ADHD Medication Prescription Rates Did Not Vary Across Visit Types

Amid the ongoing concerns surrounding virtual prescribing allowances for attention-deficit hyperactivity disorder (ADHD) medications, a new study found that health systems provide prescriptions for this condition and anxiety at similar rates across in-person and virtual settings.

Amid an increase in ADHD diagnoses in the United States, the US Drug Enforcement Administration (DEA) has been considering whether to continue virtual ADHD medication prescription allowances following the end of the public health emergency.

Thus, researchers aimed to determine whether prescribing rates varied between in-person and virtual settings.

To do so, researchers reviewed 205,065 visits for ADHD and 933,455 visits for anxiety from Jan. 1, 2020, to March 31. Considering factors related to diagnosis and demographics, researchers matched patients who participated in telehealth to those who engaged in an office visit. They used data from Cosmos, a HIPAA-defined limited dataset of more than 190 million patients from 208 healthcare organizations using the Epic EHR system.

From this data, they found that ADHD medication prescribing rates within 30 days of an initial diagnosis were similar across settings, totaling about 60 percent. Researchers considered both stimulant and non-stimulant medications. Stimulant medications were more common, making up 84 percent and 87 percent of prescriptions for telehealth and office visits, respectively. Researchers did, however, note that this study did not include telehealth-only providers.

These study findings present valuable insight into trends surrounding virtual ADHD medication prescriptions. As debates related to allowances occur, this data analysis adds to our understanding of prescription rates in virtual and in-person care settings.

However, the DEA has indicated growing skepticism regarding the virtual prescribing of medication for ADHD.

In September 2022, telemental health company Done Health faced a DEA investigation for potentially overprescribing ADHD medications.

Just before then, in June 2022, the Federal Trade Commission (FTC) launched a probe surrounding the practices of Cerebral, another telemental health startup. This FTC investigation explored whether Cerebral participated in deceptive marketing.

Prior to either action by the federal agencies, CVS and Walmart announced that they would reject prescriptions from these two startups. CVS Health confirmed this choice via an email to mHealthIntelligence in May 2022.

"As a result of our being unable to resolve concerns we have with Cerebral and Done Health, effective May 26, 2022, CVS Pharmacy will no longer accept prescriptions for controlled substances issued through these companies," said Mike DeAngelis, executive director of corporate communications at CVS Health, in the email.

To further govern telehealth-based prescribing, the DEA proposed several adjustments to policies.

In February, the DEA announced proposed rules surrounding telehealth-based prescribing. In this release, the organization described its plans to extend certain flexibilities while bringing back previous rules that would limit the virtual prescribing of controlled substances like Adderall, Oxycodone, Vicodin, and Ritalin.

However, in May, the DEA and the Substance Abuse and Mental Health Administration (SAMHSA) issued a rule to extend allowances for the remote prescribing of controlled substances through November 2023. This rule followed an outcry from telehealth advocates across the country.

“The DEA received a record 38,000 comments on its proposed telemedicine rules. We take those comments seriously and are considering them carefully,” said Miriam E. Delphin-Rittmon, the HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, said in a statement. “We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities for six months while we work to find a way forward to give Americans that access with appropriate safeguards.”