Why Cost Matters for Medication Adherence

For patients prescribed dextroamphetamine XR, cost can be the difference between staying on treatment and going without. Research consistently shows that out-of-pocket costs are one of the biggest drivers of medication non-adherence — and stimulant medications are no exception.

When a patient walks out of your office with a prescription they can't afford to fill, the clinical work you just did loses much of its value. This guide gives you practical tools to help your patients access dextroamphetamine XR at a price they can manage.

What Your Patients Are Paying

Since the brand-name Dexedrine Spansule is discontinued, only generic dextroamphetamine sulfate extended-release capsules are available. But "generic" doesn't always mean "cheap":

• Cash price without insurance: $50 to $250 for 30 capsules, depending on strength, manufacturer, and pharmacy
• Average retail price: $80 to $180 for a 30-day supply
• With a discount card: As low as $32 for 30 capsules through GoodRx or SingleCare
• With insurance: Copays vary widely — $0 to $75 depending on the plan, tier, and formulary status

The variability is significant. A patient filling at one pharmacy may pay $180 out of pocket while the same prescription costs $40 two miles away with a coupon card. Many patients don't know these price differences exist.

Manufacturer Savings Programs

Unlike many brand-name medications, generic dextroamphetamine XR does not have a dedicated manufacturer savings program or copay card. The original brand (Dexedrine Spansule) was discontinued by GSK, and no current generic manufacturer offers a patient savings card.

This means other cost-reduction strategies become more important for this medication.

Coupon and Discount Cards

Prescription discount cards are often the fastest way to reduce out-of-pocket costs for patients who are uninsured, underinsured, or facing high copays. These are free to use and accepted at most pharmacies:

Top Options for Dextroamphetamine XR

• GoodRx: Prices as low as $32 for 30 capsules. Available at CVS, Walgreens, Walmart, Rite Aid, and most independents. Patients can access coupons at goodrx.com or through the app.
• SingleCare: Competitive pricing, often within a few dollars of GoodRx. Accepted at major chains.
• RxSaver: Another comparison tool that shows prices at nearby pharmacies.
• Optum Perks: Formerly SearchRx. Good pricing and widely accepted.
• BuzzRx, America's Pharmacy, CareCard: Additional options worth checking, especially at independent pharmacies where one card may work better than another.

Important note for insured patients: Discount cards cannot be combined with insurance. However, for patients with high-deductible plans or whose insurance doesn't cover the medication, a discount card may actually be cheaper than the insurance copay. It's worth comparing both options.

How to Integrate This into Your Practice

Consider keeping a printed GoodRx or SingleCare card at your front desk. When prescribing a stimulant, mention: "If the cost is high at the pharmacy, show them this card — it may lower the price." This takes 10 seconds and can save your patient over $100.

Patient Assistance Programs

For patients with financial hardship — particularly those who are uninsured or on fixed incomes — patient assistance programs (PAPs) can help:

• NeedyMeds (needymeds.org): Database of assistance programs for generic medications, including state-based programs and charitable foundations.
• RxAssist (rxassist.org): Comprehensive directory of patient assistance programs organized by medication.
• Partnership for Prescription Assistance: Helps connect uninsured patients with programs they qualify for.
• State Medicaid programs: Generic stimulants like dextroamphetamine ER are covered by most state Medicaid formularies, often with no copay or copays under $5. If your patient is eligible but not enrolled, a social worker can help with the application.

The application process for PAPs can be time-consuming. If your practice has a social worker or patient navigator, routing cost-related concerns to them can save clinical time while ensuring the patient gets help.

Generic Alternatives and Therapeutic Substitution

Since dextroamphetamine XR is already a generic, there's no brand-to-generic switch available. However, therapeutic substitution may help in certain situations:

Within the Amphetamine Class

• Mixed amphetamine salts ER (generic Adderall XR): Widely available in generic form. May be easier to find during the current shortage depending on the manufacturer and strength.
• Dextroamphetamine immediate-release (generic Zenzedi): Available in more dosage strengths (2.5 mg to 30 mg). Requires twice- or thrice-daily dosing but may be more consistently available.
• Lisdexamfetamine (Vyvanse): A prodrug of dextroamphetamine. Now available in generic form. May be covered at a lower tier on some formularies. Longer duration (12–14 hours) but typically more expensive.

Different Stimulant Class

• Methylphenidate ER (generic Concerta, generic Ritalin LA): A reasonable alternative for patients who tolerate methylphenidate. Often more readily available and competitively priced.

When considering therapeutic substitution, discuss the rationale with your patient. Some patients have been specifically titrated to dextroamphetamine XR and may not respond the same way to alternatives. But for patients struggling with cost or availability, knowing their options is empowering.

For a patient-facing comparison of alternatives, you can share: Alternatives to dextroamphetamine XR.

Building Cost Conversations into Your Workflow

Many patients won't volunteer that cost is a barrier. They'll nod, take the prescription, and simply not fill it. Here are ways to normalize cost discussions:

At the Prescribing Stage

• Ask directly: "Do you have any concerns about the cost of this medication?" Simple, non-judgmental, and effective.
• Mention pricing upfront: "Generic dextroamphetamine XR usually costs between $30 and $180 depending on the pharmacy. A discount card can help if your insurance doesn't cover it well."
• Prescribe generically: Always write for "dextroamphetamine sulfate ER" rather than a specific manufacturer, allowing the pharmacy to fill with whatever they have in stock.

At Follow-Up Visits

• Check adherence: If a patient reports missed doses, ask if cost or availability is the reason.
• Review insurance changes: Formularies change annually. A medication that was covered last year may not be this year.
• Refer to pharmacy resources: Direct patients to Medfinder for Providers to help locate pharmacies with current stock and competitive pricing.

Staff and Workflow Tips

• Train front-desk staff to offer a discount card (GoodRx, SingleCare) when patients mention cost concerns.
• Keep a handout with PAP resources (NeedyMeds, RxAssist, state Medicaid information) in exam rooms.
• Set up a process for prior authorization requests so patients don't get surprised at the pharmacy counter.

Availability and the Shortage Factor

Cost and availability are intertwined. During the current stimulant shortage, some patients are paying premium prices simply because the only pharmacy with stock is charging more. Others are driving long distances to fill prescriptions.

Help your patients by:

• Checking Medfinder for Providers to see which pharmacies have dextroamphetamine XR in stock before sending the prescription
• Being flexible with prescription quantities — some pharmacies may have partial stock
• Having a backup plan (an alternative medication or formulation) ready if the primary choice isn't available

For a comprehensive guide on helping patients navigate the shortage, see our article on helping your patients find dextroamphetamine XR in stock.

Final Thoughts

Helping your patients save money on dextroamphetamine XR doesn't require complex interventions. A discount card, a cost conversation, and awareness of available programs can make the difference between a patient who fills their prescription and one who doesn't.

The tools are simple: GoodRx and SingleCare for immediate savings, NeedyMeds and RxAssist for financial hardship cases, and therapeutic substitution when cost or availability demands it. Make cost part of the conversation — your patients' adherence (and outcomes) will benefit.

Visit Medfinder for Providers for tools to help your patients find dextroamphetamine XR in stock at competitive prices.