ADHD Medication Shortage and the National Fallout: What to do Now?

Starting in late summer/early fall 2022, generic dextroamphetamine-amphetamine (Adderall) for attention-deficit hyperactivity disorder (ADHD) joined the growing list of medications on national backorder within the United States. Although the exact cause of this massive shortage is not fully known, there are several theories as to why it occurred so quickly and on such a large scale.

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Some generic manufacturers, such as Teva, have claimed it is due to a combination of increased demand and manufacturing delays, which have come in the form of labor shortages and supply chain issues.¹ Another hypothesis for the shortage is that the growth of telehealth has led to an exponential increase in demand for ADHD treatment.

According to data reviewed by The Washington Post, prescriptions for Adderall increased by more than 30% over the past 5 years and further accelerated during the COVID-19 pandemic.²

Additionally, IQVIA has stated that 2021 showed a 10% increase in Adderall prescriptions compared to 2020.¹ Whether this scarcity is solely a result of increased demand has yet to be determined, but it cannot be discounted that increased demand and supply delays have played a major role in the persistence of the shortage.

In more recent months, methylphenidate has been prescribed more frequently to serve as a substitution for patients with ADHD having trouble obtaining Adderall. This provided a band-aid solution for a few months until, sure enough, methylphenidate went on backorder as well.

While not as widespread, this shortage has proven to be very frustrating for patients, some of whom had already gone without their original medication for some time only to have their substitution go on shortage as well.

Other patients who were originally on methylphenidate saw their maintenance treatment disappear, thrusting them into a nationwide issue that has no end in sight. This brings us to a unique place in the world of pharmacy.

Currently, patients with ADHD are in a very difficult position. Their options for available treatments are shrinking and there is no ideal alternative at this moment.

They can either choose to wait an indeterminate amount of time for their medication to return to circulation or they can switch to a drug that is still available (for the time being). These available drugs are typically branded products that are extremely difficult to afford, even if insurance covers some of the cost.

Vyvanse and brand Adderall appear to be the only ADHD drugs that semi-consistently appear in the drug-order every day. If a patient manages to receive a prescription for one of these drugs, they may be forced to pay significantly more out-of-pocket to ward off exacerbations of their ADHD and withdrawal symptoms. The pharmacist is one of the most available resources to assist with this.

Whether through assisting with prior authorizations or finding co-pay assistance programs, pharmacists are crucial in supporting their patients with ADHD in this current environment. For example, patients may not be aware that Vyvanse has a savings card on the manufacturer’s website that may be used with insurance if their co-pay is still high.

Some prescribers may even have samples that patients can use at no charge. These are by no means ideal solutions, but they are a few of the shrinking list of options at our disposal currently.

Although there is no end in sight for this lengthy nationwide shortage, pharmacists must continue to do their best at providing quality care for these patients. These patients are disheartened, and most of them have never been without their medication before.

Many of them are experiencing withdrawal symptoms and are facing a worse form of their condition than when they started their medication in childhood. These frustrations and concerns must be met with empathy and a willingness to help, even if you feel like a broken record repeating, “Adderall is still on national backorder.”

About the Author

Matthew Robertsis a PharmD Candidate at Duquesne University in Pittsburgh, PA, anticipated to graduate in Spring 2023, who completed this research during an Advanced Pharmacy Practice Rotation at STACK, focused in specialty pharmacy, technology, and entrepreneurship. For more information about completing an APPE at STACK, visit managewithstack.com.

References

1. Swetlitz, Ike. “Teva's Adderall Shortage Seen Continuing into March (Teva).” Bloomberg.com, Bloomberg LP, 12 Oct. 2022, https://www.bloomberg.com/news/articles/2022-10-12/teva-adderall-shortage-expected-to-continue-into-march-fda-says#xj4y7vzkg?leadSource=uverify%20wall.

2. Gilbert, Daniel, and Teddy Amenabar. “An Adderall Shortage Hasn't Let up. Here's Why.” The Washington Post, WP Company, 16 Mar. 2023, https://www.washingtonpost.com/business/2023/03/14/adderall-shortage-telehealth-prescriptions/.