Position statement on Stimulant Medication Prescribing - PAKC - Psychiatry Associates of Kansas City

Position statement on Stimulant Medication Prescribing

Rules for prescribing and dispensing stimulant ADHD medications such as Adderall, Vyvanse, Ritalin, Concerta, have been changing rapidly. These rules are being put in place at both the federal and state levels to minimize the risk of abuse of these substances. Providers and pharmacies alike have been struggling to stay up to date with the most recent recommendations. Some rules vary from state to state. To make matters more confusing, many proposed rules have not yet been formalized but are expected to be followed. Providers and pharmacists are being held responsible for following these rules even though the rules themselves remain unclear.

Many providers are choosing to stop prescribing these medications. The providers of PAKC remain committed to ensuring that our patients are treated with the highest standard of care and the best treatment options available.

PAKC will be doing our best to stay abreast of all federal and state guidelines regarding prescribing stimulant medication. In general, these guidelines are focused on four main areas: 1) Improving the accuracy and objectivity of diagnosis of ADHD and monitoring response to treatment. 2) Ensuring that prescriptions for stimulant medication remain within commonly accepted doses and quantities, and that stimulant medications are not being combined with other controlled substances or substances of abuse. 3) Patients are seen in person regularly and have regular follow-up appointments. 4) Prescribers must be in geographic proximity to their patients and the pharmacies they use.

To address these guidelines PAKC has implemented the following policies:

1) Improving the accuracy and objectivity of diagnosis of ADHD and monitoring response to treatment:

All existing patients 16 years of age and older who are presently prescribed stimulant medication and all newly evaluated patients who are being considered for stimulant therapy will undergo confirmatory psychometric testing. This may be obtained through PAKC or from an outside provider.

Annual monitoring by retesting of all patients on long term stimulant therapies will be required to objective evidence of response to treatment.

PAKC does not currently require universal drug screening, but this will be requested when clinically relevant.

2) Ensuring that prescriptions for stimulant medication remain within commonly accepted doses and quantities, and that stimulant medications are not being combined with other controlled substances or substances of abuse:

PAKC has implemented corporate dosage guidelines for quantity and maximum dosage on all stimulant medications. All prescribers will adhere to this policy. Prescribing practices of all providers will be reviewed regularly to ensure compliance with dosing limits.

PAKC will utilize prescription drug monitoring software on patients prescribed controlled substances such as stimulant medication to ensure that patients are not receiving these medications from other providers.

No early refills will be allowed on any stimulant medication.

Patients prescribed other controlled substances may not be eligible for continued stimulant therapy.

3) Patients are seen in person regularly and have regular follow-up appointments:

All patients will be required to be seen in person prior to being prescribed any stimulant medications.

All patients will be seen at least annually in person thereafter.

All patients being prescribed stimulant medication will be seen no less frequently than every three months. Stimulant medication will not be refilled under any circumstances if follow-up visits are beyond the three month limit.

4) Prescribers must be in geographic proximity to their patients and the pharmacies they use:

PAKC providers will prescribe only to pharmacies in states in which they are licensed (Missouri and Kansas).

PAKC providers will see patients only in states in which they are licensed.

All patients who are treated by a PAKC provider must have primary residence in the states of Missouri or Kansas.