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1. There is a strong slant against off-label uses of drugs in general

2. Insurance companies require extra paperwork for anything other than the 2 or 3 most common drugs. I ended up on Dexmethylphenidate after trying a few others; I rate it as "okay" but still so much better than unmedicated that I paid a few hundred dollars out-of-pocket for it while I was convincing the insurance company to approve it. I ended up on ER, which doesn't work as well because they wouldn't approve 2x 10mg of non ER but would approve 1x 20mg of the ER. sigh



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