This site is intended for US health care professionals only.

IMPORTANT SAFETY INFORMATION

This site is intended for US health care professionals only.

WARNING: ABUSE AND DEPENDENCE

  • CNS stimulants (amphetamines and methylphenidate-containing products), including Vyvanse, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy.
Full Safety Information Below

Vyvanse is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in patients ages 6 and above, and for the treatment of moderate to severe binge eating disorder (B.E.D.) in adults. Vyvanse is not indicated or recommended for weight loss. Use of other sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events. The safety and effectiveness of Vyvanse for the treatment of obesity have not been established.

Understanding Health Care Payers

There are many different types of health care payers and plans, although all health insurance can be grouped under 2 major categories: private and public. Most Americans have some type of private (also known as commercial) health insurance coverage.1

Private Health Plans

Commercial plans are typically divided into 2 categories: fee-for-service (also known as indemnity plans) and managed care. Today, almost all health plans incorporate some form of a managed care component.2

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Health Maintenance Organization (HMO)

  • Provides care through a network of physicians and hospitals in particular geographic or service areas, who are either employed by or under contract with the HMO
  • Members receive all of their care through the HMO
  • Most HMOs ask members to choose a doctor or medical group to be their primary care physician (PCP)
  • In many HMOs, members must get authorization (also known as a referral) from their PCP to see other providers
  • Members generally have no coverage for services provided outside of the HMO network1

Preferred Provider Organization (PPO)

  • Offers a choice of getting care within or outside of a provider network with no referral necessary
  • Members may use out-of-network providers and facilities, but they will have to pay more than if they had used in-network ones1

Point-Of-Service (POS)

  • A combination of a PPO and an HMO plan
  • Members choose an in-network PCP and are encouraged to use in-network providers and facilities
  • Members can visit any in-network provider without a referral
  • If members go outside of the network, services are covered at a lower rate, unless they receive a referral from their PCP1

Consumer-Driven Health Plan (CDHP)

  • Has a high deductible and a tax-advantaged savings account
  • Contributions and withdrawals to the savings account may only be used for qualified health care expenses and remain tax free
  • Preventive care is covered without cost sharing3

Pharmacy Benefit Manager (PBM)

  • A third-party administrator of prescription drug programs
  • PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims
  • Examples of PBMs are CVS Caremark and Express Scripts, Inc.4

Catastrophic Plans

  • Does not cover any benefits other than 3 primary care visits per year before the plan's deductible is met
  • The monthly premium is generally lower than other plans, but the out-of-pocket costs for deductibles, co-pays, and co-insurance are higher5

Coverage through employers

Most health coverage is provided through employers or other organizations. Enrollment requirements and costs are determined by the company and vary depending on the plan type. The patient’s out-of-pocket costs (deductibles, co-pays, and co-insurance) can vary, based on differing plan restrictions, benefit levels, and other variables. Learning more about the types of health insurance may help you in making coverage decisions that affect your patients.9

Public Health Plans

Public plans are also known as government-funded plans and include Medicare, Medicaid, and CHIP.1

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Medicare

  • A federal program that provides health insurance coverage to eligible elderly and disabled individuals
  • Coverage benefits vary based on the site of service (e.g., doctor's office, hospital inpatient, hospital outpatient, or home health treatments)6

Medicaid

  • A state administered program designed to provide health insurance coverage to individuals who have a low income
  • Each state sets its own guidelines regarding eligibility and services7

Children’s Health Insurance Program (CHIP)

  • A state program designed to provide coverage to uninsured children whose families' income falls under a certain level, but is too high to qualify for Medicaid8

The information in this website relating to payers, insurance, and benefits is general information for educational purposes only. The information is not legal advice, is not to be acted or relied on as such, and may not be current. Check applicable law and individual health plan coverage, costs, and terms because they may change without notice. This information is based on public records.

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This site is intended solely for US residents and is governed solely by US laws and government regulations. Please see our online privacy policy for more information. While Shire US Inc. makes reasonable efforts to include accurate, up-to-date information on the site, Shire US Inc. makes no warranties or representations as to its accuracy. Shire US Inc. assumes no liability for any errors or omissions in the content of the site.

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