Diagnosis: Attention Deficit Hyperactivity Disorder (ADHD).
Treatment: Vyvanse 50 MG (milligram) OR (oral) CAPS (capsules).

The insurer denied Vyvanse 50 MG OR CAPS. The health plan's determination is upheld.

The patient is a young male with history of attention deficit hyperactivity disorder (ADHD). His psychiatrist has switched the patient from Adderall XR (extended release) to Vyvanse, which is not covered by his plan. He is also taking Intuniv.

Vyvanse 50mg (milligrams) is not medically necessary for the patient. The plan alternatives, Focalin XR and Ritalin LA (long acting) have not been tried and Vyvanse would not be more advantageous given the patient's medical presentation.

The patient has tried and failed Adderall XR. It is noted that he has poor appetite on this medication, and effects are wearing off. He has not had trials of Ritalin LA (long acting) or Focalin which is supported by review of pharmacy claims. Ritalin LA and Focalin would be reasonable alternatives given the patient's symptoms and therapeutic failure of Adderall XR, as these medications are effective and are Food and Drug Administration (FDA) approved medications to treat ADHD in adolescents.