Provider Alert: Uptick in Scrutiny of Providers and Pharmacies over ADHD Prescriptions

Frier Levitt attorneys speak with prosecutors, Boards of Pharmacies, PBM auditors, wholesalers, and the like on a daily basis on behalf of pharmacies nationally. We regularly spot trends and report back to the industry. We are closely monitoring Adderall and other ADHD medications in particular due to heightened scrutiny by various entities.

Adderall prescriptions can get pharmacies and prescribers in trouble in 2023, starting with wholesalers cutting off the supply for pharmacies and ending with federal government investigations. During the COVID-19 Pandemic, online mental health providers were provided extended flexibilities regarding covered telehealth services, leading to easier access to mental health for patients and a spike in prescriptions for controlled substances such as Adderall. However, the boom in telehealth prescriptions and coverage for Adderall has spurred investigations into the practices of both prescribers and dispensing pharmacies.

Beginning in May 2022, large chain pharmacies such as Walmart and CVS began refusing to fill, in large part, Adderall prescriptions written by prescribers working for telehealth startups such as Cerebral and Done Health. Since May 2022, Cerebral is the subject of an ongoing federal investigation for possible/alleged violations of the Controlled Substances Act for their prescribing practices, including filling prescriptions for Adderall.

From the pharmacy side, in early December 2022, the Drug Enforcement Administration (“DEA”) served Truepill, an online and preferred pharmacy of Cerebral, with an order to show cause seeking the revocation of the DEA certificate of registration. The DEA is alleging that Truepill illegally dispensed controlled substances such as Adderall pursuant to prescriptions which were not issued for a legitimate medical purpose in the usual course of business.

Beyond the federal investigations, wholesalers such as AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp. tightened the monitoring of suspicious orders coming from pharmacies and are now banning some pharmacists from receiving all controlled substances after filling certain prescriptions. Specifically, wholesalers are targeting pharmacies that fill prescriptions written by physicians that frequently prescribe controlled substances or prescribe both a stimulant and a sedative to the same patient.

The DEA specifically expressed concern about aggressive marketing tactics used by telehealth companies which could lead to ADHD over prescription akin to the Opioid Crisis. Notably, Adderall prescriptions rose more than 10% in 2021 and through October 2022, double the annual increase of previous years. Given the focus by both governmental agencies and wholesalers, we predict that scrutiny of Adderall prescriptions will rise.

Prescribers and pharmacies should have adequate compliance protocols in place and proactively review controlled substance prescriptions, specifically Adderall, from 2020 until present. Compliance efforts can minimize future enforcement and can often lead to self-disclosure protocols, which could potentially relieve the amount of liability assumed by providers. Further, if a prescriber or pharmacy already received a subpoena or a letter from a wholesaler banning the pharmacy from receiving controlled substances, it is imperative to contact Frier Levitt to navigate the subpoena or wholesaler ban.

How Frier Levitt Can Help

Frier Levitt understands that one investigation or a ban from a wholesaler for a pharmacy can have collateral consequences. Contact Frier Levitt to address any questions or concerns regarding your practice and/or pharmacy with an experienced healthcare compliance attorney.