Leucovorin is a synthetic form of Vitamin B9. Natural vitamin B9 is folate, found in green leafy vegetables. B9 is very important in the production of brain chemicals (neurotransmitters) and well as maintaining many aspects of cell function, especially in the developing brain.

Many people are not able to use folic acid or even natural folate due to problems either with the receptors that allow B9 to enter the cell or with the enzymes that convert B9 to the necessary format or both. These problems are especially prominent in individuals with autism.

The scientific evidence showing benefits in certain conditions is building. I will prescribe leucovorin for patients with a diagnosis of autism and for parents who already have an autistic child, especially if they are wanting to get pregnant again. Children with a diagnosis of PANS or a diagnosis of PANDAS might benefit from Leucovorin as well. Very early data suggests that Leucovorin might help with infertility in some couples, so I have added it to the list.

When used to treat autism, a recent review article reported the following adverse effects:

• Excitement or agitation 11.7%

• Agression 9%

• Insomnia 8.5%

• Tantrums 6.2%

• Headaches 4.9%

NOTE: These side effects have not been documented in non-autistic individuals.

I recommend that all of my Leucovorin patients make an effort to avoid Folic Acid in their diet and supplements. A diet free of cow’s mild will also be recommended when starting on Leucovorin treatment.

I might recommend one or two other supplements, but I am not a Functional Medicine doctor so will not be starting you or your child on a host of supplements.

I charge $300 for the initial visit. This includes a brief followup phone call or email at the 2 week mark to make sure things are going according to plan.

There will be a 12 week followup for which I charge $150.

Annual renewal visits cost $150.

NOTE: all visits are by telemedicine.

Costs for leucovorin vary according to dose and, especially, according to insurance coverage. I recently had patients report prescriptions for 30 tablets of 25 mg leucovorin filled for $30 and another for $62. We will advise you about how to reduce casts at the time of your appointment.

Since I am just now starting to prescribe lecuovorin my comments are not as definite as I would like. Based on other comments I have seen it is likely that some insurances will provide coverage for a portion of the telemedicine visits and it is likely that they will cover part of the prescription cost. No promises. Some of the testing needed by some of my patients may not be covered by most insurances. But most of my patients will not require lab testing.

No. But we will provide you with a “super bill” containing all of the information you will need to submit the claim to your insurance company.

While there is no doubt that laboratory testing would improve the accuracy of Leucovorin treatment, the reality of this treatment is that it is simply another form of vitamin B9. There is mounting evidence that this form of B9 performs much better than Folic Acid, which is in many foods, infant formula and most multivitamins.

If you are interested in appropriate testing discuss it with me at the time of your appointment. The following could be perused:

• Folate Receptor Alpha Antibody testing - $295.

• Methylation Genetic Testing - $599.

• Labcorps Methylation Testing - $400 - $600.

Insurance will not pay for the first two but might pay for the last one. We can discuss lab testing at the time of your initial visit and I can order Labcorps tests if you decide to go this route.

See the section about Lab Tests below for more information.

Go to the “Schedule Your Visit” tab and click on the link. We encourage our patients to make their appointment online but if necessary we can help you to make the appointment over the phone. Note: we do not staff our phones throughout the day. If you leave a message we will return you call usually within one business day.

Unless you are already a patient of our practice, we will need you to fill out our “New Patient Forms” for a new Leucovorin patient. Here is the link: https://app.formdr.com/practice/NDY2MTg=/form/jXqyzDFWlhBFohnH7rIlKwb9PgX-tZZr

We will also need you to send us medical records to confirm your diagnosis. These should also include your medical history and your current medication list unless you listed each of these items on the new patient forms. Again, if you are already a patient of our practice, no new records are required.

Make sure the records you send us include your name and date of birth. This is very important.

For children, please get an accurate weight within a few days of the appointment. This is also very important.

Have your pharmacy contact information handy for your appointment, including the name, address, phone number and, if possible, the “Store ID #”.

The most secure way to send us your medical records is to attach them to the appropriate box in the New Patient Forms. This is through a HIPPA secure site. Alternatively, and less secure, would be to attach your medical records to an email to us or send them by fax.

The initial appointment usually runs about 45 minutes. We leave an hour on the schedule which allows us to go a little over if we need to and gives me time to send the prescription to your pharmacy.

The 12 week follow up visit runs about 30 minutes.

The annual renewals go about 30 minutes.

I do not require any laboratory testing for patients with a confirmed diagnosis of autism or for any parent of a child that was later diagnosed with autism.

I do think testing for all patients seeking Leucovorin treatment would be great, but I do not feel testing is necessary in order to give Leucovorin a try. If you are interested in getting tested, I can help you with that. See the section on “Lab Tests”.