Does Blue Cross Blue Shield of Minnesota Cover Vyvanse

Learn if Blue Cross Blue Shield of Minnesota covers Vyvanse. Explore reasons for denial, tips for coverage, Vyvanse costs, and common FAQs.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage Overview for Vyvanse

 

  • Blue Cross Blue Shield of Minnesota (BCBSMN) may cover Vyvanse for the treatment of ADHD and binge eating disorder. Coverage depends on the specific health plan.
  •  

  • Members must often meet criteria such as a formal diagnosis and previous failure with other medications.
  •  

    Prior Authorization and Criteria

     

    • Prior authorization is typically required. The prescribing doctor must provide documentation supporting the need for Vyvanse.
    •  

    • Patients may need to try and fail other less expensive medications before coverage is approved.

     

    Prescription Guidelines

     

    • Prescriptions must be filled at participating pharmacies within the BCBSMN network.
    •  

    • The number of pills covered may be limited to a month's supply, depending on the plan's specific rules.

     

    Out-of-Pocket Considerations

     

    • Copayments, coinsurance, or deductibles may apply, depending on the plan’s benefit structure.
    •  

    • Check the formulary tier level of Vyvanse under your plan to understand potential out-of-pocket costs.

     

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 Minnesota

 

Verify Coverage Benefits

 

  • Log into your Blue Cross Blue Shield of Minnesota member account online. You'll need your membership number and personal information.
  •  

  • Navigate to your plan benefits section to check if Vyvanse is listed under your pharmacy or prescription benefits.
  •  

  • If not clear, contact customer service using the phone number on your insurance card to confirm if Vyvanse is covered under your plan.

 

Understand Your Prescription Tier

 

  • Determine the tier or category that Vyvanse falls into within your plan. Medications are often categorized into tiers which affect copayment levels.
  •  

  • Review the copayment or co-insurance levels associated with the specific tier that includes ADHD medications like Vyvanse.

 

Consult Your Doctor

 

  • Make an appointment with your healthcare provider to discuss your need for Vyvanse as a treatment option.
  •  

  • Ensure your doctor knows your insurance provider to suggest alternatives if Vyvanse is not covered, or to provide supporting documentation if needed.

 

Pre-Authorization Process

 

  • If required, ask your doctor to initiate a pre-authorization request with Blue Cross Blue Shield of Minnesota. This step is essential for certain medications.
  •  

  • Provide any necessary documentation or information that your insurance might require to process this pre-authorization. Your doctor’s office can assist with this.

 

Understand and Use Your Pharmacy Benefits

 

  • Use a participating pharmacy network outlined by Blue Cross Blue Shield to fill your Vyvanse prescription to ensure benefits apply.
  •  

  • Confirm that the chosen pharmacy has your correct insurance information for smooth processing when filing or refilling your prescription.

 

Appeal a Denial if Necessary

 

  • If your coverage request for Vyvanse is denied, review the denial letter carefully for reasons and instructions on how to appeal the decision.
  •  

  • Gather any additional medical documentation or a letter from your healthcare provider to support the necessity of Vyvanse for your treatment in your appeal letter.
  •  

  • Submit your appeal as directed by the information provided by Blue Cross Blue Shield of Minnesota, and follow up if necessary.

 

Review and Adjust Plans Annually

 

  • At the end of your plan year, review upcoming plan options during the open enrollment period to ensure Vyvanse remains covered or if there's a need to choose a better-suited plan.

 

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 Minnesota Cover Vyvanse

Learn if Blue Cross Blue Shield of Minnesota covers Vyvanse. Explore reasons for denial, tips for coverage, Vyvanse costs, and common FAQs.
Curex allergy drops unboxing

Is Vyvanse Covered by Blue Cross Blue Shield of Minnesota

 

Coverage Overview for Vyvanse

 

  • Blue Cross Blue Shield of Minnesota (BCBSMN) may cover Vyvanse for the treatment of ADHD and binge eating disorder. Coverage depends on the specific health plan.
  •  

  • Members must often meet criteria such as a formal diagnosis and previous failure with other medications.
  •  

    Prior Authorization and Criteria

     

    • Prior authorization is typically required. The prescribing doctor must provide documentation supporting the need for Vyvanse.
    •  

    • Patients may need to try and fail other less expensive medications before coverage is approved.

     

    Prescription Guidelines

     

    • Prescriptions must be filled at participating pharmacies within the BCBSMN network.
    •  

    • The number of pills covered may be limited to a month's supply, depending on the plan's specific rules.

     

    Out-of-Pocket Considerations

     

    • Copayments, coinsurance, or deductibles may apply, depending on the plan’s benefit structure.
    •  

    • Check the formulary tier level of Vyvanse under your plan to understand potential out-of-pocket costs.

     

A weight management program tailored to you

Start with Curex

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

 

Criteria for Vyvanse Coverage

 

  • Vyvanse is covered when prescribed by a licensed healthcare provider for patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) or Binge Eating Disorder (BED).
  •  

  • Patients must be 18 years or older for the treatment of Binge Eating Disorder (BED) and 6 years or older for ADHD.
  •  

  • Documentation of a comprehensive behavioral assessment supporting the diagnosis of ADHD or BED must be provided.
  •  

  • For ADHD, there must be documented evidence that the patient experiences symptoms that significantly interfere with daily functioning across multiple settings (e.g., home, school, or work).
  •  

  • For BED, patients must display moderate to severe binge eating behaviors, defined as at least 2 binge eating episodes per week for a minimum duration of 6 months.

 

Trial and Failure of Alternative Therapies

 

  • There must be documentation of the trial and failure of at least one other stimulant or non-stimulant ADHD medication prior to Vyvanse, unless contraindicated or not tolerated.
  •  

  • For BED, documentation of trial and failure of at least one other psychopharmacologic intervention or cognitive-behavioral therapy is required before prescribing Vyvanse.

 

Monitoring and Follow-Up

 

  • Ongoing evaluation and monitoring of the patient's response to the medication must be scheduled regularly, with adjustments made as needed based on clinical judgement.
  •  

  • The prescriber should document any side effects and the effectiveness of Vyvanse in managing the patient's symptoms during follow-up visits.

 

Other Criteria

 

  • The healthcare provider must attest that Vyvanse is prescribed at the recommended dosage according to current clinical guidelines and patient needs.
  •  

  • For patients with any comorbid psychiatric conditions, Vyvanse should be prescribed in consultation with or with approval from a mental health specialist.

 

Why Blue Cross Blue Shield of Minnesota Might Deny Vyvanse Coverage

 

Reasons for Denial of Vyvanse Coverage

 

  • Vyvanse is prescribed for a condition not approved by the FDA, meaning the drug is being used for an off-label purpose not supported by clinical evidence or regulatory approval.
  •  

  • The patient does not meet specific age criteria, such as being outside of the approved age range for treatment with Vyvanse for the indicated condition.
  •  

  • Lack of documentation showing that Vyvanse is medically necessary. This could include insufficient clinical justification or failure to demonstrate that alternative therapies have been tried and were ineffective.
  •  

  • Failure to adhere to prior authorization requirements, including not submitting necessary prior authorization requests before the medication is dispensed.
  •  

  • Patient’s policy does not include coverage for prescription drugs, or specifically excludes coverage for certain medications, including Vyvanse.
  •  

  • Prescription exceeds the dosage limit set by the insurance policy, which can occur when a prescribed dose is higher than what is considered standard or safe according to formulary guidelines.
  •  

  • Non-compliance with step therapy protocols, which require trying less expensive or generic alternatives before approving coverage for Vyvanse.
  •  

  • Refill requests are made too soon based on the quantity limits set by the insurer, which controls the amount of medication that can be dispensed within a given time frame.

 

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 Minnesota

 

Verify Coverage Benefits

 

  • Log into your Blue Cross Blue Shield of Minnesota member account online. You'll need your membership number and personal information.
  •  

  • Navigate to your plan benefits section to check if Vyvanse is listed under your pharmacy or prescription benefits.
  •  

  • If not clear, contact customer service using the phone number on your insurance card to confirm if Vyvanse is covered under your plan.

 

Understand Your Prescription Tier

 

  • Determine the tier or category that Vyvanse falls into within your plan. Medications are often categorized into tiers which affect copayment levels.
  •  

  • Review the copayment or co-insurance levels associated with the specific tier that includes ADHD medications like Vyvanse.

 

Consult Your Doctor

 

  • Make an appointment with your healthcare provider to discuss your need for Vyvanse as a treatment option.
  •  

  • Ensure your doctor knows your insurance provider to suggest alternatives if Vyvanse is not covered, or to provide supporting documentation if needed.

 

Pre-Authorization Process

 

  • If required, ask your doctor to initiate a pre-authorization request with Blue Cross Blue Shield of Minnesota. This step is essential for certain medications.
  •  

  • Provide any necessary documentation or information that your insurance might require to process this pre-authorization. Your doctor’s office can assist with this.

 

Understand and Use Your Pharmacy Benefits

 

  • Use a participating pharmacy network outlined by Blue Cross Blue Shield to fill your Vyvanse prescription to ensure benefits apply.
  •  

  • Confirm that the chosen pharmacy has your correct insurance information for smooth processing when filing or refilling your prescription.

 

Appeal a Denial if Necessary

 

  • If your coverage request for Vyvanse is denied, review the denial letter carefully for reasons and instructions on how to appeal the decision.
  •  

  • Gather any additional medical documentation or a letter from your healthcare provider to support the necessity of Vyvanse for your treatment in your appeal letter.
  •  

  • Submit your appeal as directed by the information provided by Blue Cross Blue Shield of Minnesota, and follow up if necessary.

 

Review and Adjust Plans Annually

 

  • At the end of your plan year, review upcoming plan options during the open enrollment period to ensure Vyvanse remains covered or if there's a need to choose a better-suited plan.

 

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