Home Forums Discussions General Discussion ADHD medications

First, how many offices are being affected by the ADHD meds shortage?

Second when you do a telehealth or an office visit for ADHD, are you doing it every three months and sending in three scripts or once a month?

Rx's are once a month and it seems that Adderall XR seems to be the most problematic. Most pharmacies do not have it in stock. Vyvanse can be had if they call around. Because I do not do electronic scripts for these meds they have the Rx in hand and shop around.

We have to use EPCS. So do you charge them each month?

That was the whole idea of EPCS -- so they couldn't shop around, lol.

Texas will no longer allow paper scripts for schedule 2s. As an NP, I am not allowed to send in schedule 2s. I consult with my collaborative Physician on all of these pts and he will send in the script. One problem is he is not in the office daily. The shortage has been for all forms of Adderall, in this area. I try some of the other medications but then run into insurance issues. We have started having the pts call pharmacies to see who has it in stock and then send to that pharmacy for that pt. Pharmacies are sometimes filling the quantity they have in stock, say #15, out of a #30 script. The other 15 is just lost because the pharmacy will not keep that script on hand to fill once they get stock. We have to send in a new script when the pt tells us this happened and the pharmacy has stock back on the shelves. We also have to check PMP Aware to make sure of the quantity dispensed. Pharmacies can not transfer schedule 2s from on to the other even if it is one Walgreens to another on the other side of town! All of this is very time consuming.

Bert- we will send in #30 or #90 depending on the insurance coverage. We make pts be seen every 3 months regardless. If insurance only pays for #30 at a time then we will send in a refill at the 1 and 2 month mark and then have a visit at month 3. We do not charge for the 1 month at a time refills.

We can at least send in three scripts and they hold them on file.

No, it is not a visit, . The caretaker calls ahead and picks the Prescription up. I will see them every 3 months.

How do you do this?

You can do it one of two ways. You can either give them the first prescription, say on June 2nd, then write on the second one, "Do not fill before June 1st on the second and do not fill before Just 30th on the last one.

We are lucky, because ALL THE PHARMACIES here except Hannaford, which is most of them will accept:

1 of 3
2 of 3
3 of 3

and they file the other two and they decide when to fill them just like they would with a Benzo and two refills, etc.

Same here. 3 prescriptions. The last two read "Refill on or about _____"

My son has been out of his ADHD meds since MARCH - He's gained about 20 pounds and seems to have grown 6 inches. He's 14. I can only imagine the frustration you Providers must be feeling with parents constantly calling to find out wHy HaVeN'T yOu fILLeD thEir pREscRiPtiOn?!?

They are on back order, but none of our patients go more than two days without. They or the pharmacy or we call around. Also, if they are on Concerta 54 mg, we may go to 36 mg or change to Metadate CD or something in the meantime.

So I currently edit and send and do 2 factor auth for each of 3 prescriptions in clunky newcrop screens to read fill on xx/xx/xxxx.

Any faster way to do this? Any flow tips? Can my MA queue them up with the date fill text?

Printing to paper rx was faster...

The chronicity is basically like this:

Used to be we had to hand write them on tamper proof paper, which as you can imagine writing for two or three different strengths three times was not only laborious (9 scripts) but bound to cause more errors. Then write Do not fill before: Stupid thing about that system was how many times did we/I leave the pad around for anyone to grab.

Then we started printing either to 8 1/2 by 11 -- we went right to the Star Micronics print out three at a time. You would write Do not fill before. So, we just got two stamps that said Do not fill before June 1 and the other said Do not fill before July 1 which was technically correct so it worked. Just changed June to August the following month. This was bad because patients constantly lost scripts, sold scripts, went to different pharmacies, etc. BUT, at least now if they went in to get a prescription and Wal-try didn't have them, they could hand carry the script to another pharmacy. Now, we have to EPCS it again.

For me, EPCS was better because we just had better documentation and you could go into NewCrop and hit one button without the PIN and send up to 9 scripts I believe. All set up by the nurse.

Then NewCrap and I have no idea why the developers freaked out and couldn't understand logic, wouldn't allow you to send more than one of the same strength script. So, no matter what you typed on it, you can only send one of each. So, you can send 7 scripts at a time, but they would have to be Adderall XR 10 and Adderall 5 and Ritalin 20, etc. Which made no fuc.... sense. I was on the advisory board for NewCrop and my contact had to break the news to me. She tried to tell them. There is no difference diversion wise from sending

Concerta 36 fill by
Concerta 36 fill by
Concerta 36 fill by

Click send versus

Concerta 36 fill by

Click send

Concerta 36 fill by

Click send

etc.

In both cases they all made it to the same pharmacy basically at the same time.

Now in version 11.2 and up, you can EPCS from within AC and I believe you can send them in batches with the fill by thing either done automatically or manually -- don't use it myself. Most EMRs will send them in batches and do the auto thing.

But, one EMR for sure will then record all three in the patients med list.

I am lucky because when I went to my pharmacy (and EPCS was all anyone was talking about in Maine -- before Trump and Covid), my pharmacist said put the onus on the pharmacy and write 1 of 3, 2 of 3 and 3 of 3. That works for ALL our phamacies except Hannaford as they will only take on month at a time.

Here is what is stupid and it is why September has Physician Suicide Awareness Day in it.

Opioids: Can only do one script per month and generally do three months before a medication check (so three months of scripts)
Benzos: Can do 5 refills if done by six months (good luck with that), but mostly we do 2 and do a med check so three months. EASY
ADHD: Can't write refills but can send three scripts.

THIS IS FUC....... STUPID!!!!!!! This entire headache and bullshit would be gone if they allowed a refill number on the damned script. What is the damned difference.

And, like every other drug, if the pharmacy only has 10 pills, they should simply document they owe the patient 20 and not make us send another script.

But, the farmacist can see that it has been 28 days or 30 days and should be able to figure out if it is too soon to fill without our writing Do not fill by, etc. etc.

"Anywhere I wrote Fill by, in general, I mean Do not fill before."

Bert my understanding is that the generic Concerta has been discontinued and they jacked the brand name price up a couple of hundred dollars. If insurance covers it, my favorite is Azstarys (I hate that name) which is like Vyvanse for methylphenidate - a prodrug of dexmethylphenidate (serdexmethylphenidate) and demethylphenidate XR. If you can't get a brand name I use the crappy Ritalin SR generic. Anyone try Qelbree? It sure sounds like a me-too drug of Strattera only costlier. Strattera seemed better in kids than adults.

I do not know anything about its not being generic anymore. I hadn't heard that. I know that MaineCare (Medicaid) will only cover the brand name, but that is not uncommon as they will get better rebates with the brand name drug over the generic at times. Just as with Focalin XR. I was still under the impression that for self-pay and private insurance the pharmacist had to change Concerta to the generic. Very well could be wrong.

The problem with drugs like Azstarys is given my Medicaid population is around 65% and statistically more Medicaid patients are on ADHD meds (in my practice anyway) it is not covered by MaineCare without an impossible PA. Why do you like it? I am certainly looking at it.

This is what I tell my patients considering Strattera. It is an incredible medication. You do not have the sleep issues. You do not have the appetite issues. You can give it in the morning or night. I tell them the only problem with it is it doesn't work. It may work on 10% of my patients, but I never start there. I do use it to help overlap the morning or because it tends to last longer if given in the morning.

I did have one -- and one only -- who was losing stature and I had to take him off his stimulant medication.

I tend to go with Concerta, Metadate CD (generic only), Vyvanse. I will use Focalin XR since it is covered by MaineCare but I have a lot of problems with lability issues around two to three weeks much like I get some aggression with Adderall XR after the same amount of time. But, when that side effect doesn't occur, they both work relatively well, except for the greater diversion with IR Adderall.