Amid a nationwide ADHD medication shortage, patients are paying significantly more for medication to help them focus at school, work and home.
The shortage has put financial pressure on families, forcing them to look for alternatives. Often, their only option is expensive brand-name medications.
The prices paid by retail community pharmacies for many popular ADHD medications may be on a upward trend, a USA TODAY analysis found, increasing at the rate of inflation as Adderall supplies dwindle through October 2022. And in some cases the price has doubled or tripled.
A Delaware mother diagnosed with ADHD, whose husband and 17-year-old daughter also have attention-deficit/hyperactivity disorder, told USA TODAY that when the Adderall shortage was announced, her doctor told her daughter her only option was Switched to what they could get, Vyvanse.
As a result, the amount she paid each month after insurance increased by $20 to $300 for her medication. The medicine is too expensive for more than one person in the household, and she said her priority is her daughters’ health and education.
With medication and school accommodations, my daughter is a straight-A student. Without the medication, she is failing, said the mother, who asked to be identified only by her first name, Sam, because her husband does not want his employer to know about his diagnosis. This is a huge difference.
Prices for many medications used to treat ADHD are rising, as reflected in national average drug acquisition cost data. By mid-December, the amount pharmacies paid for certain doses of both brand-name and generic Adderall rose faster than inflation. For some versions of methylphenidate, sold under the Ritalin and Concerta brand names, the average price paid by small to medium-sized independent and chain pharmacies has nearly doubled since last year. The average cost of dexmethylphenidate, sold under the brand name Focalin, has more than doubled.
Having exhausted the remaining Focalin she was rationing, Sam did not receive any medication for weeks, causing her to forget to eat, have difficulty maintaining focus at work, and struggle to complete household chores. Had to face such challenges. Like a person with a broken leg who gets around without crutches, everyday tasks are more difficult and take more energy. However, unlike someone with a cast, many ADHD symptoms are internal and invisible to others.
You can’t really compare it, but if there were a shortage of cancer drugs, there would be much more of an uproar than there would be a shortage of ADHD drugs because people don’t realize it’s a disability,” Sam said. It is very debilitating. It has a huge impact on your quality of life.
According to the Centers for Disease Control and Prevention, at least 6 million children ages 3-17 in the U.S. have been diagnosed with ADHD. While the picture is less clear for those age 18 or older, some studies estimate that ADHD affects as many as 11 million American adults.
The Sams family is one of many whose lives have been disrupted by the shortage, which began last year after manufacturing delays at companies that make Adderall, including Teva, according to the Food and Drug Administration.
Then, in a domino effect, other common ADHD medications became scarce as patients began looking for alternatives. The increased demand for ADHD medications and strict regulations on these drugs have created a confluence of factors, said Antonio Ciaccia, CEO of 46Brooklyn Research, an Ohio-based nonprofit drug pricing research firm.
Search our database to track changes in the price paid by pharmacies for common ADHD medications.
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Medication shortages are an additional source of anxiety and stress for people with ADHD. When forced to do without it or use an imperfect substitute, performance in the classroom or workplace suffers. Routines and relationships get spoiled.
People trivialize ADHD and make jokes about it, but it’s no laughing matter, says Dr. Edward Hallowell, a child and adult psychiatrist and leading expert in the field, who lives with the condition himself. he said. Traffic accidents are much more common among people with ADHD, and it becomes even more dangerous if you don’t have medications.
Finding a pharmacy that has a drug available during a shortage is like finding gold, Hollowell said. Other patients have compared their experiences to a frustrating and never-ending game of finding a cure.
In addition to spending more on the drug, Sam and his family had to travel longer distances and pay extra for gas to reach pharmacies with available stock.
“We should not have to travel for an hour for 30 pills,” he said. That’s almost an extra ADHD tax.
The process often starts with calling pharmacies to see who has the drug. However, if they are not regular customers, efforts to prevent illegal distribution or abuse of drugs may be thwarted.
Some pharmacies won’t disclose over the phone which controlled substances they have as a security measure, said Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists.
If a patient gets lucky and finds something in stock, it becomes a race to coordinate with their doctor and send the prescription to the right pharmacy before the inventory runs out.
A semi-effective medication may not be better than no medication at all, but patients compare it to using glasses with half the strength you need. Some people take what they can get, even if they don’t respond well to a particular drug or dosage. According to the Cleveland Clinic, others may not adopt the alternatives because they increase anxiety, increase heart rate, affect sleep cycles or simply don’t work.
According to research from the National Institutes of Health, ADHD is caused by low levels of dopamine and norepinephrine, neurotransmitters that play important roles in people’s motivation and ability to complete tasks. Stimulant medications, which are also used to treat narcolepsy and binge eating disorders, work by increasing the amount of these chemicals in the brain, which makes it easier for people with ADHD to concentrate and perform tasks. Can help.
Without Vyvanse, which Sams’ daughter now takes in lieu of Adderall, she has difficulty managing and completing homework. A job that normally takes an hour or two took six hours, Sam said.
Drug price data shows that Vyvanse has been the more expensive option for years. The original manufacturer’s patent expired in August, and the FDA only recently approved generic versions of the brand-name drug. Ciaccia said that once a generic drug is approved, it could take anywhere from a few weeks to more than a year for pharmacies to receive their first shipments from manufacturers.
The FDA is currently reporting shortages of generic Vyvanse across several companies, so it’s unclear how soon patients will be able to find lower-cost versions of the drug.
What is causing the ADHD medication shortage?
Doctors are diagnosing more ADHD and writing more prescriptions for medications that treat it. Additionally, due to limitations in their production, these medicines became scarce.
The recent growth of telehealth and virtual prescribing during the COVID-19 pandemic is one explanation for the increased demand for medications, Ganio said, as patients have easier access to health care providers. Doctors were allowed to diagnose ADHD and prescribe controlled substances online, which previously required an in-person visit. That flexibility has been extended to December 31, 2024.
Some people were diagnosed when pandemic shutdowns forced them to work from home or their children had to attend school virtually. For some, the loss of workplace or school structure exacerbated symptoms. Often, when children are diagnosed, their parents are also affected.
In emailed responses to USA TODAY, the top two suppliers of Adderall blamed the shortage on increased demand, but experts say other factors, such as federal limits on the production of controlled substances, also played a role.
According to the Drug Enforcement Administration, stimulants such as amphetamine in Adderall or methylphenidate in Ritalin are classified as controlled substances because they have a high potential for abuse that can lead to severe psychological or physical dependence. This classification is to prevent misuse or abuse.
Thus, the agency oversees everything from how much manufacturers produce to how much doctors and pharmacists can prescribe and how much they can dispense. Regulatory constraints on the drug supply chain, including industrywide limits on the production of ADHD drugs, make it challenging to quickly resolve the shortage.
The DEA and FDA have acknowledged the role of record-high prescription rates of stimulant medications in the ADHD medication shortage. Total dispensing of stimulants in the US increased by 45% from 2012 to 2021, according to a joint paper released by the two agencies in August.
However, questions remain between manufacturers and the DEA about who is responsible for the shortage, Ganio said. The agency said manufacturers are sitting on unused materials, while manufacturers say they do not have enough materials, and the DEA needs to loosen quota restrictions.
In 2022, manufacturers did not produce the full amount they were allowed to because of these limitations, resulting in a shortage of 1 billion doses that could have been produced but were not made or shipped and 2023. The data showed a similar trend, the DEA wrote in a letter early last month.
The three largest generic drug makers, Teva, Sandoz and Sun Pharma, told USA TODAY that they have produced as much as the DEA has allowed them and, in fact, have requested larger quotas to meet demand.
In an email statement, Sun Pharma told USA TODAY that the DEA has rejected its request for permission to manufacture more of the ADHD drug for 2023. The company said it has reiterated its request for next year and is hopeful of approval.
What is being done to end the ADHD medication shortage?
The DEA said it is adjusting its quota rules and coordinating with manufacturers to increase production of ADHD stimulants.
In early November the agency wrote that the DEA is in communication with the manufacturers concerned, and 17 out of 18 manufacturers have informed us that they will use their allotted quota amount and increase production of the stimulant drugs.
In a written statement, Sandoz said the DEA is approving company requests for larger quotas, allowing them to fulfill customer orders.
While it is too early to know when the shortage will end, Ganio said it is promising to see the DEA working with producers and adjusting its quota allocation process.
Manufacturing cannot be ramped up overnight, he said, so hopefully manufacturers can increase production and within a few months, we will see more supply hit.
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