Focalin (Dexmethylphenidate) Medicare Coverage

Focalin
Chemical name: Dexmethylphenidate

Brand name: Focalin

Typical dosage: 10mg

Typical type: Tablet1

Focalin is a medication used to treat ADHD. Focalin is available as a brand name drug or as a generic and comes as an oral capsule and an oral tablet.

Focalin is a medication used to treat ADHD. It contains the active ingredient Dexmethylphenidate.

Focalin is a central nervous system stimulant that increases dopamine and norepinephrine in the brain. Focalin comes as an immediate-release oral tablet that is taken 2 times daily or an extended-release tablet that is taken 1 time daily.

Common side effects of Focalin include dizziness, fatigue, excitability, stomach pain, heartburn, weight loss, insomnia, dry mouth, upset stomach and throat pain.

Does Medicare cover Focalin or Dexmethylphenidate?

While some Medicare plans may not cover Focalin, some Medicare Advantage plans and Medicare Part D plans may cover generic Dexmethylphenidate.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.1

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Dexmethylphenidate.

Find Medicare Advantage plans with drug coverage

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Dexmethylphenidate with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.

Additional information

Focalin is a C-II controlled medication. C-II medications have a very high potential for addiction, abuse and misuse. Let your doctor know if you have a history of abusing drugs or alcohol before using Focalin.

You can build tolerance to your dose of Focalin, to the point that it may not work as well. Don’t increase your daily dose without talking to your doctor.

Focalin can cause new or worsening changes in behavior and mood. Talk to your doctor right away if you experience worsening depression, hallucinations, suicidal thoughts or actions, nervousness, extreme mood swings, anxiety or a lack of interest in life.

Talk to your doctor if you experience chest pain, an abnormal heartbeat, weakness on 1 side of the body, trouble speaking or thinking, changes in balance, eyesight changes, dizziness or if you faint.  

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.