Does Anthem Cover Adderall and Prescription Drug Rehab?

Yes, Anthem commercial plans generally include substance use disorder treatment, and that covers addiction to Adderall and other stimulants, ketamine and sleeping pills like Ambien. Anthem's own consumer guide lists substance use treatment such as rehab and counseling among the behavioral health services its Marketplace plans cover, while noting that benefits vary by state and plan. Before starting a program, confirm your benefits, network status and any approval requirements for your specific plan.

Anthem is a Blue Cross Blue Shield company in a number of states, so you may see "Anthem Blue Cross" or "Anthem Blue Cross and Blue Shield" on your card. This page is organized as questions and answers, and it covers employer and individual commercial plans only.

Does Anthem treat Adderall addiction the same as other addictions?

It should. Stimulant use disorder, ketamine use disorder and sedative use disorder are all substance use disorders. Federal parity law, as the U.S. Department of Labor explains, means a plan that covers substance use disorder care cannot apply stricter copays, deductibles, visit caps or approval rules to that care than to comparable medical care. That applies whether the drug was prescribed to you or not.

HealthCare.gov adds that individual and small group plans must include substance use disorder treatment as an essential health benefit and cannot deny coverage or charge more because of an existing addiction.

What kinds of treatment might Anthem cover?

Depending on your plan, covered services can include:

• Inpatient care, including medically managed detox
• Residential rehab
• Partial hospitalization and intensive outpatient programs
• Individual, group and family therapy, in person or by video
• Psychiatric visits and medication management
• Psychological testing

For stimulants, the core of treatment is behavioral. SAMHSA states there are no FDA-approved medications for stimulant use disorder and describes contingency management as particularly effective. Our guide to how stimulant addiction is treated explains what a good program looks like, and Adderall rehab lists programs nationwide.

Who is Carelon, and why does that name keep coming up?

Carelon Behavioral Health is part of the same parent company as Anthem. Anthem's employer materials say its behavioral health network is growing as Carelon providers are added, and describe Carelon support for members at high risk from substance use, including phone support, help arranging care and coaching.

For some employer plans, Anthem also describes add-on behavioral health packages. One, aimed at mid-sized employers, includes substance use disorder advocacy, concierge navigation and access to a high-performing substance use provider network. Whether you have any of this depends on what your employer bought, so ask HR or member services.

Do I need prior authorization?

Often, for structured programs. Anthem publishes its precertification requirements by state and plan type, so there is no single national list. In general, expect inpatient detox and residential stays to need approval before admission, and ask specifically about partial hospitalization and intensive outpatient. Routine therapy visits usually do not need prior approval.

An in-network treatment center will normally request authorization for you. Ask them to confirm it is approved, and for how many days, before you arrive. If you are an Anthem member being treated in another state, the program works through that state's Blue company, and Anthem provides a lookup for out-of-area precertification rules that uses the first three characters of your ID number.

How do I find an in-network program?

Anthem's mental health pages point members to the Find Care tool on anthem.com and in the Sydney Health app, where you can search by location or specialty. You can also chat with Anthem in the app or call Member Services at the number on your ID card. Your primary care doctor can make a referral and help coordinate care.

If your employer offers Anthem's Employee Assistance Program, you may have a set number of no-cost counseling sessions. An EAP counselor can be a helpful first conversation, though it is not a substitute for a rehab program if you need one.

You can also start with our directory, for example Adderall rehab in Indiana, stimulant rehab in Louisville or ketamine rehab in Los Angeles. Then check each program's Anthem network status.

Can I use virtual care?

Yes, for many plans. Anthem says therapists are available for video visits through Sydney Health and anthem.com, and that virtual visits are free on most of its Marketplace plans, although members of high-deductible plans with an HSA and catastrophic plans must meet their deductible first. Virtual therapy can work well for aftercare or milder stimulant problems, but someone in a sleeping pill withdrawal or a mental health crisis needs in-person care.

What if the problem is Ambien or another sleeping pill?

Do not stop long-term or high-dose sleeping pills suddenly without medical guidance. A prescriber-led taper or a supervised Ambien detox is usually the safer path, and inpatient detox is the level of care most likely to need approval first. Combining sleeping pills with alcohol or opioids is dangerous. For background, read Ambien addiction and Lunesta and Sonata addiction.

And ketamine?

Ketamine misuse is covered under the same substance use benefits. It is separate from supervised esketamine treatment, which is prescribed under its own safety program. See ketamine withdrawal for what stopping can feel like.

What will it cost me?

Your cost depends on your deductible, coinsurance, copays and out-of-pocket maximum. Anthem notes that going out of network can mean a higher share of costs. Parity rules mean behavioral health cost-sharing should not be harsher than for comparable medical care, but you still need to check your own plan's numbers.

What if Anthem denies my claim?

Ask for the denial reason in writing, have your doctor request a peer-to-peer review, and file an internal appeal. The Department of Labor says you generally have 180 days to appeal, can ask the plan for its medical necessity criteria, and can request an independent external review if the denial stands. Your state insurance department can also help with insured plans. Guides for other carriers are in our insurance section.

If stopping a stimulant or ketamine brings thoughts of suicide, call or text 988. For any emergency, call 911 or go to the nearest emergency room.

Sources

• Understanding Mental Health Coverage in the U.S. (Anthem)
• Connecting to Mental Healthcare (Anthem)
• Group Behavioral Health (Anthem)
• Meeting the Challenges of Mental Health Care (Anthem)
• Medical Policy and Precertification Lookup for Out-of-Area Members (Anthem)
• Understanding Your Mental Health and Substance Use Disorder Benefits (U.S. Department of Labor)
• The Mental Health Parity and Addiction Equity Act (Centers for Medicare & Medicaid Services)
• Mental Health and Substance Abuse Health Coverage Options (HealthCare.gov)
• Advisory: Contingency Management for the Treatment of Substance Use Disorders (SAMHSA)

Related guides

• Adderall Addiction: Signs, Risks and Treatment Options
• Vyvanse Addiction: Signs, Risks and Treatment Options
• Ritalin and Concerta Addiction: Signs, Risks and Treatment
• Ketamine Addiction: Signs, Risks and Treatment Options
• Ambien Addiction: Signs, Risks and Treatment Options
• Lunesta and Sonata Addiction: Risks and Treatment

Find treatment

Adderall Rehab by stateStimulant Rehab by stateKetamine Rehab by stateAmbien & Sleeping Pill Rehab by state