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Most patients respond well to older, lower-cost ADHD medications.

Newer ADHD drugs mainly differ in duration and release, not brain effects.

Higher-cost options may help those needing longer or more tailored coverage.

Insurance hurdles and cost often limit access to newer treatments.

When your child or teenager has ADHD, you face many difficult decisions, including whether or not to use medications to control the symptoms. In the last decade or two, a number of new medications for ADHD have been released. As usual, new drugs available only in brand-name form tend to be very expensive, and most insurance plans don’t include them in their formulary. This means you have to pay $500 or more out of pocket each month or go through a very arduous preauthorization process and often multiple appeals to get these approved. Are these new medications worth it?

Brief history of ADHD medications

The modern era of medications for ADHD started in the mid-20th century. One of the most commonly used medications, methylphenidate, was introduced in 1957 and has been on the market continuously ever since. Use of various forms of amphetamine also has a long history, and as of today, all stimulant-type medications for ADHD are versions or derivatives of these two.

These longstanding ADHD medications are not only widely available—they are also very inexpensive. So, who needs the recent and much more expensive versions?

The pharmacology of stimulants

The brain action of most stimulants is very similar, and newer versions pretty much work in the brain like the older medications, so it would seem that recent versions don’t bring anything new to the table. But what they do in the brain is only part of the story. The real difference between the older, cheaper versions and newer alternatives lies in the onset of effect and the duration of action.

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