HealthRX.com · Printable cost worksheet
Vyvanse prescription cost worksheet for pharmacy and insurer calls
Use this sheet when a Vyvanse prescription costs more than expected. Fill in your prescription details, gather the papers you need, ask your pharmacist or insurer the listed questions, and track prices at each pharmacy over time.
Prescription details
Copy these exactly from the prescription label or the pharmacy receipt.
Form dispensedCapsule, chewable tablet, or oral solution
Strength written on prescriptionCopy the strength and unit from the label
Quantity and days supplyCount and supply length shown on the label
Date filled
Gather before you call
- Bring the prescription label or the receipt from the pharmacy
- Write the insurance plan name and member ID from your card
- Note whether the prescription is for a brand or generic form
- Check the FDA approval list for lisdexamfetamine forms
- Confirm which forms your pharmacy has in stock today
- List any prior authorization or coverage letters you have received
- Bring a list of other pharmacies you could compare with
- Note the price the pharmacy quoted and the amount your plan paid
Questions for your pharmacist or insurer
- Is a generic lisdexamfetamine form available for this prescription?
- Would a different form of the same strength change the price?
- Does my plan cover the chewable form or the capsule form better?
- Is a prior authorization needed before this fill is covered?
- What is the cash price if I do not use insurance?
- Can you check whether another nearby pharmacy stocks this form?
- Why did the price change from my last fill?
- What steps can I take if the claim is denied?
Price comparison log
Record each fill or quote so you can compare pharmacies and forms.
| Date | Pharmacy | Form | Price quoted | Plan paid |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.