Position Statement on Stimulant Medication Prescribing

Rules for prescribing and dispensing stimulant ADHD medications such as Adderall, Vyvanse, Ritalin, and Concerta have been changing rapidly. These rules are being implemented 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 continue to stay current with all federal and state guidelines regarding stimulant prescribing. In general, these guidelines focus on four main areas:

1. Improving the accuracy and objectivity of ADHD diagnosis and monitoring response to treatment
2. Ensuring prescriptions remain within accepted doses and are not combined with other controlled substances
3. Requiring regular in-person visits and follow-up appointments
4. Ensuring prescribers are in geographic proximity to their patients and pharmacies

PAKC Policies

1) Diagnostic Accuracy and Monitoring

• All patients age 16 and older who are prescribed or being considered for stimulant therapy will undergo confirmatory psychometric testing.
• Annual retesting is required for patients on long-term stimulant therapy to provide objective evidence of treatment response.
• Drug screening is not required universally but may be requested when clinically appropriate.

2) Responsible Prescribing Practices

• PAKC follows strict internal dosage and quantity guidelines for all stimulant medications.
• Prescribing practices are reviewed regularly to ensure compliance.
• Prescription monitoring programs are used to ensure patients are not receiving medications from multiple providers.
• No early refills are allowed for stimulant medications.
• Patients taking other controlled substances may not be eligible for stimulant therapy.

3) Required Follow-Up and In-Person Visits

• All patients must be seen in person before stimulant medications are prescribed.
• Patients must be seen at least annually in person thereafter.
• Follow-up visits are required at least every 3 months.
• Medications will not be refilled if follow-up exceeds the 3-month limit.

4) Geographic and Licensing Requirements

• Prescriptions will only be sent to pharmacies in states where providers are licensed (Missouri and Kansas).
• Patients must be seen in states where providers are licensed.
• Patients must maintain primary residence in Missouri or Kansas.