Dexmethylphenidate (Focalin, Focalin XR) — Point32Health
s/p cerebrovascular event (e.g. ischemic stroke)
Initial criteria
- Patient age ≥ 25 years
- AND one of the following: (a) Documented diagnosis of (i) ADHD or ADD before age 12 OR (ii) Narcolepsy OR (iii) Traumatic Brain Injury or cerebrovascular event (e.g. ischemic stroke) OR (iv) Excessive daytime sedation associated with a chronic medical condition (e.g. cancer, terminal illness, organic brain disorder, obstructive sleep apnea/hypopnea syndrome, multiple sclerosis, depression, chronic fatigue syndrome, Parkinson’s disease) OR (v) Depressive condition in which stimulant will be used as augmentation with concomitant antidepressant(s)) OR (b) Documentation of signs or symptoms of ADHD before age 18 years
- For Vyvanse (lisdexamfetamine): documented diagnosis of Binge Eating Disorder (B.E.D.) AND patient age ≥ 18 years
- For Qelbree (viloxazine): diagnosis of ADHD AND patient age ≥ 6 years AND inadequate response, contraindication, and/or intolerance to atomoxetine (Strattera)
Reauthorization criteria
- Subsequent approvals for non-FDA-approved indications reviewed on a case-by-case basis
Approval duration
per compendia recommendation; subsequent reviews case-by-case