Your Patients Can't Find Their Medication — Here's How You Can Help

As a prescriber, you've likely heard the same frustrated refrain from your ADHD patients over the past three years: "My pharmacy doesn't have my Focalin XR." The national stimulant shortage that began in late 2022 continues to disrupt treatment for patients on Dexmethylphenidate ER, and many feel they're navigating it alone.

You can't fix the shortage. But you can significantly reduce the burden it places on your patients. This guide outlines practical, actionable steps you can incorporate into your clinical workflow to help patients maintain access to their ADHD treatment.

Current Availability of Focalin XR

As of early 2026, Dexmethylphenidate ER remains on the ASHP drug shortage list. Key points about current availability:

• Multiple manufacturers (Par, Teva, and others) report intermittent supply across various strengths
• Some manufacturers have released short-dated product (expiration mid-2026)
• The most commonly prescribed strengths (10 mg, 20 mg) tend to be the hardest to find
• Supply varies significantly by region — a pharmacy 30 minutes away may have stock when local pharmacies don't
• Brand-name Focalin XR from Novartis has limited availability

For the latest manufacturer-specific updates, the ASHP Drug Shortage Resource Center is the most reliable source.

Why Patients Can't Find Focalin XR

Understanding the barriers your patients face can help you intervene more effectively:

Pharmacies Won't Confirm Controlled Substance Inventory

Many pharmacies have policies against disclosing inventory for Schedule II medications over the phone, for understandable security reasons. This means patients may need to physically visit multiple pharmacies or rely on their prescriber to call on their behalf.

Chain Pharmacy Ordering Limitations

Large chain pharmacies often have centralized ordering systems with limited flexibility. If the distribution center doesn't have Dexmethylphenidate ER in stock, the pharmacy can't order it — regardless of patient need.

Insurance Complications

Even when patients find a pharmacy with stock, insurance-related barriers (wrong pharmacy network, prior authorization requirements, quantity limits) can prevent them from filling. Patients dealing with a shortage are often simultaneously dealing with administrative hurdles.

Geographic Disparities

Rural areas and regions with fewer pharmacies are disproportionately affected. A patient in a metropolitan area might have 30 pharmacies to check; a patient in a rural county might have two or three.

What Providers Can Do: 5 Actionable Steps

Step 1: Check Availability Before Prescribing

Rather than writing a prescription and hoping the patient can fill it, take a proactive approach. Use Medfinder to check which local pharmacies currently have Dexmethylphenidate ER in stock before you send the prescription. This takes 30 seconds and can save your patient hours of frustration.

If Focalin XR isn't available locally, you'll know immediately and can discuss alternatives or direct the prescription to a pharmacy that has stock — even if it's further from the patient's home.

Step 2: Have a Backup Medication Plan Ready

For every patient on Focalin XR, consider having a documented backup plan in their chart. This should include:

• An equivalent dose of an alternative stimulant (e.g., Concerta, Ritalin LA, or an amphetamine-based option)
• Whether the patient has been counseled about the backup option
• Any insurance or prior authorization considerations

When the patient calls to say they can't fill their prescription, your staff can quickly pivot to the backup plan without requiring a full office visit. This reduces treatment gaps and saves clinical time.

Step 3: Prescribe Flexibly When Possible

During a shortage, small prescribing adjustments can improve your patient's chances of finding their medication:

• Consider alternate strengths: If 20 mg capsules are unavailable, two 10 mg capsules might be in stock. Similarly, less common strengths like 15 mg or 35 mg may have better availability.
• Immediate-release bridge: Focalin IR (Dexmethylphenidate immediate-release) uses the same active ingredient and may be available when the ER formulation isn't. Divide the total daily ER dose into 2 IR doses given 4 hours apart.
• Send to a different pharmacy: If you identify a pharmacy with stock via Medfinder, e-prescribe directly there. Patients often don't realize their prescriber can route prescriptions to any licensed pharmacy.

Step 4: Streamline Prior Authorizations for Switches

Medication switches during a shortage often trigger prior authorization requirements. You can reduce delays by:

• Using standardized shortage-related language in PA submissions: "Switching from Dexmethylphenidate ER due to national drug shortage — patient's current medication is unavailable at all local pharmacies"
• Keeping a template for shortage-related PAs that your staff can submit quickly
• Proactively requesting PA for the backup medication before the primary medication runs out
• Documenting previous medication trials in a format that insurers can easily review

Step 5: Educate Your Patients

Many patients don't know the tools and strategies available to them. Take a moment to share:

• Medfinder — a free tool to check pharmacy stock for Focalin XR and other medications
• Independent pharmacies — often have different supply chains than the big chains
• Early refills — most states allow filling Schedule II prescriptions 1-2 days early
• Cost-saving resources — share our guide to saving money on Focalin XR with patients facing cost barriers

Alternative Medications to Consider

When Focalin XR isn't available, these are the most common alternatives with approximate dose conversions:

• Concerta (Methylphenidate ER): 2:1 dose ratio (Focalin XR 20 mg ≈ Concerta 36-54 mg). OROS release system, ~12-hour duration.
• Ritalin LA (Methylphenidate ER): 2:1 dose ratio. Bimodal release, ~8-hour duration. Capsules can be opened and sprinkled.
• Vyvanse (Lisdexamfetamine): Different drug class (amphetamine). No direct dose conversion — start low and titrate. ~14-hour duration. Generic now available.
• Adderall XR (Mixed Amphetamine Salts ER): Different drug class. No direct conversion. ~10-12 hours. Also affected by shortages but may have better availability in some regions.

For more details on alternatives, see Alternatives to Focalin XR.

Workflow Tips for Your Practice

Integrating shortage management into your practice workflow can reduce the burden on both providers and staff:

• Add a shortage check to your refill workflow: Before sending any Focalin XR refill, have staff verify availability via Medfinder
• Create a patient handout: A one-page document with shortage information, links to Medfinder, and your office's backup plan process
• Use secure messaging: Let patients report availability issues via your patient portal to reduce phone calls
• Batch shortage-related tasks: Designate a time each day for handling shortage-related prescription changes and PAs
• Track which strengths/manufacturers are available: Keeping a running list (updated weekly) can help you make smarter prescribing decisions

Final Thoughts

The Focalin XR shortage is a systemic problem that requires systemic solutions — increased manufacturing capacity, adjusted DEA quotas, and improved supply chain resilience. But at the point of care, you can make a meaningful difference by being proactive, flexible, and resourceful.

Your patients are already frustrated. Meeting them with a plan — rather than a shrug — builds trust and maintains treatment continuity during a challenging time.

For additional resources, visit medfinder.com/providers. For the latest shortage data, see our provider shortage briefing.