Focalin (Dexmethylphenidate) Medicare Coverage

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.

How much does Dexmethylphenidate cost with Medicare?

Dexmethylphenidate coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Dexmethylphenidate?

According to GoodRx, 82% of Medicare Advantage plans and Medicare Part D plans covered Dexmethylphenidate, the generic form of Focalin, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Dexmethylphenidate include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• 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. We represent carriers such as Humana, Aetna, UHC, Anthem BCBS, Wellcare, Cigna Healthcare, and Kaiser Permanente.

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.

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.