Pharmacy Pearls: ADHD Stimulants

Pharmacy Pearls: ADHD Stimulants

March 12th, 2019 | NewsPharmacy Pearls

This month, we are releasing an AHP quality improvement initiative for ADHD in patients ≤21 years of age. Recognizing that ADHD is complicated in terms of diagnosis, the impact of comorbidities, and multiple available treatment options, we have chosen to initially focus on rates of pediatric ADHD diagnosis and network-wide prescribing patterns of stimulant medications (brand vs. generic).

Our goals are to share information related to existing published diagnosis and treatment guidelines (DSM-5, MCMS ADHD Guideline, AAP ADHD Guideline, and recent Project TEACH Newsletter), highlight caveats related to diagnosis and the role of co-morbidities, and provide information related to stimulant medication selection including comparative costs.

We will be releasing this information in three formats:

  1. Your individual AHP Pediatric Quadruple Aim Report
  2. Upon request* ADHD patient specific information (following release of the Quadruple Aim Report)
  3. AHP Pharmacy Pearls on Stimulants for ADHD

Take home points regarding information you will see:
1. AHP Pediatric Quadruple Aim Report (refer to Efficiency & Clinical Integration Section)

ADHD Diagnosis Rate Data:
ADHD affects 5-7% of the school age population. Patient mix varies among PCP practices, so providing a diagnosis rate snapshot is not a ranking of providers best or worst—but rather an opportunity for you to see how your panel compares to others’ within your practice and the network as related to pediatric ADHD diagnosis. Our hope is that providers will review the ADHD guidelines and DSM 5 criteria and be reminded to consider alternate or comorbid diagnoses of anxiety, learning disorders, and trauma, as well as to include a family/environment assessment in the diagnostic and behavioral treatment approach for their patients being evaluated for ADHD.

ADHD Stimulant Medication Cost Analysis:
Information in this report will reflect aggregate network PCP prescribing, representing a snapshot of brand vs. generic prescribing and contributory cost of each from a systems perspective. This information is included to demonstrate the large contribution of spend related to brand name agents. We recognize that there are many patient-specific factors that go into selecting the ideal stimulant agent for your patient. Our goal is NOT to drive 100% use of generic medications, but rather for PCPs to have more information at their disposal regarding stimulant treatment options, alternatives and cost information that helps inform their treatment choices. Guidelines from the AAP and AACP do not endorse preference for one stimulant over another. We encourage beginning treatment with generic stimulants whenever possible but most importantly support patient-centered decision-making. The choice of an initial stimulant agent should be based on age of the child, duration of effect, side effects and comorbidities, the ability to swallow a pill, patient/caregiver preference, and cost/coverage (which may be independent of generic vs brand name and ultimately influenced by the patient/families out-of-pocket cost burden).

*If you are interested in taking a moment to review your Excellus Commercial and Medicare patients prescribed stimulants (by you), after the release of the Quadruple Aim you can email LJ Shipley to request your patient list reflecting active prescriptions written by you in September 2018.

2. The AHP Pharmacy Pearls on Stimulants for ADHD below provides a brief overview of both guidelines for diagnosis and information on the wide variety of available stimulants including duration of effect and some basic (cash price) cost comparisons. Preferred prescription products remains a moving target, as you know, because of variations between insurance plans and changing formularies. Please remember that if you are experiencing difficulties or have questions regarding stimulant selection or switches, you can contact our AHP Pharmacy team for assistance.

Thank you for your feedback on this initiative and for your ongoing care and advocacy for the kids and families in your own practice and across our communities. Initiatives like this one are designed to be informative and helpful to your individual practice of pediatric medicine. Any savings realized in this space helps to support our work together on other preventive care initiatives. We have a lot of important work to do together going forward, particularly in the areas of behavioral health and in the prenatal/early childhood areas where prevention and health promotion are so valuable. Stay tuned!