Drug - Stimulants
Therapeutic Area - ADD/ADHD
Beginning July 5, 2016, stimulant medications will be limited to the maximum FDA approved daily dose.
||Common brand names
||Maximum daily dose
|18.8 mg/day (6-12 years); 12.5 mg (13 years and older)
||Focalin and generics
||Focalin XR and generics
||Dexedrine, ProCentra,and generics
||Ritalin and generics
||Concerta and generics
|Methylphenidate solution, suspension
|Methylphenidate chewable tablets
|Mixed amphetamine salts
||Adderall, Adderall XR*, generics
- Patient must be 3 years of age or older AND
- Patient must have a diagnosis of ADD or ADHD. Appropriate diagnosis code must be transmitted on prescription drug claim.
- Requests must not exceed maximum daily dose as approved by the FDA
- Quantity requests exceeding the listed dose per day will be reviewed for medical necessity. Prescriber must provide evidence to support safety and additional efficacy of the higher than maximum doses as documented in published biomedical literature, demonstrating safety and efficacy of doses/quantities greater than those approved by the FDA for the diagnosis indicated.
- Treatment to suppress appetite
- Treatment of obesity
- Other off-label uses
MHCP Provider Call Center 651-431-2700 or 800-366-5411