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Illinois Medicaid - HFSMedicaid · Coverage · Provider Notice · IL · Pediatrics, Psychiatry, NeurologyMedium impact

PDL Update to Brand-name Focalin XR Capsules

Act
by Aug 7, 2026
Effective date
Jul 24, 2026
Identified
Aug 8, 2026

Summary

The manufacturer of brand-name Focalin XR (dexmethylphenidate extended-release) capsules has discontinued production. Illinois Medicaid has designated generic dexmethylphenidate ER capsules as preferred while continuing to list brand-name Focalin XR as preferred on the PDL until inventory is depleted. This change applies to both Fee-For-Service and Managed Care Organizations effective July 24, 2026.

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What to do

by Aug 7, 2026 · 5 steps
01Billing and pharmacy teams should monitor prescription claims for Focalin XR brand-name to identify when patients transition to generic dexmethylphenidate ER.
02Update internal records and patient communication templates to reflect the preferred status of generic dexmethylphenidate ER.
03Coordinate with prescribing providers (physicians and APRNs) to encourage generic substitution for new prescriptions.
04No immediate billing code changes required, but ensure claims processing systems are prepared to accept both brand-name (while inventory lasts) and generic formulations without denial.
05Contact the Bureau of Professional and Ancillary Services at 877-782-5565 with coverage questions.

Original notice

PDL Update to Brand-name Focalin XR Capsules
hfs.illinois.gov · Always check the source before changing claims.
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Related policy hubs

Illinois Medicaid - HFS policiesIL policy changesPediatricsPsychiatryNeurology

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