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July 2016

Therapeutic Area - ADD/ADHD

Beginning July 5, 2016, stimulant medications will be limited to the maximum FDA approved daily dose.

Drug Common brand names Maximum daily dose
Amphetamine extended-release

Adzenys XR-ODT
Dyanavel XR

18.8 mg/day (6-12 years); 12.5 mg (13 years and older)
20 mg/day
Atomexetine Strattera 100 mg/day
Dexmethylphenidate Focalin and generics 20 mg/day
Dexmethylphenidate extended-release Focalin XR and generics 40 mg/day
Dextroamphetamine Dexedrine, ProCentra,and generics 60 mg/day
Lixdexamfetamine Vyvanse 70 mg/day
Methylphenidate Ritalin and generics 60 mg/day
Methylphenidate extended-release Concerta and generics
Aptensio XR
72 mg/day
60 mg/day
Methylphenidate patches Daytrana 30 mg/day
Methylphenidate solution, suspension Quillivant XR 60 mg/day
Methylphenidate chewable tablets Quillichew ER 60 mg/day
Mixed amphetamine salts Adderall, Adderall XR*, generics 60 mg/day

Approval criteria

  • 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 limits

  • 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.

Denial criteria

  • Treatment to suppress appetite
  • Treatment of obesity
  • Other off-label uses


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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