ADHD Drugs
PDL Reference Documents
- ADHD Scan - Dec 05, 2024
- ADHD Drugs - Oct 06, 2022
- ADHD DERP summary - Jun 02, 2022
- ADHD Literature Scan - Aug 06, 2020
- ADHD Literature Scan - Sep 27, 2018
- ADHD Class Update - Sep 28, 2017
- ADHD - Mar 31, 2016
- ADHD DERP Scan Summary - Jan 29, 2015
- Class Scan: ADHD - Jul 25, 2013
- DERP Drug Class Review Executive Summary: Pharmacological Treatments for ADHD - Mar 29, 2012
- Class Update: Attention Deficit Hyperactivity Disorder (ADHD) - Mar 29, 2012
Drug Use Review Documents
- ADHD Drugs Off-label use health impact evaluation - Jun 06, 2024
- ADHD Drugs Off-label policy impact - Jun 06, 2024
- ADHD Drugs - Oct 06, 2022
- ADHD Drug Use Evaluation - Jun 02, 2022
- Combination Use of Antipsychotics and Other Psychotropic Drugs - Apr 01, 2021
- ADHD Drug Use Evaluation - May 23, 2019
- Drugs for ADHD - Jul 28, 2016
- ADHD Drug Use Evaluation - May 29, 2014
- Retrospective Drug Use Review: Follow Up Care for Children Prescribed Their First ADHD Medication - Sep 26, 2013
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
|---|---|---|---|---|---|
| amphetamine sulfate | AMPHETAMINE SULFATE | TABLET | Y | Age and Quantity Limits | |
| amphetamine sulfate | EVEKEO | TABLET | Y | Age and Quantity Limits | |
| atomoxetine HCl | ATOMOXETINE HCL | CAPSULE | Y | Age and Quantity Limits | |
| atomoxetine HCl | STRATTERA | CAPSULE | Y | Age and Quantity Limits | |
| clonidine HCl | CLONIDINE HCL ER | TAB ER 12H | Y | ||
| dexmethylphenidate HCl | DEXMETHYLPHENIDATE HCL ER | CPBP 50-50 | Y | Age and Quantity Limits | |
| dexmethylphenidate HCl | FOCALIN XR | CPBP 50-50 | Y | Age and Quantity Limits | |
| dexmethylphenidate HCl | DEXMETHYLPHENIDATE HCL | TABLET | Y | Age and Quantity Limits | |
| dexmethylphenidate HCl | FOCALIN | TABLET | Y | Age and Quantity Limits | |
| dextroamphetamine sulfate | DEXEDRINE | CAPSULE ER | Y | Age and Quantity Limits | |
| dextroamphetamine sulfate | DEXTROAMPHETAMINE SULFATE ER | CAPSULE ER | Y | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | ADDERALL XR | CAP ER 24H | Y | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | DEXTROAMPHETAMINE-AMPHET ER | CAP ER 24H | Y | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | DEXTROAMPHETAMINE-AMPHETAMINE | TABLET | Y | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | ADDERALL | TABLET | Y | Age and Quantity Limits | |
| guanfacine HCl | GUANFACINE HCL ER | TAB ER 24H | Y | ||
| guanfacine HCl | INTUNIV | TAB ER 24H | Y | ||
| lisdexamfetamine dimesylate | VYVANSE | CAPSULE | Y | Age and Quantity Limits | May 26, 2016 |
| lisdexamfetamine dimesylate | LISDEXAMFETAMINE DIMESYLATE | CAPSULE | Y | Age and Quantity Limits | |
| lisdexamfetamine dimesylate | LISDEXAMFETAMINE DIMESYLATE | TAB CHEW | Y | Age and Quantity Limits | |
| lisdexamfetamine dimesylate | VYVANSE | TAB CHEW | Y | Age and Quantity Limits | |
| methylphenidate | METHYLPHENIDATE | PATCH TD24 | Y | Age and Quantity Limits | |
| methylphenidate | DAYTRANA | PATCH TD24 | Y | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE HCL ER (CD) | CPBP 30-70 | Y | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE HCL CD | CPBP 30-70 | Y | Age and Quantity Limits | |
| methylphenidate HCl | RELEXXII | TAB ER 24 | Y | Age and Quantity Limits | |
| methylphenidate HCl | CONCERTA | TAB ER 24 | Y | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER | TAB ER 24 | Y | Age and Quantity Limits | |
| methylphenidate HCl | RITALIN | TABLET | Y | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE HCL | TABLET | Y | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER | TABLET ER | Y | Age and Quantity Limits | |
| viloxazine HCl | QELBREE | CAP ER 24H | Y | Age and Quantity Limits | |
| clonidine HCl | ONYDA XR | SUS ER 24H | V | ||
| amphetamine | DYANAVEL XR | SUS BP 24H | N | Age and Quantity Limits | |
| amphetamine | DYANAVEL XR | TAB BP 24H | N | Age and Quantity Limits | |
| amphetamine | ADZENYS XR-ODT | TAB RAP BP | N | Age and Quantity Limits | |
| amphetamine sulfate | EVEKEO ODT | TAB RAPDIS | N | Age and Quantity Limits | |
| dextroamphetamine | XELSTRYM | PATCH TD24 | N | Age and Quantity Limits | |
| dextroamphetamine sulfate | PROCENTRA | SOLUTION | N | Age and Quantity Limits | |
| dextroamphetamine sulfate | DEXTROAMPHETAMINE SULFATE | SOLUTION | N | Age and Quantity Limits | |
| dextroamphetamine sulfate | ZENZEDI | TABLET | N | Age and Quantity Limits | |
| dextroamphetamine sulfate | DEXTROAMPHETAMINE SULFATE | TABLET | N | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | DEXTROAMPHETAMINE-AMPHET ER | CPTP 24HR | N | Age and Quantity Limits | |
| dextroamphetamine/amphetamine | MYDAYIS | CPTP 24HR | N | Age and Quantity Limits | |
| methamphetamine HCl | METHAMPHETAMINE HCL | TABLET | N | Age and Quantity Limits | |
| methylphenidate | COTEMPLA XR-ODT | TAB RAP BP | N | Age and Quantity Limits | |
| methylphenidate HCl | RITALIN LA | CPBP 50-50 | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER (LA) | CPBP 50-50 | N | Age and Quantity Limits | |
| methylphenidate HCl | JORNAY PM | CPDR ER SP | N | Age and Quantity Limits | |
| methylphenidate HCl | APTENSIO XR | CSBP 40-60 | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER | CSBP 40-60 | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLIN | SOLUTION | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE HCL | SOLUTION | N | Age and Quantity Limits | |
| methylphenidate HCl | QUILLIVANT XR | SU ER RC24 | N | Age and Quantity Limits | |
| methylphenidate HCl | QUILLICHEW ER | TAB CBP24H | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE HCL | TAB CHEW | N | Age and Quantity Limits | |
| methylphenidate HCl | RELEXXII | TAB ER 24 | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER | TAB ER 24 | N | Age and Quantity Limits | |
| serdexmethylphen/dexmethylphen | AZSTARYS | CAPSULE | N | Age and Quantity Limits | |
| methylphenidate HCl | METHYLPHENIDATE ER (LA) | CPBP 50-50 | Age and Quantity Limits |