When Cost Becomes the Barrier to Adherence

You've evaluated the patient, confirmed the ADHD diagnosis, and determined that Qelbree (Viloxazine) is the right clinical choice. Then the patient calls back: "I can't afford it."

This is one of the most common — and most preventable — reasons patients abandon a treatment plan. Qelbree is a brand-name-only medication with a cash price of $362–$525 per month, and even patients with commercial insurance may face high copays or prior authorization delays that feel like rejection.

As a prescriber, you're in a unique position to anticipate these barriers and proactively connect patients with savings resources. This guide walks through the options available in 2026.

What Your Patients Are Paying

Understanding the cost landscape helps you set realistic expectations during the prescribing conversation:

• Cash price (uninsured): $362–$525/month for a 30-day supply of extended-release capsules
• Commercial insurance: Most plans cover Qelbree but frequently require prior authorization. Step therapy (requiring trial of a stimulant or Atomoxetine first) is common. Even after approval, specialty tier copays can range from $50–$150/month.
• Medicare Part D: May cover with prior authorization, but cost-sharing in the coverage gap can be significant
• Medicaid: Coverage varies by state. Not all Medicaid programs include Qelbree on their formularies.

Patients often don't tell you about cost concerns unless you ask. Building a brief cost check into your prescribing workflow can prevent avoidable discontinuation.

Manufacturer Savings Programs

Supernus Qelbree Savings Card

This is the first resource to offer every eligible patient:

• Eligible patients: Commercially insured individuals
• Benefit: Copay reduced to as low as $20 per prescription
• Enrollment: Available at qelbree.com — patients can download the card themselves or your office can help them enroll
• Limitations: Not valid for patients with government insurance (Medicare, Medicaid, TRICARE, VA)

In practice, this card covers the majority of commercially insured patients and can dramatically reduce out-of-pocket costs. Consider having your front desk or medical assistant mention it at checkout for every Qelbree prescription.

Supernus Support Program (Patient Assistance)

For uninsured or underinsured patients who cannot afford Qelbree at any price:

• Administered through: PharmaCord
• Eligibility: Based on financial need — typically for patients without insurance or whose insurance doesn't cover Qelbree
• How to apply: Patients can apply through their healthcare provider or directly. Also listed on NeedyMeds and SimpleFill.
• What it provides: Free or reduced-cost medication for qualifying patients

The application process requires some documentation but is straightforward. Having a staff member familiar with the process can significantly increase completion rates.

Coupon and Discount Cards

For patients whose insurance doesn't cover Qelbree or who face high copays, third-party discount programs can help:

• GoodRx: Shows cash prices at various pharmacies and offers coupons that may lower the cost. Useful for comparing prices across locations.
• SingleCare: Similar to GoodRx, offers prescription discount cards accepted at most major pharmacies
• RxSaver: Another option for comparing pharmacy prices with downloadable coupons
• Inside Rx: Partners with brand manufacturers and may offer additional savings

Important caveat: These discount cards cannot be combined with insurance. They're most useful for cash-pay patients. For commercially insured patients, the manufacturer savings card typically provides better value.

Generic Alternatives and Therapeutic Substitution

When cost is an insurmountable barrier, it's worth discussing alternatives:

No Generic Qelbree Available

There is currently no generic version of Viloxazine extended-release. The earliest generic entry is estimated for 2033–2035. This means there's no low-cost bioequivalent option.

Therapeutic Alternatives to Consider

If Qelbree's cost is prohibitive, these non-stimulant alternatives have generic options available:

• Atomoxetine (generic Strattera): $30–$60/month. Another selective norepinephrine reuptake inhibitor approved for ADHD in children 6+ and adults. The closest pharmacological alternative to Qelbree, though the two agents are chemically distinct and some patients respond to one but not the other.
• Guanfacine ER (generic Intuniv): $20–$50/month. Alpha-2 adrenergic agonist approved for ADHD in children 6–17. Different mechanism of action but well-established efficacy.
• Clonidine ER (generic Kapvay): $15–$40/month. Another alpha-2 agonist option for pediatric ADHD.
• Bupropion (generic Wellbutrin): $10–$30/month. Used off-label for ADHD. Norepinephrine-dopamine reuptake inhibitor. Not FDA-approved for ADHD but supported by some evidence, particularly in adults.

For a comprehensive comparison, refer patients to our Qelbree alternatives guide.

When switching from Qelbree to an alternative, document the clinical rationale (cost-driven therapeutic substitution) to support any future appeals if the patient wants to return to Qelbree.

Building Cost Conversations into Your Workflow

The most effective way to prevent cost-related nonadherence is to address it proactively. Here are practical strategies:

At the Point of Prescribing

• Mention the price: "Qelbree is a brand-name medication that costs $362–$525 without insurance. Let me tell you about the savings options available."
• Offer the savings card: Hand the patient information about the Supernus savings card or have them enroll before they leave your office
• Check formulary status: If possible, verify whether Qelbree is covered by the patient's plan and what tier it's on before writing the prescription

At Follow-Up Visits

• Ask: "Have you had any trouble affording or finding your Qelbree?"
• If they're struggling, reassess — are they aware of the savings card? Would a therapeutic alternative be acceptable?
• Document cost barriers in the chart for prior authorization appeals

For Your Staff

• Train front desk and MA staff to mention the savings card for every Qelbree prescription
• Keep a quick-reference sheet with enrollment links and phone numbers for patient assistance programs
• Consider designating a "benefits navigator" role if your practice prescribes specialty medications frequently

Pharmacy Stock Issues

Cost isn't the only barrier — availability is too. Qelbree is a newer brand-name medication that many pharmacies don't routinely stock. Direct patients to Medfinder for Providers to help locate pharmacies with Qelbree in stock. For more on managing supply-side challenges, see our provider's guide to finding Qelbree in stock.

Prior Authorization Tips

Since most commercial plans require prior authorization for Qelbree, a few tips to improve approval rates:

• Document previous medication trials and their outcomes (especially if step therapy is required)
• Note specific reasons stimulants are not appropriate (substance use history, cardiovascular concerns, patient preference, side effects)
• Include the FDA-approved indication and the patient's diagnosis with supporting clinical details
• If denied, appeal with additional documentation — many initial denials are overturned on appeal

Final Thoughts

Prescribing the right medication is only half the battle. If patients can't afford to fill the prescription, even the best clinical decision falls short. By proactively discussing cost, enrolling patients in savings programs, and knowing when therapeutic alternatives are appropriate, you can significantly improve adherence and outcomes.

For more resources on managing Qelbree prescriptions, explore our provider guides on shortage management and finding stock for patients. And sign up for Medfinder for Providers to help your patients locate Qelbree at pharmacies near them.