Diagnosis: Attention Deficit Hyperactivity Disorder
Treatment: Vyvanse
The insurer denied: Vyvanse
The denial is overturned.

The patient is an adolescent male with known attention-deficit/hyperactivity disorder (ADHD). The patient has attempted generic and brand Adderall XR (extended release) with negative side effects of increased heart rate and difficulty sleeping with no improvement in school performance. The patient has been on Vyvanse (lisdexamfetamine) for 3 years.

The treatment with Vyvanse is medically necessary.

A review notes (1), "Since there are no reliable biomarkers that can predict individualized response to long-acting stimulants, clinicians need to consider their distinctive pharmacokinetic properties, including the pharmacokinetic profile, rate and extent of absorption, variability, dose proportionality, bioequivalence, and potential for accumulation. Clinicians also need to understand that certain factors can contribute to increased variability in pharmacokinetics and potentially affect outcomes."
The patient has had a positive clinical outcome on Vyvanse with a documented lack of a positive behavioral effect and a negative cardiac effect on the other medications. As it is known, medications with similar mechanisms of action used as treatment for this pathology do not always have the same clinical outcome. As such, as the patient has a positive clinical outcome on the prescribed medication, the patient should continue the medication. The proposed treatment is medically necessary.