FillMapSummaCare Gold 2000 with 3 Free PCP Visits · 52664-52664OH1530026-0About this plan

Does SummaCare Gold 2000 with 3 Free PCP Visits cover methylphenidate?

1 · Your plan

SummaCare Gold 2000 with 3 Free PCP Visits

52664-52664OH1530026-0 · ACA · ACA Marketplace

2 · Your medication

methylphenidate

methylphenidateunder SummaCare Gold 2000 with 3 Free PCP Visits

Covered — some forms require prior authorization

5 of 29 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.

Tier: Non preferred generic
Approval first: Required
Try another first: No
Amount limit: Yes

Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (29)

30/70 Release 24 HR methylphenidate hydrochloride 10 MG Extended Release Oral CapsuleAmount limit
30/70 Release 24 HR methylphenidate hydrochloride 20 MG Extended Release Oral CapsuleAmount limit
30/70 Release 24 HR methylphenidate hydrochloride 30 MG Extended Release Oral CapsuleAmount limit
30/70 Release 24 HR methylphenidate hydrochloride 40 MG Extended Release Oral CapsuleAmount limit
30/70 Release 24 HR methylphenidate hydrochloride 50 MG Extended Release Oral CapsuleAmount limit
30/70 Release 24 HR methylphenidate hydrochloride 60 MG Extended Release Oral CapsuleAmount limit
50/50 Release 24 HR methylphenidate hydrochloride 10 MG Extended Release Oral CapsuleAmount limit
50/50 Release 24 HR methylphenidate hydrochloride 20 MG Extended Release Oral CapsuleAmount limit
50/50 Release 24 HR methylphenidate hydrochloride 30 MG Extended Release Oral CapsuleAmount limit
50/50 Release 24 HR methylphenidate hydrochloride 40 MG Extended Release Oral CapsuleAmount limit
50/50 Release 24 HR methylphenidate hydrochloride 60 MG Extended Release Oral CapsuleAmount limit
8 HR methylphenidate hydrochloride 10 MG Extended Release Oral TabletAmount limit
8 HR methylphenidate hydrochloride 20 MG Extended Release Oral TabletAmount limit
8 HR methylphenidate hydrochloride 20 MG Extended Release Oral Tablet [Metadate]Approval firstAmount limit
9 HR methylphenidate 1.11 MG/HR Transdermal SystemApproval firstAmount limit
9 HR methylphenidate 1.67 MG/HR Transdermal SystemApproval firstAmount limit
9 HR methylphenidate 2.22 MG/HR Transdermal SystemApproval firstAmount limit
9 HR methylphenidate 3.33 MG/HR Transdermal SystemApproval firstAmount limit
BX Rating 24 HR methylphenidate hydrochloride 18 MG Extended Release Oral TabletAmount limit
BX Rating 24 HR methylphenidate hydrochloride 27 MG Extended Release Oral TabletAmount limit
BX Rating 24 HR methylphenidate hydrochloride 36 MG Extended Release Oral TabletAmount limit
BX Rating 24 HR methylphenidate hydrochloride 54 MG Extended Release Oral TabletAmount limit
methylphenidate hydrochloride 10 MG Chewable TabletAmount limit
methylphenidate hydrochloride 10 MG Oral TabletAmount limit
methylphenidate hydrochloride 2 MG/ML Oral Solution
methylphenidate hydrochloride 2.5 MG Chewable TabletAmount limit
methylphenidate hydrochloride 20 MG Oral TabletAmount limit
methylphenidate hydrochloride 5 MG Chewable TabletAmount limit
methylphenidate hydrochloride 5 MG Oral TabletAmount limit

← All coverage for methylphenidate