DEXMETHYLPHENIDATE HYDROCHLORIDE EXTENDED-RELEASE 30 mg Capsule, Extended Release
Also known as Dexmethylphenidate Hydrochloride. Coverage in Maine and New Hampshire (CMS PDP Region 01).
1 of 9 stand-alone Part D plans in Maine and New Hampshire cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
29 Medicare Advantage plans in ME, NH do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. ME: 21 plans · NH: 8 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$104.30/mo premium · $130.00 deductible | 4Non-Preferred Drug | 30% | — | $2.3331 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.