Does Blue Cross Blue Shield of Massachusetts Cover Vyvanse

Discover if Blue Cross Blue Shield of Massachusetts covers Vyvanse and learn steps to secure coverage while exploring Vyvanse costs without insurance.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Does Blue Cross Blue Shield of Massachusetts Cover Vyvanse?

 

  • **Coverage Conditions**: Blue Cross Blue Shield of Massachusetts typically covers Vyvanse for FDA-approved indications such as ADHD and binge eating disorder, subject to plan specifics and medical necessity.
  •  

  • **Prior Authorization**: Many plans require prior authorization where a physician must provide documentation supporting the need for Vyvanse based on clinical criteria.
  •  

  • **Prescription Limitations**: Coverage may include restrictions on dosage quantities and limits on the duration of prescriptions to ensure safe usage.
  •  

  • **Step Therapy**: Some plans might require trying alternative medications before approving Vyvanse, following a step therapy protocol.
  •  

  • **Copayments/Deductibles**: The cost-sharing structure including copayments or deductibles will vary based on the individual plan and pharmacy benefits.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Vyvanse Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Blue Cross Blue Shield of Massachusetts

 

  • Start by contacting Blue Cross Blue Shield (BCBS) of Massachusetts customer service. You can find the contact information on your insurance card or the official BCBS Massachusetts website.
  •  

  • Ask specifically about your plan's coverage details for Vyvanse, including any required prior authorizations, step therapy, or quantity limits.

 

Review Your Prescription Benefits

 

  • Log into your BCBS Massachusetts member portal to access detailed information about your pharmaceutical benefits.
  •  

  • Search for Vyvanse in your plan’s drug formulary to determine its coverage tier and any prerequisites for coverage.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Vyvanse.
  •  

  • Your doctor will need to provide a prescription and possibly a letter of medical necessity depending on the plan's requirements.

 

Submit Prior Authorization If Required

 

  • If your plan requires prior authorization, work with your doctor to submit the necessary documentation to BCBS Massachusetts.
  •  

  • Ensure that your doctor includes all relevant medical history and reasons why Vyvanse is necessary for your treatment.

 

Follow Up with Blue Cross Blue Shield

 

  • Once the prior authorization request is submitted, follow up with BCBS Massachusetts to confirm that they have received and processed your request.
  •  

  • Inquire about the timeline for approval to ensure there are no delays with your medication needs.

 

Check for Cost-Saving Programs

 

  • Inquire about any available cost-saving programs, such as savings cards from the manufacturer, that may help reduce your out-of-pocket expenses for Vyvanse.
  •  

  • Some insurance plans offer discounts or co-pay assistance for specific drugs, so it's worth checking with BCBS Massachusetts.

 

Understand Appeal Options

 

  • If your request for Vyvanse coverage is denied, review the reason for denial provided by BCBS Massachusetts.
  •  

  • Work with your healthcare provider to appeal the decision if you believe coverage should be approved based on your medical needs.

 

Stay Informed and Be Proactive

 

  • Stay updated on any changes to your BCBS Massachusetts plan's benefits and drug formulary that may affect your coverage for Vyvanse.
  •  

  • Maintaining proactive communication with BCBS, your pharmacy, and your healthcare provider will ensure any issues are tackled promptly.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Vyvanse

Discover if Blue Cross Blue Shield of Massachusetts covers Vyvanse and learn steps to secure coverage while exploring Vyvanse costs without insurance.
Curex allergy drops unboxing

Is Vyvanse Covered by Blue Cross Blue Shield of Massachusetts

 

Does Blue Cross Blue Shield of Massachusetts Cover Vyvanse?

 

  • **Coverage Conditions**: Blue Cross Blue Shield of Massachusetts typically covers Vyvanse for FDA-approved indications such as ADHD and binge eating disorder, subject to plan specifics and medical necessity.
  •  

  • **Prior Authorization**: Many plans require prior authorization where a physician must provide documentation supporting the need for Vyvanse based on clinical criteria.
  •  

  • **Prescription Limitations**: Coverage may include restrictions on dosage quantities and limits on the duration of prescriptions to ensure safe usage.
  •  

  • **Step Therapy**: Some plans might require trying alternative medications before approving Vyvanse, following a step therapy protocol.
  •  

  • **Copayments/Deductibles**: The cost-sharing structure including copayments or deductibles will vary based on the individual plan and pharmacy benefits.

A weight management program tailored to you

Start with Curex

Blue Cross Blue Shield of Massachusetts's Approved Criteria for Vyvanse Coverage

 

Criteria for Initial Coverage of Vyvanse

 

  • Diagnosis: The patient must have a documented diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Binge Eating Disorder.
  •  

  • Age Requirement: Coverage is available for patients who are six years of age and older for ADHD treatment. For Binge Eating Disorder, the patient must be 18 years or older.
  •  

  • Other Treatments: The patient must have tried and not responded adequately to at least one other formulary stimulant medication, unless contraindicated or not tolerated.
  •  

  • Medical Necessity: Documentation supporting the medical necessity of Vyvanse over other therapeutic alternatives is required.

 

Continued Coverage Criteria

 

  • Demonstrated Effectiveness: The patient must show documented improvement in ADHD symptoms or reduction in binge eating behaviors with Vyvanse treatment.
  •  

  • Regular Review: Continued coverage requires regular assessment of therapeutic benefit and the necessity of ongoing treatment.
  •  

  • Treatment Compliance: The patient has adhered to the prescribed Vyvanse regimen and has participated in follow-up evaluations as required.

 

Dosage and Quantity Limits

 

  • Approved Dosage: The prescribed dosage must align with the FDA-approved dosing guidelines for Vyvanse, considering patient age and diagnosed condition.
  •  

  • Quantity Limits: Coverage may have specific monthly quantity limits to ensure safe use, subject to prior authorization for higher quantities.
  •  

  • Adjustment Criteria: Any requests for dosage adjustments require documentation of medical need and expected therapeutic benefit.

 

Special Considerations

 

  • Pediatric Use: For pediatric patients, documentation should include growth charts and any relevant psychological or behavioral assessments.
  •  

  • Specialty Provider: Evaluation and prescription preferably by a psychiatrist, neurologist, or specialist in ADHD/Binge Eating Disorder are recommended for initial coverage approvals.
  •  

  • Coordination of Care: Coordination with healthcare providers, including therapists and primary care physicians, is encouraged to monitor treatment efficacy and safety.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Vyvanse Coverage

 

Criteria for Denial of Vyvanse Coverage

 

  • **Non-FDA Approved Use:** Vyvanse prescribed for conditions not approved by the FDA may not be covered. Certain off-label uses can lead to a denial.
  •  

  • **Lack of Medical Necessity:** If the prescribing doctor fails to demonstrate the medical necessity of Vyvanse for the patient, coverage may be denied.
  •  

  • **Failure to Adhere to Policy Guidelines:** Non-compliance with any outlined policy requirements or guidelines specific to ADHD medication coverage can result in denial.
  •  

  • **Quantity Limits Exceeded:** Requests for quantities that exceed authorization limits set by the insurer may not be covered.
  •  

  • **Prior Authorization Not Obtained:** Vyvanse typically requires prior authorization. Failure to obtain this authorization can result in coverage denial.
  •  

  • **Non-Participating Providers:** Prescriptions filled at pharmacies or by providers not within the insurance network may not be covered.
  •  

  • **Inappropriate Age Group:** Prescriptions for age groups not specified in the policy guidelines might be denied.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Vyvanse Cost without Insurance?

 

Understanding the Cost of Vyvanse Without Insurance

 

  • Purchase prices for Vyvanse can vary depending on factors such as the dosage and the location of purchase. Typically, a 30-day supply of Vyvanse can price approximately between $350 and $500.
  •  

  • Costs might differ by pharmacy, with some options offering discounts or savings programs for those paying out-of-pocket.
  •  

  • It’s advisable to explore pharmacy discount cards or manufacturer copay assistance programs, as they can sometimes reduce the retail price.
  •  

  • Online pharmacy services may also present more competitive pricing, but always ensure they are reputable and that prescriptions are valid and properly filled.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Vyvanse Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Blue Cross Blue Shield of Massachusetts

 

  • Start by contacting Blue Cross Blue Shield (BCBS) of Massachusetts customer service. You can find the contact information on your insurance card or the official BCBS Massachusetts website.
  •  

  • Ask specifically about your plan's coverage details for Vyvanse, including any required prior authorizations, step therapy, or quantity limits.

 

Review Your Prescription Benefits

 

  • Log into your BCBS Massachusetts member portal to access detailed information about your pharmaceutical benefits.
  •  

  • Search for Vyvanse in your plan’s drug formulary to determine its coverage tier and any prerequisites for coverage.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Vyvanse.
  •  

  • Your doctor will need to provide a prescription and possibly a letter of medical necessity depending on the plan's requirements.

 

Submit Prior Authorization If Required

 

  • If your plan requires prior authorization, work with your doctor to submit the necessary documentation to BCBS Massachusetts.
  •  

  • Ensure that your doctor includes all relevant medical history and reasons why Vyvanse is necessary for your treatment.

 

Follow Up with Blue Cross Blue Shield

 

  • Once the prior authorization request is submitted, follow up with BCBS Massachusetts to confirm that they have received and processed your request.
  •  

  • Inquire about the timeline for approval to ensure there are no delays with your medication needs.

 

Check for Cost-Saving Programs

 

  • Inquire about any available cost-saving programs, such as savings cards from the manufacturer, that may help reduce your out-of-pocket expenses for Vyvanse.
  •  

  • Some insurance plans offer discounts or co-pay assistance for specific drugs, so it's worth checking with BCBS Massachusetts.

 

Understand Appeal Options

 

  • If your request for Vyvanse coverage is denied, review the reason for denial provided by BCBS Massachusetts.
  •  

  • Work with your healthcare provider to appeal the decision if you believe coverage should be approved based on your medical needs.

 

Stay Informed and Be Proactive

 

  • Stay updated on any changes to your BCBS Massachusetts plan's benefits and drug formulary that may affect your coverage for Vyvanse.
  •  

  • Maintaining proactive communication with BCBS, your pharmacy, and your healthcare provider will ensure any issues are tackled promptly.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Vyvanse FAQ

What are the side effects of Vyvanse?

 

Common Side Effects

 

  • Loss of appetite
  • Insomnia
  • Dry mouth
  • Anxiety
  • Weight loss
  • Increased heart rate

 

Less Common Side Effects

 

  • Dizziness
  • Diarrhea
  • Rash
  • Blurred vision
  • Irritability

 

Serious Side Effects

 

  • Chest pain
  • Shortness of breath
  • Hallucinations
  • Severe anxiety or panic attacks
  • Swelling of extremities
  • Uncontrolled movements or vocal outbursts

 

Recommendations

 

  • Consult with a healthcare provider if side effects persist or worsen.
  • Monitor heart rate and blood pressure regularly.
  • Inform your doctor of any other medications being taken.

 

How long does Vyvanse stay in your system?

 

How Vyvanse Functions

 

  • Vyvanse is a prodrug, meaning it's inactive until metabolized in the body, which affects its duration.

 

Duration in the System

 

  • Vyvanse typically lasts 10-12 hours for therapeutic effects due to its extended-release formulation.
  • The half-life is around 10-13 hours, meaning it takes this time for half of the drug to be eliminated.

 

Detection Window

 

  • Blood: Detectable for up to 8 hours after ingestion.
  • Urine: Can be detected for up to 3 days, depending on metabolism and dosage.
  • Hair: May remain detectable for up to a month or longer.

 

Factors Influencing Duration

 

  • Metabolic rate, age, organ function, and dosage can alter the duration.
  • Chronic use may lead to accumulation, slightly extending the detectable period.

 

Is Vyvanse the same as Adderall?

 

Difference Between Vyvanse and Adderall

 

  • Composition: Vyvanse contains lisdexamfetamine, a prodrug requiring conversion in the body, while Adderall contains mixed amphetamine salts.
  •  

  • Onset: Vyvanse typically takes longer to start acting due to its prodrug nature, whereas Adderall provides quicker results.
  •  

  • Duration: Vyvanse lasts about 10-14 hours, while Adderall's duration varies based on the formulation: instant-release lasts 4-6 hours, extended-release lasts up to 12 hours.
  •  

  • Use: Both treat ADHD, but Vyvanse is also approved for binge eating disorder.
  •  

  • Abuse Potential: Vyvanse's requirement for metabolic activation reduces its immediate abuse risk compared to Adderall.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow