DETERMINE ELIGIBILITYIS THE FOCALIN XR® CO-PAY CARD* RIGHT FOR YOU?

To find out if you are eligible for the FOCALIN XR Co-Pay Card, simply answer the questions below. Please note that this information must be entered by you or a caregiver, and cannot be entered by a third party.

focalin savings card
*
Limitations apply. Up to a $720 annual limit. Offer not valid under Medicare, Medicaid, or any other federal or state program. Novartis reserves the right to rescind, revoke, or amend this program without notice. Limitations may apply in MA and CA. See complete Terms & Conditions for details.

1.

I certify that I am over the age of 18 and that I am the patient, or have the patient's consent/legal authority to enroll in the FOCALIN XR Co-Pay Card.

YES

NO

You must be 18 years or older to complete this enrollment form. Please have a parent or caregiver who is at least 18 years of age complete the enrollment process or call 1-866-877-4633.

2.

Do you have private (non-governmental) insurance to cover the costs of your prescription medication? This includes, but is not limited to, employer-sponsored plans, including the Federal Employees Health Benefits (FEHB) Program, or plans from the Health Care Marketplace ("Exchanges").

YES

NO

Patient IneligibleIt doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as it's only valid for those with private (non-governmental) insurance. If you are unsure about your type of insurance, please contact your insurer or call 1-800-245-5356 to find out if there are other forms of support for you. Learn more.

3.

Are you a resident of Massachusetts or California?

YES

NO

Patient IneligibleIt doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid for Massachusetts or California residents. Please call 1-800-245-5356 to find out if there are other forms of support for you. Learn more.

4.

Are you enrolled in a federal or state health care program or plan that helps cover the cost of your prescription medication? This includes, but is not limited to, Medicare Part D, Medicare Advantage, Medicaid, VA, DoD, TRICARE, and any other government-sponsored pharmaceutical benefit program.

YES

NO

Patient IneligibleIt doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid under Medicare, Medicaid, or any other federal or state program. If you are unsure about your type of insurance, please contact your insurer or call 1-800-245-5356 to find out if there are other forms of support for you. Learn more.

5.

Are you paying cash for the full price of the prescription?

YES

NO

Patient IneligibleIt doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid for cash-paying patients. Please call 1-800-245-5356 to find out if there are other forms of support for you. Learn more.

*Terms and conditions

Limitations apply. Valid only for those with private insurance. The Program includes the Co-Pay Card, Payment Card (if applicable), and Rebate, with a combined annual limit up to $720. Patient pays the first $10 of co-pay. Novartis pays up to the next $60 per 30-day supply. Patient is responsible for any costs once limit is reached in a calendar year. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, (iii) where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. The value of this Program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this Program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. Offer not valid in CA or MA. This Program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.

INDICATION

What is FOCALIN XR?

  • FOCALIN XR is a central nervous system (CNS) stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). FOCALIN XR may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.
  • FOCALIN XR should be used as a part of a total treatment program for ADHD that may include counseling or other therapies

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about FOCALIN XR?

FOCALIN XR is a federal controlled substance (CII) because it can be abused or lead to dependence. Keep FOCALIN XR in a safe place to prevent misuse and abuse. Selling or giving away FOCALIN XR may harm others, and is against the law.

Tell your doctor if you or your child have abused or been dependent on alcohol, prescription medicines, or street drugs.

Who should not take FOCALIN XR?

FOCALIN XR should not be taken if you or your child:

  • are allergic to methylphenidate hydrochloride, or any of the ingredients in FOCALIN XR.
  • are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.

The following have been reported with use of methylphenidate hydrochloride and other stimulant medicines:

  • Heart-related problems: Sudden death in patients who have heart problems or heart defects, stroke and heart attack in adults, increased blood pressure and heart rate. Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting FOCALIN XR and then check blood pressure and heart rate regularly during treatment with FOCALIN XR. Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking FOCALIN XR.
  • Mental (psychiatric) problems: New or worse behavior and thought problems, new or worse bipolar illness, new or worse aggressive behavior or hostility, new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms. Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression. Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking FOCALIN XR, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

FOCALIN XR may not be right for you or your child.

Before starting FOCALIN XR, tell your or your child's doctor:

  • if you are pregnant or plan to become pregnant. It is not known if FOCALIN XR will harm your unborn baby. Talk to your doctor if you are pregnant or plan to become pregnant.
  • if you are breastfeeding or plan to breastfeed. FOCALIN XR passes into your breast milk. You and your doctor should decide if you will take FOCALIN XR or breastfeed.

Tell your doctor about all of the medicines that you or your child takes, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not start any new medicine while taking FOCALIN XR without talking to your doctor first.

What are the possible side effects of FOCALIN XR?

FOCALIN XR may cause serious side effects, including:

  • painful and prolonged erections (priapism) have occurred with methylphenidate. If you or your child develops priapism, seek medical help right away. Because of the potential for lasting damage, priapism should be evaluated by a doctor immediately.
  • circulation problems in fingers and toes (peripheral vasculopathy, including Raynaud's phenomenon), where fingers or toes may feel numb, cool, painful, or may change color from pale, to blue, to red. Tell your doctor if you or your child have numbness, pain, skin color change, or sensitivity to temperature in the fingers or toes.
  • Call your doctor right away if you have or your child has any signs of unexplained wounds appearing on fingers or toes while taking FOCALIN XR.
  • slowing of growth (height and weight) in children. Children should have their height and weight checked often while taking FOCALIN XR. Treatment may be stopped if a problem is found during these check-ups.

Common side effects include:

  • Children (6–17 years): Dyspepsia, decreased appetite, headache, anxiety
  • Adults: Dry mouth, dyspepsia, headache, anxiety, pharyngolaryngeal pain

FOCALIN XR can be taken with or without food. Do not chew, crush, or divide the capsules or the beads in the capsule. If you or your child cannot swallow the capsule, open it and sprinkle the small beads of medicine over a spoonful of applesauce and swallow it right away without chewing.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call
1-800-FDA-1088.

Please see full Prescribing Information, including Boxed WARNING, and Medication Guide .