It's not exactly a secret that my executive function has been playing hooky on me for a while, and by a while, I mean “my entire life, but I didn't notice despite failing out of college twice.”
At the beginning of this year, after talking with a friend, I decided to try medication for my ADHD. There were many reasons I was hesitant. I had tried medication for depression earlier in my life, and it had all hit me in weird and idiosyncratic ways. Also, my mom is anti-medicine in many ways, and I'm still unpacking this in my own life. But finally, and hardest, there was part of me that didn't think I deserved it.
When I talked about this with myself, I usually used the word “needed” instead of “deserved.” But what it came down to was that I looked at my life, looked at the things I had accomplished without medication, and felt that I should be able to do the things I needed to without medication since I had been able to do that at some times in the past, which obviously (ha ha) meant that if I was unable to do so now, it was because of some kind of personal failing, not a need for medication.
Never mind that I knew I was struggling and never mind that I was demonstrably not getting things done any more. If I had been kinder to myself, I would have perhaps said that the fact that I could do things before and couldn't now was probably proof that I did need help. But none of that mattered to my judgmental brain.
A friend of mine started taking medication, and I could see it working in her life. So after a month of thinking “well of course she deserves it, but I, a person who is different from her, does not” I decided that maybe this was weird and bullshit and I should give it a try. What was the worst that could happen? That I had a bad experience and had to quit?
Before I talked to my insurance company and my regular doctor, I wanted to make sure that medication would work for me. So I went to
Done, an online ADHD prescription system (not available in all states) and tried a month of the lowest possible dose (10 mg) of Vyvanse. It was amazing. I got into a rhythm. I could do things. The house was cleaner. The plants stopped dying.
So I decided to switch over to my insurance. There, things ground to a halt. I had to jump through a billion hoops to get a second official diagnosis. (In order to get a diagnosis, I had to remind myself that when they ask “do you have difficulty doing ____” that if I have had to spend weeks creating an elaborate system to do ____, the correct answer is, “yes, the only way I am able to do ____ is because I have spent weeks creating this not-quite fail-proof system” and not “no, that's easy, I only had to fail to do it for two years straight before I sat down and fixed it.”)
Then, shiny diagnosis in hand, I went to my primary care prescriber and asked for a prescription for the tiniest dose of Vyvanse, the medication that I knew worked for me, and…totally bounced off the concept of prior authorizations. Over the next two months, they had me try four separate medications, and I realized that I was, in fact, extremely susceptible to stimulants and even the tiniest dose of another medication was often too much and horrifically distracting. Two months and much annoyance later, my insurer finally approved a prior authorization for Vyvanse.
To illustrate my extreme annoyance here (non-US citizens who live in countries that want to switch to a more US-like system, please pay attention), we do not have great insurance. We pay an enormous amount of money for it, but our insurance covers nothing except the tiny minimum required by law until we hit our deductible, which we have not done in the dozen years we've been with this insurer.
So this entire shebang taking medications that are awful has nothing to do with how much my insurer will pay. I am paying for the medication out of pocket. It's about whether my insurer will let my doctor prescribe something for me that I will personally pay for, because if something terrible happens to me later in the year, that might end up changing how much they have to pay out for the terrible thing.
Four months of rigmarole later, I finally got a prescription for Vyvanse, the thing that I already knew worked. Yay!
Except. (We are not done. Did you know we are not done?) I needed to buy the medication through their pharmacy benefit manager. Of course I needed to buy through their pharmacy benefit manager. The cost of the medication through their pharmacy benefit manager was more expensive than just getting it from Costco. But at least, this way, it would count against my deductible, I guess?
Except. (We are still not done.) It turns out that the generic that my insurance's pharmacy benefit manager stocks does not work. At all. Oh wait--it gave me a headache. That was it.
It took me a little while to figure this out, and then I googled, and lo and behold, other people had said the same thing. I tried using it for a month. I tried following some advice I saw people talking about on a reddit thread that involved dumping the contents of the capsule in water and swirling it around.
Did that work? Maybe? Slightly more than nothing? I don't know.
At that point, I gave up. My doing things medication wasn't working. I had spent too much time trying to get the doing things medication. I had no more energy for doing the things necessary to get a different doing things medication.
A few weeks ago, I once again started wondering why it was so hard to do things. I remembered that medication helps, and then remembered why I'd given up on getting the doing things medication and just…thought…"well, fine, why not just send the prescription to a different pharmacy with a different generic? Yes, it means my insurer won't cover it (lol) (which means I'm paying less money but it doesn't count against my deductible) but it will actually work."
I am happy to report that once again, I have functional doing things medication, and once again, I am able to manage basic tasks. One of those basic tasks will be switching to an insurer next year that lets me buy my doing things medication from a pharmacy that actually produces a functional version of the drug I need. Which will mean: yay, more rigmarole!
I don't know how anyone with a more disabling case of ADHD is able to get their doing things medication.
