Jay Tarnow, MD

Many Insurance companies are taking Intuniv and Focalin off of their formularies and therefore the cost to the consumer has increased tremendously, in some cases $300. This is a tactic by the insurance company to lower their costs and to shift that cost on to the consumer. This is an unfortunate situation and in my opinion unwise. The insurance companies say this is to lower healthcare costs but they are just passing the responsibility back to the consumer by forcing the consumer to purchase generic formularies. However, the generic for Intuniv is very different. The generic (guanfacine or Tenex) is short acting and must be given at least twice per day. The most common side effect of the generic medication is sedation. The beauty of Intuniv is that it is long acting and can be given once daily. I prescribe the generic medication in the evening and it helps ADHD children fall asleep. As you know going to sleep can be a real chore for ADHD children and their parents. So what should a parent do? Schedule an appointment for one month.

The doses are not comparable so we will need to make the following changes:

1. Stop the Intuniv slowly by decreasing 1mg every three days
2. Then restart on guanfacine by giving 1mg every three days
3. Then add half pill to that for three days
4. Then go to 2mg (2 - 1mg pills) for one week
5. After a week I try to reduce the evening dose to 1.5mg (one and half pill) in the evening and use the other half for the A.M.
6. By doing this, I am trying to minimize the sedation during the day. After 1 week I then move the other half tablet from the evening to the morning, thus the child is taking 1mg in the morning and 1mg in the evening.

If the child needs more and can tolerate without the sedation side effect, we can then add to the middle of the day. So are you now confused, tense, and worried? That is why I say that insurance companies removing Intuniv from the formulary and thereby “incentivizing” parents to use the generic is unwise. Each child has variations on how they metabolize medication, therefore it may not go as planned and you may need to contact your doctor again to adjust the dosage (This is why I recommend Pharmacogenomic Testing). All of this adjusting takes at least 15minutes of a physician’s time and that would be approximately $80-100 per patient. So are the costs really lower? Or have we just shifted the costs? What about the cost to the parent’s time, and the cost of the child being overly sedated in school?

We have been having the same problem with insurance companies removing Focalin XR from their formulary. The patients I put on Focalin are those with ADHD/ADD that also have anxiety. Focalin is the stimulant that causes the least amount of anxiety. This is based on research and my many years of experience. Focalin is the dextro stereoisomer of methylphenidate. It is different than other forms of methylphenidate such as Concerta, Metadate CD, Ritalin LA, methylin, and methylphenidate ER; since these all are mixed stereoisomers of the dextro and levo forms. Therefore, when FocalinXR is taken off the formulary we now have to experiment. Many of the patients who were placed on FocalinXR probably had a trial of another stimulant that caused side effects. Usually the insurance companies will pay for the generic dexmethylphenidate but this only last 4 hours so the patient will need to take a dose in the middle of the day. Many children have rebound when taking the short acting forms. If the child is in school this means the child visiting the school nurse, if there is one. If not, the school will need to hire one.

Is this really decreasing the costs? I suggest parents get in touch with their Human Resource Directors to inform them of the problem.

Good Luck!

Jay Tarnow, M.D.

Stop Letting the Illness Manage You and Your Family:  The Tarnow Center Chronic Illness Self-Management Program

As a parent, there is nothing you wouldn’t do to keep your children healthy and safe.  This is why having a child diagnosed with a chronic illness is perhaps one of the most difficult, life-changing events to happen to families.  There are a number of chronic illnesses that affect children and adolescents such as:

• Asthma
• Cancer
• Cerebral palsy
• Cystic fibrosis
• Diabetes
• Epilepsy
• Inflammatory bowel disease
• Juvenile rheumatoid arthritis
• Sickle cell disease
• Spina bifida

The Tarnow Center Chronic Illness Self-Management Program aims to provide children, adolescents, and their families with the skills necessary to successfully manage and cope with chronic illness and thereby reduce or prevent the occurrence of negative outcomes.  We do this by offering a range of services, including:

• Comprehensive psychological evaluations
• Individual therapy
• Family therapy
• Group therapy
• Biofeedback
• Neurofeedback
• Collaboration with Center psychiatrists for medication therapy

For more information about our Program or to get started on the path toward managing your child’s chronic illness, please contact Dr. Melissa Carpentier at 713-621-9515 or email This email address is being protected from spambots. You need JavaScript enabled to view it..

I have the wonderful privilege of serving Houston families and their children diagnosed with autism and learning differences. The circumstances surrounding our meetings usually involve their child’s recent diagnosis of autism. Parents attend aba therapy sessions, and are often in crisis about their child’s condition. Parents seek out applied behavioral therapies with the hopes that their child will recover, and grow up to have a “normal” life. Some of the first questions parents ask are these:

How long will my child require aba therapy?

When will my child be able to attend a normal school?

Time and again parents seek out reassurance that their child’s symptoms will subside quickly. Having been in their shoes, I can hardly blame their panic, and questions about a potential end to their child’s condition.

I too asked the developmental pediatrician who diagnosed my child: “What will PDD-NOS look like as my son gets older?” I too asked: “Will my child be able to attend a typical school?” Like so many of my clients, I sat in dismay as the pediatrician responded that he did not know what my son would look like as he got older, and that he did not know if he would be able to attend a normal school. In those moments I felt completely in the dark, but looking back I realize it was the absolute best thing the pediatrician could have told me.

As a parent some of the hardest feelings to manage are powerlessness and uncertainty surrounding our children. Years ago the pediatrician did not give me answers. I was left with a helpless sense of not knowing. My son’s future was left as a huge blank, with nothing to fill in. I was powerless to know what my son’s outcome would be.

As a behavior analyst I am unable to provide parents with absolutes in predicting their child’s growth and learning. Like the pediatrician, I do not know how long my clients will require behavioral supports or whether they will have success in a typical school. I cannot predict that my clients will develop meaningful relationships with peers. I cannot predict if they will learn to participate in organized sports, or ultimately attend college. Parents can choose to be alarmed by the uncertainty of what is too come, or they can hold on with hopeful anticipation of what might fill in the blank, of their child’s story.

It has been my experience that the pediatrician who diagnosed my child could have never predicted that he would end up in a mainstream classroom, at Stratford High School. It is also my experience that the pediatrician could have never predicted that my son would be ranked as the top 50th basketball player in the state of Texas, in the class of 2018. The pediatrician could have never predicted that my son would voluntarily give me bear hugs and tell silly jokes that make us laugh. As it turns out, leaving my son’s story unfinished also left us wide open to many possibilities that were unimaginable. We work continue to work hard to assist my son to fill in the “blank”, and it appears that he is just getting started!

I often challenge parents to take a deep breath. I reassure parents that not knowing what is going to happen may not be the worst thing. I often remind parents that children are resilient, and that learning is happening all of the time (even when you least expect). I encourage parents to consider their child’s progress, no matter how small. I encourage parents to be patient, and to be open to new possibilities for their child. I tell parents that their child may teach them a thing or two, after it is all said and done.

My deepest wish is that parents read this article and remain hopeful. I am a behavior analyst, but my first priority is that of a parent. I encourage my fellow parents to get ready! For I truly believe the best is yet to come! I would love to meet you and your child. Please call and make an appointment at the Tarnow Center today!