CareOregon OHP (Medicaid) Stimulant Update
By Cory Bradley, Senior Pharmacy Clinical Coordinator
CareOregon has exciting news to share regarding Medicaid stimulant coverage. For years, adults have been asked to use the immediate-release versions, with extended-release stimulants reserved for school-aged children. As of December 1, generic Adderall XR (mixed salts amphetamine ER) will be covered for all ages. Although there is still not a lot of evidence supporting extended-release options being safer or more effective, they are obviously popular for their once-a-day dosing. Generic costs have finally fallen enough that CareOregon feels the generic Adderall XR can be covered. However, due to remaining elevated costs for methylphenidate ER products, the age restriction will remain in place on those products. The generic Adderall XR will be covered for just 1 capsule per day, so higher doses will still need prior authorization.
A commonly requested stimulant that remains non-covered is Vyvanse. Vyvanse is metabolized into dextroamphetamine (one of the products in generic Adderall XR). The advantage of Vyvanse is that its metabolism from an inactive drug to an active metabolite creates its extended-release mechanism. Though its duration of action is not necessarily much longer than other formulations and there is no evidence it is superior to generic stimulants. It remains brand-only and significantly more expensive than the alternatives. Occasionally providers advocate for Vyvanse when risk of stimulant abuse is felt to be present, but Vyvanse is still a Schedule II stimulant with significant abuse potential. Non-stimulant options (bupropion and atomoxetine) should be considered first line if risk of abuse is suspected. The risk/benefit of using stimulants at all in this population should be carefully considered.
CareOregon OHP Coverage of Key Stimulants (12/1/20)
Product | Children | Adults | Duration of Action | Relative Costs |
Immediate-Release | ||||
Generic Adderall IR | Covered | Covered | 6 hrs | $ |
Generic Ritalin SR | Covered | Covered | 3-5 hrs | $ |
Extended-Release | ||||
Generic Adderall XR | Covered | Covered | 10-12 hrs | $$ |
Generic Concerta | Covered | PA required | 12 hrs | $$$$$$$ |
Generic Ritalin LA | Covered | PA required | 6-9 hrs | $$$$$ |
Generic Metadate CD | Covered | PA required | 6-9 hrs | $$$$$$ |
Generic Focalin XR | Covered (NEW) | PA required | 8-12 hrs | $$$$$$ |
Vyvanse | Non-formulary | Non-formulary | 10-12 hrs | $$$$$$$$$$$$$$$$ |
