CVS Caremark / Non-Formulary Prescription – Please Help

I'm hoping this is the right place to post this – I'm so confused what my options are and need advice more along the lines of just how prescription insurance works. I've only had my own insurance for a few years and it still baffles me at times.

I have prescription insurance through my employer via CVS Caremark. I've been diagnosed with ADHD and prescribed a certain medication that's experienced a shortage recently. Luckily, I've had no issue obtaining it. For reference, I've been taking this medication for several years and have a valid Prior Authorization that's good until 2024.

However, CVS Caremark removed this brand (XR specifically) from the Preferred Drug List effective 1/1/23. When I went to pick up the medication, now the mixed salts XR generic, the cost for a 30-day supply went from $10 out of pocket to close to $150. Considering I take this everyday, that's quite a spike in price, especially considering I went from brand name to generic and generics are supposed to be cost-saving. Over the last month, I've also found the generic to not be as effective. I don't know if there's a science to it, but it feels like it's not lasting as long and I may have to go up in dosage.

TL;DR is there a way to get the now Non-Formulary Brand Name medication approved for me specifically and/or lower the cost of it with my insurance (CVS Caremark). Yes, I've checked GoodRx and other coupon sites. Still quite expensive.

I'm so frustrated as this medication has been literally lifechanging and allows me to function better in daily life, making me happier overall. I have a number of other conditions, so I'd really like to maintain this bit of stability I've found in my life.

Thanks in advance for helping me navigate the enigma that is U.S. insurance!

submitted by /u/catchmekat
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