In the US, strict and ever-changing prescribing rules, medication shortages, and increased scrutiny on controlled substances prescribed remotely are making it difficult for patients to access medication.
Healthcare organisations providing ADHD care across multiple locations with high patient volumes face even more challenges navigating prescribing regulations.
Provider hesitation when prescribing ADHD stimulant medication
The combination of ongoing stimulant shortages and stricter prescribing rules have made some ADHD care providers hesitant to diagnose ADHD, concerned that they won’t be able to provide effective treatment.
These barriers don’t just affect patients – they impact ADHD services. Delayed diagnoses and treatment can lead to worse outcomes, lower patient satisfaction, and increased administrative burden.
What are the challenges of prescribing ADHD medications through telehealth?
Stimulants are Schedule II controlled substances under the Controlled Substances Act (CSA) and are subject to strict prescribing rules.
The Ryan Haight Act requires in-person medical evaluations before prescribing controlled substances via telehealth. Following ongoing waivers of the act since COVID-19, the DEA and HHS have extended telehealth prescribing flexibilities for controlled substances until December 31, 2025.
States have varying rules about telehealth prescribing – some may require additional documentation, consultations, or in-person visits which complicates the process for healthcare organisations that provide care across multiple states.
You can continue to prescribe necessary medications via telehealth to ensure uninterrupted patient care, however barriers to telehealth prescription may be reinstated at the end of the year.
What can large organisations do to improve care and navigate medication shortages?
There are several strategies large organisations in the US can consider when providing ADHD care.
Communicate with patients about medication and alternative plans
Discuss concerns about using illegally acquired stimulant medications with patients whose access to prescription medication is disrupted. While untreated ADHD is associated with adverse outcomes, those who use unregulated medication significantly increase their risk of overdose with unexpected substances.
Work together to create contingency plans with your patients, such as alternative treatments or behavioural therapies to manage their symptoms effectively during these shortages.
Integrate objective ADHD testing solutions
With increased scrutiny on ADHD prescriptions, you need to ensure your diagnoses are accurate and defensible across all your sites, no matter where patients are located.
QbCheck provides measurable and objective data on attention, impulsivity, and activity levels in a remote setting or in-office, reducing the reliance on subjective reports that can be influenced by bias or inconsistency. Our ADHD testing solutions support clinicians to differentiate between similar presenting disorders and reveals treatment efficacy more accurately than a rating scale, which is crucial when medication options are limited.
According to research, QbTest captures 86% of patient’s treatment effects compared with only 37% of patient’s improvement captured by the ASRS rating scale.
QbTest can distinguish pharmacological treatment effects within hours of pharmacological titration and can be used for monitoring of long-term treatment of ADHD.
QbCheck makes it easier to streamline documentation across sites
FDA-cleared QbCheck generates clear, standardised reports that can be easily added to patient records. With objective data, you have additional documentation to justify diagnoses and prescriptions.
Objective data supporting your clinical decisions can also be useful during audits or for prior authorisation requests. It can also help you identify patients who may benefit from behavioural interventions, therapy, or lifestyle changes before deciding on medication, providing meaningful symptom relief and long-term benefits.
According to the National Institute for Clinical Excellence’s recommendation of our medical technology, clinical experts had suggested that our objective test results may reduce appeals about diagnostic decisions.
Identify patients who could benefit from alternative types of treatment
While medication is a key part of ADHD treatment management, it’s not the only option. Even without stimulant prescriptions, it’s possible to track treatment outcomes. QbCheck enables you to assess the impact of behavioural therapies or non-stimulant treatments by objectively measuring the three core ADHD symptoms over time.
This is particularly important as stimulant shortages can lead to frustration and anxiety for patients – objective testing results help to show tangible evidence of patient progress, even when medication access is limited. Our easy-to-interpret visual reports are simple for patients and families to understand, providing reassurance during uncertain times.
Collaborative care models
If medication management is the core focus of your group and expertise in therapeutic interventions is less common, consider partnering with behavioural health specialists and therapists to build a more comprehensive support system for patients. This approach distributes the burden of care and improves access to non-medication solutions.
Best practices for virtual clinics prescribing ADHD medications
- Improve documentation in your evaluations
- Communicate with managed patients on upcoming deadlines for regulatory changes
- Consider options to accommodate in-person requirements should they be reinstated either through referral partners, establishing additional locations, or temporary medical office rentals