Titration and ongoing costs

Why diagnosis is often not the final cost

For many people, a diagnosis is not the end of the journey but the start of a new phase. If medication is being considered for ADHD, this usually involves a process called titration, and ongoing monitoring afterwards. These stages can carry their own costs, which are separate from the original assessment fee. Because arrangements differ between providers and between NHS and private pathways, it's essential to ask directly what's involved and what it might cost before you commit.

What is titration?

Titration is the process of starting a medication at a low dose and adjusting it gradually, under clinical supervision, to find a dose and type that suits the individual. This typically involves several appointments to review how things are going, check for side effects, and make adjustments as needed. Titration is a clinical decision made between you and a qualified prescriber - it is not something this guide can advise on, and any decisions about medication should always be made with a qualified clinician.

Why titration can involve extra cost

Because titration usually requires multiple appointments over a period of time, it's often priced separately from the initial diagnostic assessment. Some providers include an initial period of titration within their overall package; others charge per appointment. It's worth asking:

• Is titration included in my assessment fee, or charged separately?
• How many appointments are typically involved, and how are they spaced out?
• What happens if more appointments are needed than expected?
• Who prescribes and dispenses the medication, and are there separate pharmacy costs?

Shared care arrangements

After titration, ongoing prescribing is often transferred to a GP through what's called a shared care agreement, where the specialist and GP work together to manage prescriptions. Not all GP practices agree to shared care, and this can vary by area and by practice, so it's worth asking your GP early on whether they would be able to support this arrangement. If shared care isn't available, ongoing prescribing may need to continue through the private provider, which can carry its own ongoing costs.

Ongoing monitoring and review appointments

Beyond titration, many people benefit from periodic review appointments to check how a medication or support plan is working over time. These reviews may be provided by the NHS, by a private clinic, or through a mix of both. It's reasonable to ask any provider what ongoing monitoring they recommend, how often, and what it costs.

Costs beyond medication

Ongoing costs aren't only about medication. Some people choose to access further support after diagnosis, such as coaching, therapy or workplace assessments. These are usually separate services with their own costs, and are entirely optional - there's no requirement to purchase additional support from the same provider that carried out your assessment.

Planning ahead

Because ongoing costs can add up over time, it can help to think beyond the initial assessment fee when planning. Before starting a private pathway, consider asking the provider for an outline of what the full journey - from assessment through titration and into ongoing care - might typically look like for someone in your situation, while remembering that this can only ever be an estimate, not a guarantee.

Speak to a qualified clinician

Decisions about medication, dosage and ongoing monitoring should always be made with a qualified clinician who knows your individual circumstances. This guide is intended to help you understand the general shape of the process and the kinds of costs that can arise, not to offer medical advice. If you have concerns about affordability at any stage, raise this openly with your provider or your GP - they may be able to point you towards NHS options or shared care arrangements that could reduce ongoing private costs.