Ritalin (Methylphenidate) Medicare Coverage

Ritalin
Chemical name: Methylphenidate

Brand name: Ritalin

Typical dosage: 20mg

Typical type: Tablet1

Ritalin is a medication used to treat ADHD and narcolepsy. Ritalin is available in its generic form as Methylphenidate and comes as an oral tablet.

Ritalin is a schedule II controlled medication used to treat attention deficit/hyperactivity disorder (ADD or ADHD) and symptoms of narcolepsy. The generic form of Ritalin is called Methylphenidate.

Ritalin Immediate Release (IR) is typically taken twice daily, while Ritalin Sustained Release (SR) is typically taken once daily.

Ritalin is a stimulant of the brain and increases levels of norepinephrine and dopamine. Common side effects of Ritalin include dizziness, sleepiness, dry mouth, headache, upset stomach, loss of appetite, insomnia and nose and throat irritation.

Does Medicare cover Ritalin or Methylphenidate?

Yes! 100% of Medicare Advantage plans and Medicare Part D plans cover Methylphenidate, the generic form of Ritalin. Most Medicare plans don't cover the brand name form of Ritalin.1

  • 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.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 Methylphenidate.

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Average costs for Methylphenidate (Ritalin) with Medicare drug coverage1

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

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.
$7 – $70 $3 – $69

Additional information

Ritalin should be taken 30-45 minutes before eating a meal. If you take Ritalin more than 1 time daily, take your second dose before 6pm to avoid insomnia.

Long acting (sustained release) Ritalin should be taken in the morning. Talk to your pharmacist about how to take the medication properly.

Ritalin is a schedule II controlled substance due to its high potential for abuse, misuse and addiction.

Ritalin can sometimes cause heart problems. Talk to your doctor if you experience an abnormal heartbeat, weakness on one side of the body, trouble speaking or thinking, chest pain or pressure, shortness of breath, dizziness or fainting.

Changes in mood and behavior have occurred while taking Ritalin. If you have a change in thinking, increased anger, hallucinations, depression or mood swings, talk to your doctor immediately.

 

 

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.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Ritalin. Retrieved Sep. 2019, from www.goodrx.com/ritalin.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.