Quillichew ER Shortage: A Provider's Briefing for 2026

The ongoing ADHD stimulant shortage continues to challenge prescribers and their patients heading into 2026. Quillichew ER (methylphenidate HCl extended-release chewable tablets), manufactured by Tris Pharma, remains intermittently available across the U.S. This article provides a clinical and logistical overview to help providers navigate the shortage effectively.

Current Shortage Status

Quillichew ER has been affected by the broader methylphenidate shortage since 2022. While Tris Pharma reports continued production, pharmacy-level availability remains inconsistent. The American Society of Health-System Pharmacists (ASHP) lists methylphenidate extended-release oral products as currently in shortage, with increased demand identified as the primary driver.

Key contributing factors include:

• DEA quota constraints: Annual production quotas for Schedule II substances have been increased but have not fully bridged the supply-demand gap
• Single-source manufacturing: Quillichew ER has no generic equivalent and is produced solely by Tris Pharma, creating a single point of failure in the supply chain
• Growing patient population: ADHD diagnoses continue to rise, with telehealth expanding access to evaluation and treatment
• Formulary limitations: Many insurance plans do not cover Quillichew ER or require prior authorization, reducing pharmacy stocking incentives

Clinical Profile Review

Quillichew ER occupies a unique position in the ADHD treatment landscape:

• Formulation: Extended-release chewable tablet (cherry-flavored), 30% IR / 70% ER methylphenidate
• Available strengths: 20 mg, 30 mg, 40 mg
• Dose flexibility: The 20 mg tablet is scored and can be split into 10 mg halves; the 30 mg tablet can be split into 15 mg halves
• Dosing: Once daily in the morning, with or without food. Starting dose of 20 mg, titrated weekly in 10–20 mg increments. Maximum recommended dose: 60 mg/day
• Duration of action: Approximately 8 hours
• Indication: ADHD in patients aged 6 years and older
• PKU consideration: Contains phenylalanine (3 mg per 20 mg tablet, 4.5 mg per 30 mg, 6 mg per 40 mg)

The chewable formulation makes Quillichew ER particularly valuable for pediatric patients with pill aversion, dysphagia, or developmental conditions that make swallowing solid dosage forms difficult.

Therapeutic Alternatives and Switching Considerations

When Quillichew ER is unavailable, providers should consider the following alternatives based on the patient's ability to take different dosage forms:

For Patients Who Cannot Swallow Pills

• Quillivant XR (methylphenidate ER oral suspension): The most direct alternative. Same manufacturer, same drug class. Available as a reconstituted liquid dosed with an oral syringe. Requires refrigeration. Also by Tris Pharma, so may face similar supply constraints.
• Vyvanse chewable tablets (lisdexamfetamine): Available in 10–60 mg chewable tablets. Note this is a different stimulant class (amphetamine prodrug) requiring dose re-evaluation and monitoring during transition.
• Dyanavel XR (amphetamine ER oral suspension): Another liquid option from Tris Pharma. Amphetamine-based, not methylphenidate.

For Patients Who Can Use Capsule-Sprinkle Methods

• Ritalin LA (methylphenidate ER capsules): Capsule can be opened and beads sprinkled on applesauce. Available in 10–40 mg. 50% IR / 50% ER release profile.
• Aptensio XR (methylphenidate ER capsules): Similar sprinkle option with a wider range of strengths (10–60 mg). 40% IR / 60% ER profile.
• Jornay PM (methylphenidate ER capsules): Evening-dosed, morning-effective. Capsules can be opened and sprinkled. Novel chronotherapy approach.

For Patients Who Can Swallow Tablets

• Concerta (methylphenidate ER OROS tablets): Widely available including generics. 22% IR / 78% ER profile, closest pharmacokinetic match to Quillichew ER's 30/70 split. Must be swallowed whole.

Non-Stimulant Options

If stimulant supply is broadly constrained or if a patient is open to non-stimulant therapy:

• Atomoxetine (Strattera): Generic widely available. Takes 2–6 weeks for full effect.
• Viloxazine ER (Qelbree): Newer non-stimulant; approved for children 6+ and adults.
• Guanfacine ER (Intuniv): Alpha-2 agonist, generic available. Often used as adjunct or monotherapy.
• Clonidine ER (Kapvay): Alpha-2 agonist, generic available.

Dose Conversion Guidance

There is no universal dose-equivalence table for methylphenidate formulations due to differing release profiles. General principles:

• When switching between methylphenidate products, start with the nearest equivalent total daily dose
• Account for differences in IR/ER ratios, which affect onset and duration
• When switching from methylphenidate to amphetamine class, a common starting point is approximately half the methylphenidate dose (e.g., methylphenidate 40 mg ≈ amphetamine 20 mg), but individual titration is essential
• Monitor closely for 2–4 weeks after any switch

Insurance and Access Barriers

Quillichew ER faces significant coverage barriers:

• Not covered by most Medicare Part D plans
• Many commercial plans require prior authorization or step therapy
• No generic available, so tier placement is typically non-preferred brand or specialty

To support your patients with access:

• Tris Pharma Co-pay Savings Program: Commercially insured patients may pay as little as $25/Rx. Register at coupon.trisadhd.com or call 1-888-840-7006
• Pfizer RxPathways: Patient assistance for eligible uninsured/underinsured patients. Visit pfizerrxpathways.com
• Pharmacy availability tools: Direct patients to MedFinder for Providers to help locate pharmacies with current stock

Proactive Prescribing Strategies

To minimize disruption to your patients' treatment:

1. Verify availability before prescribing: Contact the patient's pharmacy or use MedFinder to confirm stock before sending the prescription
2. Document medical necessity: Pre-emptively document why Quillichew ER is medically necessary (e.g., pill aversion, dysphagia, prior treatment failures) to streamline prior authorization
3. Develop a backup protocol: Establish a plan B medication for each Quillichew ER patient so transitions are smooth if supply lapses
4. Submit prior authorizations early: Don't wait for the pharmacy to trigger the PA. Submit concurrently with the prescription
5. Consider 90-day supplies: When the medication is available, prescribing a 90-day supply (where state law permits for CII) can reduce the frequency of refill-related stockouts

Resources for Providers

• MedFinder for Providers — Pharmacy stock lookup tool
• ASHP Drug Shortage Resource Center — Current shortage listings and clinical guidance
• FDA Drug Shortage Database — Official FDA shortage status
• Tris Pharma Savings Card — Patient savings program
• How to Help Your Patients Find Quillichew ER in Stock — Our companion provider guide

The Bottom Line

The Quillichew ER shortage is a supply-side problem compounded by regulatory constraints and a growing patient population. Proactive prescribing, familiarity with therapeutic alternatives, and awareness of patient assistance resources can help providers maintain treatment continuity for their ADHD patients. Stay informed, plan ahead, and leverage tools like MedFinder to keep your patients on track.