Many of the ADHD medication shortages that have plagued the U.S. for the last two years have now been resolved, the Food and Drug Administration says. Yet some doctors and patients report they are still struggling to get prescriptions filled.
Dr. Royce Lee, a psychiatrist at the University of Chicago Medicine, said supply has gotten better but it’s still an issue for about a third of the patients he writes prescriptions for. This often means he still has to call around to pharmacies to see if they have the medications in stock, switch patients to different drugs, and deal with insurance companies to confirm coverage.
“I do see signs of the shortages easing up,” Lee said. “But there are still enough shortages that every day we’re having to put in a little bit of work for prescriptions that need to be changed or hunted down.”
“I think a lot of people are still not getting their treatments,” he added.
A total of nine manufacturers now have ADHD medications back in stock, according to the FDA’s drug shortage database, up from six last September.
Teva Pharmaceuticals, a major manufacturer of ADHD medications, has resolved all of its shortages after certain doses were unavailable for several months, according to the agency’s database. A 5-milligram dose of one of its medications remains in limited supply, however.
SpecGx, which manufactures a generic version of the ADHD medication Vyvanse, has all dosages of its drugs back in stock after most were on back order last year.
Aurobindo Pharma, which makes a generic version of Adderall, still estimates that it will have the medication back in stock in September after pushing back its earlier estimate of December.
Many of the manufacturers note that there is still unprecedented demand for the drugs, which could strain supply.
An FDA spokesperson said the agency expects additional supply will be returning in the coming months after a new manufacturer, US Pharma Windlas, recently began distributing doses.
“The public should rest assured the FDA is working closely with numerous manufacturers and others in the supply chain to understand, mitigate and prevent or reduce the impact of intermittent or reduced availability of certain products,” the spokesperson said.
‘Happened to be lucky’
About 6 million children and teens have been diagnosed with attention-deficit/hyperactivity disorder, according to the Centers for Disease Control and Prevention, making it among the most common neurodevelopmental disorders in kids. Millions of adults are estimated to have it as well, and some may not know it.
Despite the supply improvements, some patients say they are still having trouble getting their medications.
Kaja Moen, 30, of Asheville, North Carolina, said her doctor switched her to a generic form of Vyvanse last week after the price of another ADHD medication she was taking went up. However, her CVS quickly notified her that her prescription could not be filled, and that it would be on back order for several weeks.
She proceeded to call several pharmacies in her area, which were also out of the medication, as well as the brand-name version. Her doctor then put in an order for a generic form of Concerta, another ADHD medication, but that too was in short supply.
It wasn’t until Wednesday, when she went to the pharmacy to pick up a separate medication, that a pharmacist checked their supply and was able to fill her prescription.
“I just happened to be lucky,” she said. “There is still uncertainty as to whether or not I will be able to get a refill next month.”
“It has definitely caused me to have trouble focusing at work, and doing things around the house,” she added. “Without my medication, I struggle with having the motivation to do even simple things, so getting my medications helped a lot.”
People with ADHD may have trouble paying attention, act impulsive or may seem restless. ADHD medications, such as Adderall, aim to improve concentration and focus, while reducing impulsive behavior.
Going without the medication can cause huge problems for patients, both in their personal and professional lives, said Dr. David Goodman, an assistant professor in psychiatry and behavioral sciences at the Johns Hopkins School of Medicine.
“Their performance is severely compromised,” Goodman said. “They’re more emotionally reactive, and more likely to get into unnecessary arguments with spouses, partners, co-workers. They’re inconsistent in their follow-through, so all of a sudden their supervisor may say, ‘I don’t know what’s going on with you.’”
Goodman is a member of a task force that is developing the first-ever U.S. clinical practice guidelines for the diagnosis and treatment of ADHD in adults. The guidelines could open the door for great availability of the medications, he said.
Currently, supply is getting better, he said, noting that some of his patients have no trouble getting their medication, while others still have problems. The issue could persist for three days or two weeks, depending on the patient.
“It’s better, but it’s highly variable,” Goodman said. “There are geographic variabilities. There are variabilities within the distribution of pharmacies themselves. There is the availability of some pills, but not other pills. And then you have an obstacle with insurance companies as to whether or not they’re going to cover a brand when the generic is not available.”
Signs of improvement
Due to the ongoing shortages, Lee, of the University of Chicago Medicine, said the institution has a pharmacist just to help troubleshoot prescriptions.
“We get a Monday report on everything in stock, so that clinicians can respond to that report and see, ‘Well, they only had 30 of Vyvanse on Monday, the chances on Friday of having that dose is zero,’” he said. “That’s what it takes for our university pharmacy and practice to function.”
Lee said he is concerned about equity, adding that not every patient has a provider that can devote resources to help find prescriptions.
He recommended that patients form a relationship with their local pharmacists, who may let them know when their medication is back in stock.
“What many patients don’t know is they might expect or believe we have a relationship with the pharmacies, where they can transmit to us, like there is a system that works smoothly,” he said. “The truth is there’s no such system.”
Dr. Michael Kane, a child and adolescent psychiatrist at the UNC Medical Center in Chapel Hill, North Carolina, said he still has patients who are calling around to community pharmacies to check when they’ll have the medications in stock, although supply has improved.
“Shortages were certainly worse before,” he said. “I would say they’re somewhere between marginally and moderately better at this point.”
“It’s not like in the moment I need my medicine for my test tomorrow and no one has it,” he added.
He said clinicians are telling patients to reach out to pharmacies a week before they know they’re going to need a refill.
“It’s a really tough spot,” he said. “I really have no way of knowing whether it is going to be a problem for a given patient.”
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