Editorial: Why State Pharmacy Boards Should Approve the Use of Long–Acting and Nonstimulant Medications for the Management of ADHD

Abstract

On February 5th, I testified at a public hearing by the South Carolina Pharmacy Board on the ADHD medications approved for use in their formulary for patients eligible for state supported Medicaid and Medicare prescription coverage. The South Carolina drug plan is managed by First Health, which is also involved in the management of 17 other state plans. At the time, the Board and First Health required that patients with ADHD must be treated with generic, immediate release methylphenidate (IR–MPH) and show limited, poor, or no response to this treatment before long–acting nonstimulant and stimulant preparations would be approved for use. Some extenuating factors besides such treatment failure also exist that permit the Board to approve of the use of other medications and preparations. These practices require that physicians contact the Board for prior approval before dispensing prescriptions other than for IR–MPH. While such approval is typically subsequently granted to physicians requesting it, there exists an extra burden on physician and office staff time to seek such prior approvals that can serve to discourage the use of more appropriate stimulants, delivery systems, and nonstimulants. Each person giving testimony is permitted just 3 minutes to give their opinions with a few minutes allotted for follow–up questions from members of the Board. Below are the points I made in this brief appearance. The Board voted subsequently to permit atomoxetine to be on their approved list of medications that did not require prior authorization as had been the case prior to this meeting. It is also of interest that 12 of 17 other state pharmacy boards using First Health for management of their public prescription plans have also directed First Health to grant atomoxetine such preferred status. Unfortunately, the SC Board did not vote to grant such favored status to the extended–release and still–patented stimulant delivery systems, such as Concerta, Adderall XR, Focalin XR, Medadate CD, or Vyvanse. I pass along these brief but key points should others have need of them in their own states in broadening the pre–approved pharmacy formulary for patients with ADHD.