The Cost Problem: Why Patients Need Your Help

Quillichew ER (methylphenidate extended-release chewable tablets) fills an important clinical niche — it's the only extended-release chewable stimulant for ADHD, making it essential for patients who cannot swallow pills. But with a retail price of $300–$450 for 30 tablets and no generic available, cost is a significant barrier to adherence.

As a prescriber, you're often the first person a patient or caregiver turns to when they can't afford their medication. This guide consolidates every savings pathway available for Quillichew ER so you can point patients in the right direction quickly.

For supply-related challenges, see our companion guide on helping patients find Quillichew ER in stock.

Manufacturer Savings Programs

Tris Pharma Co-pay Savings Program

This is the most impactful program for commercially insured patients.

• Eligibility: Patients with commercial (private) insurance
• Savings: Pay as little as $25 per prescription
• How to enroll: Register at coupon.trisadhd.com or call 1-888-840-7006
• Limitations: Not valid for patients on government insurance (Medicare, Medicaid, TRICARE, VA). Annual and per-fill maximums may apply.

Clinical tip: Have your staff keep printed co-pay cards in the office. Many patients don't know these programs exist, and handing them a card at the point of prescribing dramatically increases utilization.

Pfizer RxPathways (Patient Assistance Program)

For patients who are uninsured or underinsured and meet income requirements.

• Eligibility: Uninsured or underinsured patients who meet financial criteria
• Savings: Medication provided at no cost
• How to apply: Visit pfizerrxpathways.com or call Pfizer
• Provider role: You may need to complete a portion of the application or provide a prescription. The process typically takes 2–4 weeks for initial approval.

Clinical tip: Start the PAP application process before the patient runs out of medication. Consider providing samples or a short-term prescription to bridge the gap while the application is processed.

Insurance Navigation Strategies

Prior Authorization

Many insurance plans require prior authorization (PA) for Quillichew ER. Common PA criteria include:

• Confirmed ADHD diagnosis
• Documentation that the patient cannot swallow tablets or capsules
• Trial of at least one preferred formulary stimulant (step therapy)
• Age 6 or older

Best practices for PA submissions:

1. Document swallowing difficulty clearly — Use specific language: "Patient is unable to swallow solid oral dosage forms" rather than "prefers chewable."
2. Note failed alternatives — If the patient tried and failed other formulations (e.g., couldn't tolerate Quillivant XR liquid or couldn't swallow Concerta), document this.
3. Include clinical rationale — Explain why the chewable extended-release format is medically necessary, not just convenient.
4. Appeal denials — First-time PA denials are common. Peer-to-peer reviews often succeed when you can speak directly to the plan's medical director.

Step Therapy and Formulary Exceptions

If the plan requires step therapy (trying cheaper alternatives first), document outcomes of previous trials. If those alternatives were clinically inappropriate or failed, request a formulary exception.

Common step therapy requirements may include trying:

• Generic immediate-release methylphenidate
• Generic extended-release methylphenidate (Concerta authorized generic)
• Quillivant XR (liquid methylphenidate ER)

Document why each was insufficient or inappropriate for the patient.

Discount Card Programs

For patients paying cash or with high-deductible plans, pharmacy discount cards can provide meaningful savings. While they typically won't bring Quillichew ER below the manufacturer co-pay card price for insured patients, they're useful for specific situations:

• SingleCare — Compare prices at multiple pharmacies
• GoodRx — Price comparison and coupons
• RxSaver — Another comparison tool
• BuzzRx — Free discount card

Patients can check multiple cards to find the lowest price at their preferred pharmacy. However, at $300–$450 retail for a brand-name product with no generic, these cards may only provide modest discounts compared to the manufacturer programs above.

For a comprehensive list of savings options from the patient perspective, see our guide on how to save money on Quillichew ER.

Additional Patient Assistance Resources

NeedyMeds

A nonprofit database of patient assistance programs. Patients can search for Quillichew ER at needymeds.org to find all available programs in one place.

RxAssist

Another comprehensive database of assistance programs at rxassist.org. Useful for staff who are helping patients navigate options.

State Pharmaceutical Assistance Programs (SPAPs)

Some states offer their own prescription assistance programs. Eligibility and benefits vary widely. Check your state's health department website for details.

Workflow Recommendations for Your Practice

Integrating cost conversations into your prescribing workflow doesn't have to be complicated. Here's a practical approach:

At the Point of Prescribing

1. Ask about insurance coverage — Before writing the prescription, find out if the patient's plan covers Quillichew ER
2. Provide the co-pay card — Hand every commercially insured patient a Tris Pharma co-pay card or the enrollment URL
3. Discuss cost upfront — "This medication can cost $300–$450 without help, but there are programs that can bring it down to $25 or even free. Let me show you."

For Uninsured Patients

1. Initiate the Pfizer RxPathways application at the visit
2. Provide a bridge prescription or samples if available
3. Set a follow-up to check on PAP status

When Prior Authorization Is Needed

1. Submit the PA the same day as prescribing
2. Use the plan's preferred PA form (usually available on the payer portal)
3. Include all supporting documentation upfront to avoid back-and-forth
4. Track and follow up — Designate a staff member to own PA tracking

Addressing the Shortage Factor

Cost becomes even more stressful for patients dealing with the Quillichew ER shortage. When patients finally find a pharmacy with stock, the last thing they need is a cost barrier preventing them from filling the prescription.

Proactively providing savings information ensures that when supply is available, cost doesn't become the second hurdle. Direct patients to MedFinder for Providers to help locate pharmacies with stock.

When to Consider Alternatives

If cost remains prohibitive despite all available programs, it may be clinically appropriate to consider alternatives:

• Quillivant XR — Another non-swallow option (liquid) by the same manufacturer; may have different formulary placement
• Generic methylphenidate ER — If the patient can tolerate capsules that can be opened and sprinkled (e.g., generic Ritalin LA)
• Immediate-release methylphenidate — Generic tablets that can be crushed; much cheaper but require multiple daily doses

For a complete comparison, see alternatives to Quillichew ER.

Key Takeaways for Providers

• Quillichew ER costs $300–$450 retail with no generic — cost is a major adherence barrier
• The Tris Pharma co-pay card can reduce cost to $25 for commercially insured patients
• Pfizer RxPathways provides free medication for eligible uninsured patients
• Prior authorization success depends on documenting swallowing difficulty and failed alternatives
• Build cost conversations and co-pay card distribution into your prescribing workflow
• When supply and cost both pose barriers, direct patients and staff to MedFinder for Providers