Non-Oral: Other Formulations – CareOregon OHP (Medicaid) Stimulant Update
By Bryan Armstrong, Pharmacy Clinical Coordinator
While CareOregon increased access to generic Adderall XR for adults, other dosage forms of stimulants were reviewed to evaluate their role in the Medicaid formulary. We receive requests for liquids, patches, dissolvable tablets, and tablets/capsules with special release mechanisms (such as Jornay PM). While these formulations are appealing from a convenience standpoint, there is no evidence to support improvement in outcomes and they come at considerable cost. Almost all these formulations have maintained a non-formulary status at CareOregon.
Two oral solutions exist for IR stimulants, the rest are ER/XR formulations.
- Methylphenidate IR solution is the only formulary oral solution among available products.
- The most common rationale for using an alternative formulation is for pediatric patients who have difficulty swallowing. Because the generics of CareOregon’s formulary products (Metadate CD, Ritalin LA, Adderall XR, and Focalin XR) can be opened and their contents sprinkled over food, it is usually unnecessary to require a liquid or patch. These dosage forms also come at a considerable cost, especially oral solutions. The low doses of oral solutions are comparable in price to their respective tablets or capsules but quickly jump in cost to be the most expensive stimulant products available (up to 6x the cost of Vyvanse). Daytrana (methylphenidate transdermal patch) is the only non-oral product available.
For patients that have significant dysphagia or other compelling argument for avoiding traditional oral products, Daytrana can be an option. It is also less expensive than the available ER solution products. While CareOregon maintains that Daytrana is non-formulary, considerations for Daytrana coverage can be made in cases where opening and sprinkling capsules is not an option. Daytrana is a “preferred” non-formulary product, given it meets the needs for patients unable to use oral formulations while being relatively lower in cost.
