Does Oscar Health Cover Adderall?

Oscar does not publish per-drug tier detail at the plan level. The general PBM pattern is generic amphetamine/dextroamphetamine at a low tier and brand Adderall non-preferred, but your exact tier depends on your specific Oscar plan. Use the Oscar drug lookup tool at hioscar.com or call member services to confirm the tier and copay that apply to your plan.

Yes — ACA/individual plans are Oscar's core market, and generic amphetamine/dextroamphetamine is covered via Oscar's PBM with Schedule II quantity limits. Brand Adderall is non-preferred. Exact tier and cost-share are plan-specific; verify using the Oscar drug lookup tool. Oscar's digital prior-authorization workflow through the app is an advantage for ACA members who need brand authorization.

Oscar has a limited Medicare Advantage presence and select-state Medicaid plans; it is not a major Medicare or Medicaid carrier. Where Oscar operates these plans, generic Adderall is generally covered under standard Part D and Medicaid rules with PA and quantity limits. Verify whether an Oscar government plan is available in your area before relying on Oscar for Medicare or Medicaid coverage.

Coverage itself is not affected by the shortage. However, generic amphetamine/dextroamphetamine availability varies by pharmacy due to the shortage that began October 2022. If your pharmacy is out of generic, contact Oscar to document the shortage in support of a brand prior authorization, or ask your pharmacist about a brand override. The digital PA process through the Oscar app can speed up brand authorization.

Oscar's prior-authorization process is digital — your prescriber submits through the Oscar app or provider portal. Brand Adderall requires PA; generic Adderall typically does not unless a plan-specific step or quantity-limit rule applies. Required documentation includes an ADHD diagnosis and adherence to Schedule II quantity limits. Verify specific PA criteria on your Oscar plan formulary or by contacting Oscar member services.