Why Medication Cost Matters for Adherence

You can write the perfect prescription, but if your patient can't afford to fill it, it doesn't matter. Cost is one of the most common reasons patients abandon or ration their ADHD medications — and with brand Zenzedi (Dextroamphetamine Sulfate) running $550–$650 for 60 tablets without insurance, affordability isn't a minor concern. It's an adherence barrier that directly impacts treatment outcomes.

This guide walks you through the savings programs, generic options, and practical strategies you can use to help your patients access Zenzedi — or its generic equivalent — without breaking the bank.

What Your Patients Are Paying

Understanding the current pricing landscape helps you have informed conversations with patients:

• Brand Zenzedi (cash price, no insurance): $550–$650 for 60 tablets
• Generic Dextroamphetamine Sulfate IR (with discount coupon): $30–$80 for 60 tablets
• Generic Dextroamphetamine Sulfate IR (retail, no coupon): $150–$400 depending on dose and pharmacy

The price difference between brand and generic is staggering — often 10x or more. For many patients, the generic is the only viable option. Even with insurance, brand Zenzedi frequently requires prior authorization and may not be covered at all.

Insurance Coverage Overview

• Generic Dextroamphetamine: Covered by most commercial plans (Tier 2) and Medicare Part D
• Brand Zenzedi: Often requires prior authorization; may require step therapy (trying generic first); some plans exclude it entirely

If a patient's insurance denies brand Zenzedi, you may need to submit a prior authorization or letter of medical necessity explaining why the brand is required over generic.

Manufacturer Savings Programs

Zenzedi Savings Card (Azurity/Arbor)

The manufacturer offers a savings card through the Arbor E-Z Rx network of over 4,000 independent pharmacies:

• Cash-paying patients: Pay no more than $75 per prescription
• Insured patients: First prescription may be free; subsequent refills at $30 each
• Maximum savings: Up to $185 per prescription per month
• Annual limit: Up to 360 tablets per year

Key details for your workflow:

• The card works only at participating pharmacies in the Arbor E-Z Rx network — primarily independent pharmacies, not major chains
• Patients can enroll online or you can keep enrollment cards in your office
• This program may not be combined with government insurance (Medicare, Medicaid, Tricare)

Consider stocking the savings card information in your office so you can hand it to patients at the time of prescribing.

Coupon and Discount Card Programs

For patients filling generic Dextroamphetamine, third-party coupon programs can dramatically reduce out-of-pocket costs. These are free for patients to use and don't affect their insurance:

• GoodRx — Widely used; shows prices at multiple pharmacies; generic Dextroamphetamine often $30–$60 for 60 tablets
• SingleCare — Similar to GoodRx; accepted at most major chains
• RxSaver — Another comparison tool for pharmacy pricing
• BuzzRx — Free discount card with competitive pricing
• Optum Perks — Backed by UnitedHealth Group; good coverage at chain pharmacies

Remind patients that coupon prices vary by pharmacy and dose — they should compare prices at multiple locations. Sometimes independent pharmacies offer better coupon prices than chains, and vice versa. For a comprehensive patient-facing guide, you can direct them to our article on how to save money on Zenzedi.

Patient Assistance Programs

For patients who are uninsured or underinsured and meet income requirements, these programs may provide medications at no cost or significantly reduced prices:

Azurity Patient Assistance Program

The manufacturer of Zenzedi offers a patient assistance program for qualifying patients. Eligibility typically requires:

• No prescription drug coverage (or inadequate coverage)
• Household income below a specified threshold (often 200–400% of the Federal Poverty Level)
• U.S. residency

Third-Party Assistance Programs

• NeedyMeds (needymeds.org) — Comprehensive database of patient assistance programs, discount drug cards, and disease-specific resources
• RxAssist (rxassist.org) — Directory of pharmaceutical company assistance programs
• RxHope (rxhope.com) — Helps patients apply for manufacturer assistance programs

Consider having your staff become familiar with these programs so they can assist patients with applications. Some programs require a provider signature or letter of medical necessity.

Generic Alternatives and Therapeutic Substitution

The single most impactful thing you can do for a cost-burdened patient is consider whether generic Dextroamphetamine Sulfate IR will work instead of brand Zenzedi. For most patients, the generic is therapeutically equivalent and costs 85–95% less.

If a patient is not responding well to generic Dextroamphetamine (some patients report differences in efficacy between manufacturers), you might consider:

Generic Dextroamphetamine Sulfate IR

Multiple generic manufacturers produce immediate-release Dextroamphetamine tablets. If one manufacturer's version doesn't work well for a patient, try requesting a different manufacturer at the pharmacy.

Therapeutic Alternatives

If Zenzedi specifically is unavailable or unaffordable, these alternatives in the same or related drug classes may be appropriate, depending on the patient's clinical picture:

• Adderall (Mixed Amphetamine Salts): More widely available, lower cost as generic; contains both Dextroamphetamine and Levoamphetamine
• Vyvanse (Lisdexamfetamine): Prodrug of Dextroamphetamine; longer-acting; lower abuse potential; recently became available as generic in some markets
• Methylphenidate (Ritalin, Concerta): Different stimulant class; may work better for some patients; widely available as generic
• Xelstrym (Dextroamphetamine Patch): Same active ingredient as Zenzedi; transdermal delivery; newer product so may be more expensive

For a detailed clinical comparison, see our provider guide on the Zenzedi shortage and what prescribers need to know.

Building Cost Conversations Into Your Workflow

Many patients won't volunteer that they can't afford their medications. They'll just not fill the prescription — or they'll ration doses, skip days, or split tablets. Here are practical ways to address cost proactively:

At the Point of Prescribing

• Ask about cost concerns — A simple "Is cost a concern for this medication?" opens the door.
• Default to generic when appropriate — Write for "Dextroamphetamine Sulfate" and allow substitution unless there's a clinical reason for brand.
• Provide savings resources — Hand patients the manufacturer savings card info or a printed list of coupon programs.
• Check formulary coverage — If you have access to e-prescribing tools with formulary data, verify coverage before sending the prescription.

At Follow-Up Visits

• Ask if they filled the prescription — A surprising number of patients don't, and cost is often the reason.
• Monitor for rationing behavior — Taking lower doses than prescribed, skipping weekend doses, or running out early can all signal affordability issues.
• Reassess regularly — Insurance formularies change annually. A medication that was covered last year may not be this year.

For Your Staff

• Train front-office and clinical staff on the most common savings programs
• Keep a "cost resources" handout updated with current coupon card options and PAP contact information
• Consider designating a staff member as the go-to person for medication affordability questions

Finding Pharmacies With Stock

Cost savings don't matter if the patient can't find the medication. During the ongoing stimulant shortage, help patients locate pharmacies with Zenzedi in stock using Medfinder for Providers. You can also point patients to our guide on checking pharmacy stock without calling.

Final Thoughts

Medication cost shouldn't be a barrier to effective ADHD treatment, but for many patients on Zenzedi, it is. The good news is that between generic alternatives ($30–$80 with coupons), manufacturer savings cards ($75 or less per fill), and patient assistance programs, there are real options available. The challenge is that patients often don't know about them — or don't know how to access them. As a provider, you're in a unique position to bridge that gap. Build cost conversations into your workflow, keep savings resources handy, and consider generic Dextroamphetamine as your default when clinically appropriate. Your patients' adherence — and outcomes — will benefit.