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Some prescription drugs are difficult to fill. A few bills could make it easier. • Rhode Island Current

Stimulants can make life calmer and easier for people with ADHD. But filling these prescriptions is often stressful for patients, thanks to a compound problem that’s partly drug regulation and partly supply and demand.

Electronic prescribing limits the prescribing of stimulants to one pharmacy. Once a script is written and submitted, it remains with the pharmacy that received it. If the medicine is no longer in stock, the patient can call the doctor for a new prescription. Or they could wait and not take any medications.

“We have CVSs all over the state,” Sen. Alana DiMario, a Democrat from Narragansett, told the Rhode Island Current. “We should be able to refill a prescription at one CVS as easily as at another, without having to jump through many additional hoops.”

The Rhode Island Senate agreed when it voted on Thursday, May 23 36-0 to pass a bill from DiMario that would help patients get and take their ADHD medications, such as Adderall, Ritalin and Vyvanse.

DiMarios accountthat now goes to the House Committee on Health and Human Services would require the Rhode Island Department of Health to adopt a July 2023 decision regulation reviewed by the federal Drug Enforcement Administration (DEA). The revised federal rule allows patients to transfer their prescriptions for certain tightly regulated psychoactive medications, including stimulants, from one pharmacy to another.

“I think this is something that a lot of people in my chamber understand once I explain the rationale behind the bill,” DiMario said in a phone interview before the vote. “They have someone in their family, they have someone in their community, who has highlighted the difficulty this poses for them.”

DiMario’s bill would go into effect on January 1, 2025, the same date companion bill by Rep. Kathleen Fogarty, a Democrat from South Kingstown, would take effect.

Senator Alana DiMario’s bill is just waiting for the FBI to change the standards for electronic prescriptions. (Alexander Castro/Rhode Island Current)

On Wednesday, May 29, every member of the House Committee on Health and Human Services agreed to send Fogarty’s bill to the House of Representatives for a vote. The respective bills must pass the other chamber before they can appear on Governor Dan McKee’s desk. Fogarty’s bill will likely appear in the House of Representatives the week of June 3, said Larry Berman, a spokesman for the Rhode Island House, and the DiMario hearing will take place some time afterward.

The DEA first announced a shortage of Adderall in 2022. In February 2024, 87% of community pharmacists claimed they were still struggling to stock the amphetamine-based drug, according to a questionnaire of the National Community Pharmacy Association.

The shortage has put further strain on the already restrictive prescribing process, as is the case with most ADHD medications planned by the DEA. Under Fed and most state regulations, most stimulants fall into Schedule II – the second most restrictive level, reserved for drugs that have accepted medical uses but can also be highly reinforcing or addictive to consume.

Prescriptions for ADHD medications are limited to a 30-day supply cannot be refilled – although doctors can write up to three separate prescriptions at the same time, each for a one-month supply. The prescription cannot be transferred to another pharmacy, not even within the same chain. A doctor will therefore have to write and sign a completely new prescription.

Those hoops create an obstacle course for everyone involved: patients, pharmacies and doctors. Phone calls boomerang between pharmacies and patients as the latter try to find a place where they can actually fill their prescriptions. The DEA seemed to agree that there are too many problems for people already struggling with behavioral health issues.

“This rule is likely to benefit patients in many other ways, including reducing stress,” the DEA wrote in July 2023, adding that a key reason for changing the regulations is “to prevent delays in treatment and reducing patient burden.”

DiMario said, “This is one of those no-cost changes that can improve the quality of life for people in our communities.”

In fact, the DEA estimated in its final rule that patients could even save money — specifically $2.60, which the agency calculated as the cost of a five-minute phone call to a provider for a new prescription.

At the Rhode Island Department of Health, seen here on Capitol Hill, state health officials are still waiting on their federal counterparts for the technology update that will allow electronic transfer of scheduled medications. (Alexander Castro/Rhode Island Current)

Rhode Island pioneered the treatment

Stimulants have not always been warmly welcomed by the public, in part because of their widespread use among a vulnerable population: children. Coincidentally, it was at Bradley Hospital in East Providence in 1937 that psychiatrist Charles Bradley discovered for the first time Stimulants help children to be attentive and interested in schoolwork. Stimulants were used in the youth population in the post-war years, but only then after 1987when the ADHD diagnosis was revised and the neurosciences new psychiatry that pharmaceutical companies saw a new market – children with ADHD – that could be served with updated versions of older medications.

A DEA assignment report from 2023 found that total stimulant dispensing increased by almost 58% between 2012 and 2022. During that same period, prescriptions nearly tripled for two specific age groups: people aged 31 to 40 and people aged 71 to 80.

That’s a lot more people vying for Vyvanse and the like – some of them are DiMario voters. One of them, in fact, first warned DiMario about the 2023 change in DEA regulations, the senator explained as she presented her bill at a conference. March 5 hearing of the Senate Committee on Health and Human Services.

“As a result, many families continue to call around,” DiMario testified on March 5.

Maura Cotoia is one of those parents glued to the phone. Some pharmacies will reveal if they have the drug on hand. Others don’t. A not insignificant part of the day can be spent trying to figure it out. Testifying on DiMario’s behalf, Cotoia said her family is “hunting across the state for medication” for her 10-year-old son who has ADHD.

“We’ve traveled to Warwick, Newport and Hopkinton to make sure my son gets the right medication,” Cotoia said.

Since Cotoia’s son was diagnosed at age 7, there hasn’t been a single pharmacy to fill his prescription for three consecutive months.

“I think this is wild because local pharmacy chains like CVS can communicate with each other and pass prescriptions internally. They can even pass prescriptions across state lines,” Cotoia said.

Forecast unclear for these bills that fall outside the healthcare package. Their sponsors still have hope.

“As a result, many families continue to call around,” DiMario testified on March 5.

Maura Cotoia is one of those parents glued to the phone. Some pharmacies will reveal if they have the drug on hand. Others don’t. A not insignificant part of the day can be spent trying to figure it out. Testifying on DiMario’s behalf, Cotoia said her family is “hunting across the state for medication” for her 10-year-old son who has ADHD.

“We’ve traveled to Warwick, Newport and Hopkinton to make sure my son gets the right medication,” Cotoia said.

Since Cotoia’s son was diagnosed at age 7, there hasn’t been a single pharmacy to fill his prescription for three consecutive months.

“I think this is wild because local pharmacy chains like CVS can communicate with each other and pass prescriptions internally. They can even pass prescriptions across state lines,” Cotoia said.

While the DEA is willing to relax regulations on prescription transfers, the Centers for Medicare and Medicaid Services (CMS) is not.

CMS regulates prescriptions for Medicare patients, and that includes choosing the information technology used for electronic prescriptions. CMS’s current standard can support the electronic transfer of unscheduled medications, but not scheduled medications.

Dr. Utpala Bandy, who was then interim director of the Rhode Island Department of Health before retiring in March, filed testimonials for both DiMario and Fogarty’s bills, recommending that the legislation needed to be modified slightly.

“The healthcare information technology industry cannot yet support these transfers until further action is taken by (CMS),” Bandy wrote.

DiMario said before the May 23 Senate vote that she had revised the bill according to recommendations from the Department of Health. Department spokesman Joseph Wendelken confirmed May 24 that the department supports DiMario’s revised bill.

Pharmacy officials in Massachusetts quickly maneuvered to accommodate the DEA change, issuing a policy in October 2023 allowing prescription transfers.

But Massachusetts is not much further along than Rhode Island, according to an email from Omar Cabreba, a spokesperson for the Massachusetts Department of Public Health: “The Board of Registration in Pharmacy does have a policy on the transfer of unfilled prescriptions, but the technological standard required to transfer electronic prescriptions in accordance with DEA ​​rules is currently out of place.”

The National Council for Prescription Drug Programs manages the SCRIPT standard used by CMS for electronic prescriptions. a Document from May 2024 of the Council noted that while a newer version of SCRIPT supports the updated DEA rule, the version still used by CMS does not.

The shortage is now there some see signs of reduction after two years, with manufacturers such as Teva refreshed their range of generic ADHD medications from May.

So DiMario and Fogarty’s bills could accelerate the adoption of the necessary technology when it arrives. But that means no changes for ADHD patients in the near future. They may have to wait and call.

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