AND lack use of attention deficit/hyperactivity disorder (ADHD) medication, many of whom are children, continues through most of 2023, making it sometimes difficult find medicine like Adderall or Focalin – at least in generic form.
The shortage began in late 2022 and was particularly frustrating, Dr. Michael Ganio, senior director of pharmacy practice and quality for the American Society of Health System Physicians, because the stimulants commonly used to treat ADHD are a controlled substance — usually a type of amphetamine.
“These are really frustrating shortages because you can only get a 30-day supply at one time,” Ganio told PBS. “Patients need a new prescription every 30 days. You cannot get a 90 day supply. You can’t even pay cash for a longer delivery if you want.”
Adding to the frustration, many insurance companies — notably Medicaid, KanCare in Kansas — often won’t pay for a brand-name version of a drug if a generic is available.
That has forced some patients to pay out of pocket for a brand-name version that can cost $50 or more.
Additionally, pharmacists may not know that Medicaid will pay for the brand of drugs if the pharmacy does not have the generic in stock, instead tell patients that they must pay cash for the drugs.
Kansas Senate Public Health and Welfare Committee Chairwoman Beverly Gossage learned of some of the difficulties ADHD patients face when trying to find their medication, and reached out to the Kansas Department of Health and Environment to find out if this was indeed the case . KDHE told Gossage he would pay for brand-name drugs.
“Medicaid will pay for the brand-name drug unless the generic option is sold out,” Gossage said. “The pharmacy filling the prescription would have to submit a prior authorization (PA) request. “lack of drugs” is given as the reason. All PA applications follow the same standard process. Documentation on the PA form is required for tracking purposes.’
In addition, patients at some community health clinics — which often have their own pharmacies — may have been told that their prescriptions could only be filled at a CHC-owned facility. Gossage was told that was not the case either.
KDHE told Gossage that in most cases when a prescription is filled, it is the patient’s choice. Just ask to transfer prescriptions to another pharmacy that stocks generic drugs.
However, for controlled substances such as ADHD drugs, the original prescription would have to be canceled and then sent to a new pharmacy.
Why is there a shortage of medicines?
According to data for 2016 from the Center for Disease Control and Prevention, more than 6 million children have been diagnosed with ADHD, and about 60% are treated with medication; about 4.4% of adults were diagnosed and about 4.1% treated.
But as PBS reports, “The exact numbers of how many people have ADHD are up for debate. Since 2015 more adults according to Shire PLC, the former maker of the popular drug Vyvanse, are receiving pharmaceutical treatment for the disorder. That year, a company analysis found that 53% of the 63 million ADHD medications prescribed were for adults.”
But while increased demand may be partly responsible for the shortage, it’s not the only problem.
Relaxed regulations on in-person visits and the rise of telehealth during the pandemic have contributed to a surge in prescriptions — and Adderall is not only used to treat ADHD, but also other conditions such as narcolepsy.
Manufacturers are required to notify the FDA of any deficiency, but are not required to report the cause.
And according to NBC, nearly a year into the shortage, both drugmakers and the federal government pointing finger at self.
“The Drug Enforcement Administration, which sets limits on the types of amphetamines drug companies can use to make pills, says companies have more than enough raw materials to make stimulant ADHD drugs,” NBC reported earlier this month. “Drug manufacturers dispute that claim, saying they’ve run out of ingredients and need DEA approval to get more.”
Meanwhile, experts say the shortage won’t end anytime soon and will last at least until the end of the year.
“Let’s just say I’m very concerned,” Dr. Max Witznitzer, a pediatric neurologist who treats children with ADHD at Rainbow Babies Teaching Hospital and Children’s Hospital and Case Western Reserve University. “When kids start going back to school, we’re going to see the demand for these prescriptions increase.”
FDA and DEA va joint letter they claimed that drug manufacturers were not producing as many pills as they could be.
“According to the DEA and FDA letter, the DEA conducted an internal analysis that revealed that companies used only 70% of their allotted quota of ingredients in 2022, which they say could translate to 1 billion additional doses,” NBC reported. “According to the two agencies, the figures for 2023 are developing similarly.
“They requested that any remaining amphetamine be returned to the DEA so it could redistribute it, although the agency cannot legally require the companies to return it.”
While some drug makers may sit on unused amphetamines in hopes of increasing production, they are also not required to share if they have any leftover drugs, and may not want to disclose the information to avoid being forced to hand over the amphetamines to other companies. .
However, according to NBC News, two of the larger ADHD drug makers, Teva Pharmaceuticals and Sandoz, “responded that they had used 100% of the DEA quota allocated to them in 2022 and requested quota increases accordingly.”
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