Dexmethylphenidate

2.5 Mg — Tablet

Central Nervous System Stimulant

Also known as: Dexmethylphenidate 2.5 Mg Tablet Dexmethylphenidate 5 Mg Tablet Dexmethylphenidate 10 Mg Tablet Dexmethylphenidate Er 5 Mg Capsule Dexmethylphenidate Er 10 Mg Capsule Dexmethylphenidate Er 15 Mg Capsule Dexmethylphenidate Er 20 Mg Capsule Dexmethylphenidate Er 25 Mg Capsule Dexmethylphenidate Er 30 Mg Capsule Dexmethylphenidate Er 35 Mg Capsule Dexmethylphenidate Er 40 Mg Capsule
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026
via Focalin 		Tier 3 - Non-Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via Focalin 		Tier 3 - Non-Preferred Brand ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Advantage 2026
via Focalin 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Care 2026
via Focalin 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Value 2026
via Focalin 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Focalin 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
BCBSNC Blue Local 2026
via Focalin 		Tier 2 - Medium Cost Generic/Brand — — ✓ QL
Source: PDF  ·  Formulary date: Oct 7, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Silver RD CMS Standard Tier 2 - Generic — — ✓ QL
Connect Silver RD 5000 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Silver RD 3500 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Bronze RD CMS Standard Tier 2 - Generic — — ✓ QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Gold RD CMS Standard Tier 2 - Generic — — ✓ QL
Connect Silver RD 2200 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Gold 1500 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect myDiabetesCare Silver Tier 2 - Generic — — ✓ QL
Connect myDiabetesCare Bronze Tier 2 - Generic — — ✓ QL
Connect Gold CMS Standard Tier 2 - Generic — — ✓ QL
Connect Silver CMS Standard Tier 2 - Generic — — ✓ QL
Connect Bronze CMS Standard Tier 2 - Generic — — ✓ QL
Connect Silver 3000 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Bronze 6500 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Bronze 5500 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Silver 5000 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Connect Silver 3600 Indiv Med Deductible Tier 2 - Generic — — ✓ QL
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
NHC Advantage (HMO I-SNP) Tier 1 - Preferred Generic — — — None
PruittHealth Premier (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Advantage (HMO C-SNP) Tier 1 - Preferred Generic — — — None
Liberty Medicare Dual Plan (HMO D-SNP) Tier 1 - Preferred Generic — — — None
Senior Care (HMO I-SNP) Tier 1 - Preferred Generic — — — None
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic — — ✓ 60 per 30 days QL
Alignment Health Platinum Select (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health AVA (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 2 - Generic — — ✓ 90 per 30 days QL
Alignment Health Platinum (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health NC Duals (HMO-POS D-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
Troy Medicare (HMO) Tier 2 - Generic — — ✓ 90 per 30 days QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) Tier 2 - Generic — — ✓ 90 per 30 days QL
Wellcare Simple (HMO-POS) Tier 2 - Generic — — ✓ 60 per 30 days QL
Wellcare Simple Open (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Wellcare Giveback Open (PPO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health smartHMO (HMO) Tier 2 - Generic — — ✓ 60 per 30 days QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) Tier 2 - Generic — — ✓ 60 per 30 days QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice Giveback H5525-035 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-049 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-050 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-070 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5525-083 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Signature (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Guardian (HMO-POS I-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Champion (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Freedom (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Nursing Home Plan NC-F001 (PPO I-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HealthSpring True Choice (PPO) Tier 3 - Preferred Brand — — — None
Humana Gold Choice H8145-004 (PFFS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Healthy Blue + Medicare (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
DEVOTED CHOICE 001 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE 003 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE 005 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE 008 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
HealthSpring TotalCare (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring TotalCare Plus (HMO D-SNP) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Select (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Savings (HMO) Tier 3 - Preferred Brand — — — None
HealthSpring Preferred Plus (HMO) Tier 3 - Preferred Brand — — — None
HealthTeam Advantage Plan I (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HealthTeam Advantage Plan II (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HealthTeam Advantage Vitality Plan (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Erickson Advantage Liberty (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S001 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S2 (PPO D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Access from UHC NC-23 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0001 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0004 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0016 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0017 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0019 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
Blue Medicare PPO Enhanced (PPO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Essential Plus (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Enhanced (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Choice (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Blue Medicare Essential (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
Experience Health Medicare Advantage (HMO) Tier 3 - Preferred Brand ✓ — ✓ 60 per 30 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
HumanaChoice H5216-211 (PPO) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0021 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0022 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0007 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-D001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0008 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0009 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0011 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0012 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-V001 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-0015 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Dual Complete NC-S3 (HMO-POS D-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-24 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-25 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
AARP Medicare Advantage from UHC NC-26 (HMO-POS) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-27 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
UHC Complete Care NC-28 (HMO-POS C-SNP) Tier 3 - Preferred Brand — — ✓ 60 per 30 days QL
DEVOTED CORE 001 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 3 - Preferred Brand ✓ — ✓ 120 per 30 days PA | QL
Wellcare Dual Liberty Open (PPO D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature Giveback (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature Extra (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Enhanced (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Liberty (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Reserve (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Dual Access (HMO-POS D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Enhanced (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature Care (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Prime (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Value Plus (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Dual (HMO D-SNP) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (HMO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Wellcare Assist Open (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Aetna Medicare Signature (PPO) Tier 4 - Non-Preferred — — ✓ 60 per 30 days QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via Focalin 		Non-Preferred — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 13 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 70/30 Standard PPO 2026
via Focalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
NC State Health Plan - HDHP 2026
via Focalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
NC State Health Plan - 80/20 Plus PPO 2026
via Focalin 		Tier 3 - Non-Preferred Brand ✓ — ✓ PA | QL
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