can or maybe contact your insurance company. If you're going to be taking this medication regularly, you'll need to do a bit more homework this November when picking an insurance plan (either through your employer or through Open Enrollment (if Open Enrollment still exists....)
Anyway agreed with everyone else that GoodRX or a similar program is LIKELY going to be the right solution depending on your particular situation. keep in mind that with GRX they give different dollar amounts at different pharmacies, but if the ones in easy travel distance are all significantly more expensive, see if you can get another pharmacy to mail or deliver your meds (although if you're doing that check if they are actually insured against lost mail, it might be scary to get it mailed).
Also check the drug company's website, sometimes they have rebates available for free online that you can apply, this saved me a LOT of money for one drug I was on for several years (can't remember which anymore) and iirc the drug company rebate WAS compatible with my insurance. The entire thing is disgusting price discrimination against people who don't know to check or don't have the resources to check (time/internet/language/etc).
Finally, complain to your federal representatives about this. Get local friends/family to complain to your federal representatives about "my friend who also lives in this district can't afford his meds what are you going to do about it." Tell your federal reps how important the marketplace insurance is. Tell your state reps that you want to know what they're doing at the state level to protect you if the marketplace is shut down during this presidency.
All fantastic advice! I'll definitely be doing the following tomorrow:
Generic Adderall XR / amphetamine, dextroamphetamine is so much cheaper than Vyvanse. You might want to speak with your insurance company - often they'll cover Vyvanse if you try generic Adderall XR first and it doesn't work or some similar protocol. My asthma coverage is similar - they prefer you start with generic symbicort and then go from there because the drug cost is so much lower.
It's a pain to chase down especially for us ADHD sufferers, but acting as the middle man between the doctor and the insurance company can really help keep the drug costs down.
Yeah, that is quite the hurdle, self motivate to get the thing you need to self motivate. Well, it's take 2 years of navigating and getting up the momentum so I'm excited to try it.
In New Zealand, Vyvanse was not a funded by Pharmac* medicine until November last year. It used to cost NZ$100/month (~US$55), but now it's only $5/prescription.
Methylphenidate has been funded for a long time.
*Pharmqc is the monopsony drug buyer/government subsidy scheme.
If you have a Costco membership, try using the pharmacy. With the discount, I suspect their prescription drugs are at or just above cost.
I would say just talk to your pharmacist and psychiatrist. They will be able to figure out some good options for you.
Other people have recommended other stimulants to try. If you want to try out non stimulant medication, ask about straterra (atomoxetine). It takes a few months of daily usage for it to become effective, but it has some benefits over stimulant medication. Biggest benefit is it isn’t a schedule substance, so the only control is needing a prescription. Also, it took a long time to figure out its usefulness for ADHD, so it has always had a generic available and is super cheap. 1 year of 40 mg daily cost me $300 at Costco without any insurance whatsoever. If you get a more reasonable quantity like 3 months, it will probably cost whatever the minimum prescription cost is for your insurance.