Home Delivery of Prescribed Stimulant Medications

Home Delivery Prescribed Stimulant MedicationsHome delivery for prescription stimulant medications? Yes, stimulants. If you haven’t tried it, maybe it’s time to investigate.

“But Gina, you can’t get stimulant medication delivered to your home. That’s a controlled substance! There are laws!”

Yes, people say that every time I suggest it—for the entire 20 years that we’ve used a home-delivery pharmacy for my husband’s Concerta. But, it’s simply not true.

It is LEGAL.

Is it available on your insurance plan? That depends on the terms of your coverage.

Home Delivery Prescribed Stimulant Medications

Home Delivery: Who Benefits, Who Might Not?

Home delivery of prescribed stimulant medications might not be an option for everyone; check your health insurance plan.

It also might not be the best option for some types of patients. For example:

—College Students Living On  Campus: Maybe Not

Think twice about having a 90-day supply of stimulant medication hanging around the dorm room. Then again, think of the time-and-hassle savings.

—Patients New to ADHD Medication: Wait a While

Home-delivery is not a good option for people who are just getting started with ADHD+ medication treatment. Until you settle into a workable regimen, early days can mean lots of trial and error.

You don’t want to pay for large quantities of a medication that you’ll end up not using. That’s wasteful.

—Patients With Difficulty Locating A Pharmacy with Stimulant RX in Stock: Definitely!

Most storefront pharmacies won’t tell you over the phone if they have X stimulant in stock. I’ve heard it’s a fear-of-robbery thing, I understand.

But this makes it absolutely exhausting to find a pharmacy able to fill your monthly prescription.

Typically, there is a day or two gap between one prescription ending and the next beginning. Who has time for this scramble? Especially 12 times a year!

Gives me palpitations to even think about.

—Everyone Else: Worth Considering!

In general, home-delivery works best for people who have settled on a medication and dosage and expect to be taking it for the indefinite future. Or at least 90 days.

One thing’s for sure: Home-delivery could just save you huge amounts of time, money, and stress.

First, let’s examine the benefits and then learn about guidelines.

Benefits of Home-Delivery: The Four Cs

I count at least four categories of potential benefits:

  1. Convenience
  2. Consistency
  3. Continuity
  4. Cost-savings

Home Delivery Prescribed Stimulant Medications

1. Convenience:

Has this happened to you? You realize that you have one pill left. You leave work early and scramble to pick up a script at your doctor’s office. Then, where to fill it?

  1. Nothing says stress like having to run around to pharmacies, seeking one that has your medication in stock.
  2. Many people tell me that their local pharmacies are often out of the stimulant medications, such as Ritalin, Vyvanse, and Concerta. If they’re lucky, they might receive 10 pills and are told to come back next week for the remaining 20. Yikes.
  3. Or, the pharmacist gives them the hairy eyeball, as if they abusing the medication. (Catch 22: The more you get perturbed, the more suspicious you look to these ill-informed pharmacists!)

The mail-order pharmacies are huge, with inventories far beyond a local pharmacy’s capacity. They have greater access to distributors (such as the new distributor for Concerta’s authorized/branded generic:  Authorized Generic Concerta Update: 6/19/19).

Think about it. You could reduce the hassle of getting a prescription filled from 12 times annually to only 4 or 6 times (with a 90- or 60-day supply). Without driving anywhere. Or waiting.

When I describe the process I use for my husband’s medication (yes, that is my gift to him—and me!), folks look at me wondrously. I don’t have time to waste. Who does?

You Still Need a New  Script Each Time

Unlike non-Schedule II medications, stimulant medication cannot be prescribed with refills. You need a new script each time.

With monthly prescriptions, that means physically procuring a script each month from your physician.

Some physicians will give you several scripts for coming months, all at once. But some won’t and for good reason. 

With 60- or 90-day prescriptions, you need to get fewer paper scripts from your physician.  For some home-delivery pharmacies, you can send in the prescription two weeks ahead of time (that is, the time when the current supply is due to run out). Be sure to ask your pharmacy for clear instructions.

Caveat: Someone Has To Sign For Delivery

You typically have to sign for the delivery (USPS or UPS).

So, if no one is home to sign for it, and (if a note of attempted delivery is left) you can’t get by the Post Office to pick up, you might have to make other arrangements (delivery to office, your doctor’s office if that is convenient, etc.).

New!!  Electronic Prescribing!

[A quick word about electronic prescribing. I’ve heard about it, but haven’t seen it in action. Apparently, if your healthcare plan’s pharmacy and your physician’s office are set up for it, this is a great innovation. No more lost paper scripts!]

 

Home Delivery of Prescribed Stimulant Medications

2. Consistency

Let’s say there are three manufacturers of the generic medication you take.  By trial and error, you’ve learned that one of those generics works best for you—and the others work poorly.  They cause intolerable side effects or simply don’t work as well.

Local pharmacies often change vendors, in order to get the best price.  It’s a crapshoot each and every time.

In my experience, these large home-delivery pharmacies have more reliable supplies of specific generics. For example, throughout the mess with the downgraded Concerta generics, we were able to consistently receive the authorized generic.  Others weren’t so lucky.

[More on that topic: Reports came to me that the Walgreen’s drugstore chain was fairly reliable with Concerta’s authorized-generic supply. CVS, however, filled prescriptions with the generics that the FDA would eventually downgrade (after our campaign). Even after the inferior generics were downgraded, ADHD Roller Coaster readers reported that CVS was still filling prescriptions with the downgraded generics! This was a huge problem because the readers’ insurance plans stipulated that any Concerta prescription must be filled with a generic if one were available. Read Sound Off: Users of Generic Concerta Share Their Stories.]

Home Delivery of Prescribed Stimulant Medications

3.  Continuity

Perhaps you’ve noticed one particular problem with 30-day supplies of medication you need to take every day: Some months have 31 days.

So, even if you’re super organized and plan diligently each month to procure your script from the doctor and take it to the pharmacy, there are gaps.

What if you’re not…ahem… super-organized and planning diligently? There are huge gaps. It’s in those gaps that life can steadily spin out of control. You might not even realize what is the problem. In fact, weeks might go by while you keep thinking…why have things gotten so hard.

 

Home Delivery of Prescribed Stimulant Medications

4.  Cost-savings

Again, much will depend on the parameters of your health insurance plan. Employer-provided policies are decided by the employer. So, it’s not as if, for example, all Blue Cross policies are alike; there are huge variations.

On average, though, copayments are 29% lower through home delivery than at retail pharmacies, according to ExpressScripts spokesperson Jennifer Leone Luddy.

Update 3/21/2018:  90-day supply at local pharmacies?

A reader sends this note:

For those of you dealing with CVS Caremark and long-term mail order prescriptions – my plan now allows the same mail-order price for purchasing a 90 day supply directly from our CVS pharmacy at Target. (I assume a stand-alone CVS would be the same, but we don’t have any near here.)

This was not in any of my plan’s documentation – I heard about it from my pediatrician who had others who were able to do this. The first time the pharmacy couldn’t confirm anything about pricing until after they processed the full prescription, so I just kept my fingers crossed.

This has been a huge improvement for us. The mail-order was a huge stress, especially as we also had substitutions and ridiculous mess due to tiny misses on the scripts. (In NY State they can only fill 30 days for a stimulant unless Code B is written on the script. That was my favorite, esp since they charged the full 90-day price. After getting the med for a couple years, I’d think they would know it was a “long-term” Rx, which is what the code means, and do a better follow-up with the doctor.)

It is worth checking with your local Target, Walgreen’s, or CVS to see if they’ve been able to provide long-term fills for others. I’ve found our local Target pharmacy to be very helpful. It’s easy to tell their hands are tied in some areas, but they do what they can.

Q&A: Stimulant Prescription Home Delivery

ExpressScripts spokesperson Luddy kindly answered my questions on this topic:

Question 1:

This access to a mail-order pharmacy: Is that a benefit with all health insurance plans or does it vary by plan?

It varies by plan. But many health insurance providers offer a mail-order pharmacy, or as we call it, home delivery pharmacy, option.

Express Scripts manages the pharmacy benefit for more than 85 million Americans (about 1 in 5 Americans) on behalf of their employer or health plan.

Many other pharmacy benefit organizations offer mail-order as an option, too [Gina notes:  We’ve used Express Scripts in the past; our current plan uses PrimeMail. Both have worked similarly.]

Question 2:

When you have a local pharmacy fill the prescription, that’s typically a 30-day supply. With a home-delivery pharmacy, some insurance plans allow for 60-day or 90-day home-delivery supply. Is this variation due to the health plan or state law?

Both.  Some controlled substances have quantity limits that vary by state law, and sometimes a plan may limit the quantity available.

For patients who are prescribed a controlled substance, they should call their plan to learn more about any limitation surrounding the dispensing of the medication, and any additional paperwork required by the plan for coverage of that medication.

Question 3:

Regarding Schedule II substances—specifically, the neurostimulants such as Adderall, Ritalin, Concerta, Vyvanse, etc.   Does the ability to have these scripts filled via home delivery vary by state?  And, is that determined by the state the consumer lives in or the location of the pharmacy?

We are not aware of any limitations by either state law or plan design to prohibit these medications to be filled by home delivery pharmacies.

Question 4:

Do you have data on how many stimulant prescriptions Express Scripts filled last year via home delivery?

I do not have this data available at this time.  However, our report on ADHD medication use has some statistics on the use of these medications. Use of ADHD medications among Americans rose 35.5% from 2008 to 2012, increasing the number of privately insured individuals on these drug therapies to more than 4.8 million in 2012.

Question 5:

Our healthcare plan allows the Schedule II medication to send in the refill 60 days into a 90-day prescription.  This provides a great buffer, allowing for mail-travel time, the ability to correct any errors, and so forth without running out of Rx.  (The alternative, with local pharmacies, is having to time it to the day, hope that the pharmacy has the Rx in stock, etc.)

Refill frequency is defined by plan design; we are not aware of any existing state regulations that limit refill frequency.

____________

Okay, that information should at least get you started in exploring your options.  Please write any questions in a comment, and I’ll address those in a future post.

Also, I welcome your experiences, good or bad, with prescription home-delivery.  Your tips can help others!

Please note: I have no business relationship with  Express Scripts or any pharmacy.  This information is strictly a reader service.
—Gina Pera

44 thoughts on “Home Delivery of Prescribed Stimulant Medications”

  1. First off, going to Europe is NOT the answer. The doctor will tell you to your face that you are, and I am quoting here, “just another over medicated American”. I have been without my ADHD medication for 3 years (the length of time I have been working in Europe, incidentally) because I have been unable to get a prescription from any doctor in the 5 countries where I have tried to get one. This is despite being able to show years of medical records and prescriptions for both Ritalin, Ritalin XR, and Vyvanse.

    Now that I am back in the land of good, if expensive, medical care, I am looking to restart my medication. With all of the COVID insanity, I was hoping to find a telemedicine doctor who would be willing to write it. I can still have empty pill bottles to prove that I have been on Vyvanse.

    1. Dear Lisa,

      Thank you for echoing my perspective: It’s NOT better anywhere. It’s worse!

      Europe is fantastic compared to Asian countries such as Japan and China. Russia? Out of the question.

      The single-payer systems are the worst. Wait several years in the UK just for an evaluation. Then, if you’re very lucky, get your choice of extremely limited stimulant choices or, more likely, an antidepressant (NOT an ADHD treatment). In Australia, the NHS routinely provides Dex — and that’s it. Canada is a bit better but only because they have a strong professional community who lobbies the government. (Several ADHD pioneers were Canadians.) But there, too, access to professionals is extremely spotty.

      France’s NHS is recognized as one of the best systems. But oh boy….not the place to have ADHD. Unless you want to have a slew of anxiety and antidepressant medications thrown at you — or be psychoanalyzed. Germany is also a recognized best system. The problem there, however, is that the public is so little educated about (or accepting of) ADHD.

      It’s so painful receiving e-mails from folks in these countries.

      And then to hear Americans who’ve been brainwashed by a demagogue who knows nothing about healthcare policy….ready to ditch our entire system…

      No system is perfect. All healthcare systems have their plusses and minuses. But using ADHD as the litmus test for scientific rigor and access to care, I’ll take ours ANY DAY over any other. There is more of an onus on the consumer to identify competence (and avoid the incompetents) but at least it is there and decisions are not made by government beancounters.

      I wish you luck in re-starting your Rx. I know of no telemedicine docs who can prescribe out of state, though, so you might want to look in-state. Or not rely entirely on tele-medicine.

      g

  2. I enjoyed this post, thank you.

    A few notes.

    First, the federal laws and regulations are implemented by the states, each of them potentially differently.

    Second, doctors and pharmacies feel free to misrepresent the laws and regulations to you either because they dont know, or because they changed, or because they dont want to be bothered so they say it is the law to get you to go away.

    Third, so far as I can tell, they do not have a reliable way to diagnose ADHD nor a way to set the proper dosage of medications other than the touchy-feely, let’s try this, let’s try that.

    Fourth, even if you find a treatment that works for you and lets you live your life, you have no rights to get this medication, no one is required to help you, and they wont if its not convenient for them.

    Fifth, the system is fragile and breaks regularly and when it does you are expected to do without the medication even if it damages or destroys your career and your life.

    Sixth, if you ever in any way protest this state of affairs, they will just get rid of you, they don’t want to be bothered.

    Seventh, whenever you find a system that works, it is my experience that you should expect that at any time the system that was reliable may fail. A doctor retires, a pharmacist changes. Too bad.

    Eighth, the anxiety and disruption this causes you and the trauma that you may experience (and I have experienced a lot) is way beyond their capability to fix. They don’t care, it’s not their problem.

    Ninth, in general, if you have this disease and you find this treatment useful, as I have, then you should expect to be dealing with this is a disruptive and time consuming manner for the rest of your life or until you find another country that handles it better. I am working on that.

    I realize that many of these comments are off topic to the specific mail order stimulant question but I hope they may be helpful.

    MW

    1. Dear Michael,

      Thank you for delineating all the de-stabilizing mess. It’s just unconscionable. But, as you say, it’s the reality. Best be prepared for it.

      I will add, I think some of the professionals in question care, but they maybe aren’t clever or confident enough to navigate workarounds, make that extra push, etc..

      thanks for your comment,
      Gina

  3. I’m new to the site and it’s been very helpful. Thank you for that. I have looked into quite a few home delivery pharmacies and every one of them says they can not or don’t fill schedule II prescriptions. My doctor is more than willing to write me a 90 day script so I can have the convenience of mail order but without a pharmacy willing and able to send me my ADD medication, I’m stuck with having to go through the tiresome act of getting my prescription filled once a month. My insurance company’s mail order pharmacy doesn’t carry any controlled substances so I’m out of luck there too. I’m wondering if the laws for mail order for schedule II changed since you wrote this article, is that possible? Thanks so much for your input.

    1. Hi John,

      I’m sorry that you’re having trouble.

      It’s almost impossible to get definitive answers on anything related to health insurance coverage. Plans are so variable, even within the same company. High-deductible. Low-deductible. High co-pay. Low co-pay.

      I did my best to see what type of laws might apply. The best I could get was from the ExpressScripts spokesperson, who said this (as quoted in the post):

      We are not aware of any limitations by either state law or plan design to prohibit these medications to be filled by home delivery pharmacies.

      It might be that your plan has lesser-than-average benefits.

      That seems bizarre to me. It’s not an illegal substance. Stimulants are the first-line medication for ADHD — taken by millions of Americans.

      Good luck!
      g

    2. Nancy E Lustgarten

      Hi John, stuck in New York state and now having to renew my son’s ConcertaER prescription monthly. To add insult to injury my insurance deductible is higher than the cost of the medications for a year (just), and they don’t cover methylphenidate ER anymore (which used to be our cheaper way of getting the prescriptions). I called my NY State Legislature’s office to find out if they could reverse the new law limiting three month prescriptions of Concerta ER / and similar generics but of course this comes with the perception of being soft on drug abuse so I can’t imagine the law ever getting repealed. Sorry to go on and on…I’m just so damned tired of drug companies, insurance companies, elected officials making my life harder and harder. Best to you!

      Nancy Lustgarten

    3. Hi Nancy,

      I appreciate your frustration.

      If it is any consolation, the situation is MUCH worse for many people with ADHD in single-payer NHS countries. I hear the stories every day. Extremely limited medication choices — and often the most problematic ones (e.g. Dexedrine). Waiting two years to even get an evaluation>

      In fact, we are very lucky here in the U.S. to have a range of choices and various discount programs (in the case of newer medications).

      The important thing is to be focused on the relevant facts and be precise with terms. For example:

      1.
      When you say “they don’t cover methylphenidate ER anymore (which used to be our cheaper way of getting the prescriptions)”, do you mean the authorized generic for Concerta?

      Because there are many new (inferior) generics for Concerta and they are also called methylphenidate ER.

      I wrote this post to help people gain access to the authorized-generic (which is the brand sold as a generic). So, you might want to try the tips I write.

      2.
      I’m not sure what your being in NY state has to do with it. You mean you cannot get 90-day prescriptions at your local drugstore or via any home-delivery pharmacy benefit you might have?

      From what I can read, you can get a 90-day prescription, but the diagnosis code must be written on the prescription: https://www.health.ny.gov/professionals/narcotic/newsletters/2006-12.htm

      I hope this helps.

      Gina

  4. The last set of comments really hit home for me.

    You’re obviously much more educated in this subject than I, but could Laura be suffering from ADD rather than ADHD?

    I had never heard of ADD until I spoke to my oldest son’s high-school guidance counselor about 10 years ago. Symptoms were similar to those Laura described, i.e., difficulty concentrating, low motivation (discouraged), procrastination, feeling overwhelmed, etc…

    I took him in to his pediatrician for testing and sure enough, he diagnosed ADD. I truly believe ADD is under-diagnosed due to lack of hyperactivity symptom. Once my oldest son was diagnosed, we quickly recognized it in my younger son (even more severe) and in myself! I was told by the doctor it tends to run in families. In any event, we’re all on medication now – sons take Concerta and I take Adderall. What an improvement!

    1. Hi Jan,

      I congratulate you on following that clue — and helping your children and yourself. Kudos!

      Many people are confused about the terminology. They assume (or have been told) that ADD is ADHD without the hyperactive component.

      Trouble is, that is not true.

      There is no condition called ADD.

      The official term for ADHD is ADHD, but there are three “presentations”:

      1. Primarily hyperactive
      2. Primarily inattentive
      3. Combined

      Most adults with ADHD are not physically hyperactive; they have the combined presentation. A minority have the inattentive sub-type.

      Many people assumed that if a person with ADHD is not physically hyperactive, that person has the inattentive presentation. Also: not true.

      Years ago, as you point out, it was thought that ADHD was only physical hyperactivity. That’s because that behavior was the most obvious.

      Now we know more about the complexity that is ADHD neurobiology — and no longer base it on how someone “looks” (that is, hyperactive).

      Our challenge now is educating the public, teachers, mental-health professionals, etc. 🙂

      thanks for your comment.
      g

  5. Thank you. I have a scheduled consultation with the Kaiser folks to be screened after talking with one of their triage psychologists -it’s free, so I figured why not. If that fails, I’ll try and find an outside provider and go out of pocket.

    Do you have any advice about talking to psychiatrists about this – Bay area ones in particular? Kaiser’s maybe not the best litmus test, but no amount of prescription history or medical records from my psychiatrist seemed to matter to them. It also seems like there are more doctors devoted to treating addiction and stimulant abuse as well as marketing suspicious looking “holistic methods” than where I’m originally from. I don’t want to appear drug seeking or doctor shop – but on paper, I’m part of legions of educated sci-tech workers moving to the area “looking to get ahead”. Doctors are understandably spooked about prescribing stimulants, but I could be taking one pill of Adderall versus five pills of antidepressants/related meds.

    Thanks again.

    1. Hi Laura,

      Logic and science have nothing to do with it. And it’s hardly “holistic,” because that means taking care of the whole person — including sometimes medication, diet, physical health, etc.

      The word that fits better is “alternative.” And too often, that means….cannabis.

      In fact, I sometimes call the entire “left coast” the Third World of ADHD Treatment.

      Few believe me until they come up against it.

      My best advice is to learn all you can before you select a professional; that way you’ll be able to evaluate the professional. 🙂

      My book authoritatively covers how the evaluation should go, how medication should be selected and monitored, etc. https://amzn.to/2ZRGcpL

      I seem to recall some of my local group attendees referring to Evelyn Miccio, PsD, at KP in SF.

      You might want to join us next month. https://groups.yahoo.com/neo/groups/SiliconValleyCHADD/info

      My best advice is to learn all you can before you select a professional; that way you’ll be able to evaluate the professional. 🙂

      I have another idea but I will e-mail it to you.

      Gina

  6. Hi Gina,

    Thank you for your reply. As to your questions – am I sure that I don’t have ADHD/ADD? No, but my symptoms are in that uncomfortable middle ground which skews either way depending on how you read it. I struggle with ability to concentrate or adhere to deadlines, and do things last minute frequently despite my best efforts. This turns into/is combined with motivational issues and anxiety, which is where the depression diagnosis came in. It’s kind of a chicken-or-egg issue.

    However, this didn’t cause problems in my childhood (a big benchmark for ADHD diagnosis), not because I didn’t procrastinate or have concentration issues, but that I could get away with it since the curriculum wasn’t challenging. On top of that, I didn’t have the behavioral issues (hyperactivity, acting out, sexual stuff sometimes attributed to girls, etc). Since my grades were great and I didn’t act out, I never interacted with mental health providers until my late twenties when stuff really started to hit the fan. This is in contrast to my partner, who’s been on some ADHD treatment since he was 10.

    I’m going to try and jump through Kaiser’s testing hoops but have a feeling I’m too high functioning. I’ll likely change to the more expensive Blue Cross/Shield insurance when I get a chance, so at least I can try to find a sympathetic psych.

    1. Hi Laura,

      I know this topic very well. In fact, I am considered an expert. 🙂

      From what you write here, I see many vigorously waving red flags for ADHD.

      Perhaps your past mental-healthcare providers, ill-versed in ADHD, have convinced you that what you are dealing with depression. Or perhaps you are getting information from websites that claim ADHD expertise but have it maybe half-right.

      In other words, there is a very good chance that, while you might also have neurogenetic depression, you have ADHD.

      Living with ADHD can be “depressing.” Once a person with undiagnosed ADHD gets diagnosed and starts medication treatment, the “depression” often lifts. But, again, there is a chance that brain-based depression co-exists with ADHD.

      Many of your assumptions for ruling out ADHD merit revisiting. For example, while childhood symptoms are helpful in determining the diagnosis, they must also be viewed with an astute and contextual eye. As you say yourself, you remember procrastinating and concentrating being challenges in childhood. Your “getting away with it” perhaps simply means you were smart and didn’t have to put in the effort that other kids did.

      Many people with ADHD do well in school, with the full ADHD fallout happening only later in life, when their capacity to manage multiple “adult domains of life” is stretched.

      What I typically recommend when encountering the KP roadblock is paying a prescriber outside the system for an evaluation, get titrated on a medication, and then bring that into KP.

      Good luck!
      g

    2. Nancy E Lustgarten

      One cheaper way to go might be to try to find a gp who also specializes in ADHD. We just found out by coincidence that my son’s doctor in NY has that speciality… I don’t know if you can skip the expensive testing money pit (a short test and long conversation will typically uncover the same thing to a truly discerning eye), but it might be worth some investigating. Good luck to you. I absolutely sympathize with what you’re going through. a quick google search for AdHD testing led me to this site in California.
      Looks promising but I’m sure they too want to make money.
      https://sandiegoadhdcenter.com/

  7. Your previous reply about Bay Area residents having to fight for prescriptions hits home for me. I have a related question, but slightly different than others: I recently moved to the Bay area, and have a prescription for Adderall (or equivalent generic.) Problem is, it’s not for ADHD – it’s for treatment resistant depression. I’ve been on the merry-go-round of trying antidepressants and my psychiatrist in my home state prescribed it to me with no issue. I’ve been on it for a couple years with no problems, and it helps a ton. However, I have Kaiser insurance now and their internal policy is not to ever prescribe unless the patient is ADHD. Even then, my ADHD partner was treated like a drug addict when he had to jump through their hoops to be re-prescribed with a new doctor. I straight up got sneered at when I asked about my case and was told to start taking SSRIs again.

    Is there any way that my previous physician could write a prescription to a mail order pharmacy and I have it mailed to me? California law is worded in such a way that everywhere I’ve looked the answer is no, at least at a physical pharmacy. I’m more than willing to pay out of pocket at this point, but not to the point of asking family to pick it up and mail it to me (which may or may not be illegal). I also can’t really afford to go around to other out of network psychiatrists asking for a prescription and likely being told no.

    1. Hi Laura,

      I appreciate your predicament, especially with Kaiser. It has a bad reputation vis a vis ADHD in specific but mental healthcare in general—and have been fined many millions of dollars for the latter.

      There are pockets of helpfulness but they are hard to find.

      First, though, I hate to ask but are you SURE you don’t have ADHD?

      Many times, “treatment-resistant” depression IS ADHD. Mis-diagnosed ADHD.

      In fact, a famous study years ago examined a group of about 90 subjects with “treatment-resistant depression.” They screened for ADHD and ended up treating something like half that number with a stimulant, to which they DID respond.

      If you actually do have ADHD, it will be a lot easier if you are evaluated with and treated for that.

      Otherwise, I would ask your previous physician about prescribing across state lines. My hunch is that, since it’s a Schedule II substance, that won’t happen. But that’s just a hunch. I am not qualified to provide a definitive answer.

      This seems like a legitimate online pharmacy but I cannot attest to it. You might want to call and ask: https://www.healthwarehouse.com/catalog/pharmacy/new/

      Best of luck,
      Gina

      This article on telepsychiatry touches upon the evolving laws: https://www.techhealthperspectives.com/2018/01/22/new-state-laws-allow-telehealth-prescriptions-for-controlled-substances-yet-regulatory-obstacles-still-remain/

  8. Gina,
    I have been through the entire routine of educating pharmacists and doctors about the authorized generic for Concerta for five years now. After five years and twelve different pharmacies, we are now out of options.

    Walgreens, our previous pharmacy, flat-out told us that the pharmacy benefits manager had taken the authorized generic off of their list and they were now substituting Amneal.

    Before that was CVS, Rite-Aid, Costco, Target, Ralph’s, several independent pharmacies, etc. I just got off of a long phone call with our current pharmacist at Walmart, and she does not have any answers for us.

    She has been ordering the authorized generic for us (using the NDC code that I gave her six months ago); and although we’ve been left in the lurch several times (three weeks back-ordered, two weeks back-ordered, short ten pills on one order, etc., we have ultimately been able to get the medication until now.

    Now, (according to my pharmacist) McKesson keeps telling Walmart that they do not have it in stock and they keep substituting the junk generic from Lannett. the pharmacist assures me that she is ordering it with the NDC number, as always, but does not receive the medication. This has been going on for two months.

    Independent pharmacies can get it, but won’t take our insurance; and we can’t afford $500.00 a month. I have a call in to our insurance to see if they offer mail delivery–perhaps a bigger supply that way?

    My son is supposed to start college next week and he has been out of medication for three weeks. Any suggestions? Los Angeles is a big place, but I have literally tried at least forty pharmacies by phone (and yes, many act like I’m a drug addict and many won’t talk at all on the phone); and fifteen in person; to no avail.

    It’s easy to tell me not to panic, but I have tried everything I can think of, I have a very ill husband, and am in dire financial straits, so this is the last thing we need right now. Please let me know if you have any other helpful ideas that I haven’t tried. Btw, I also have to drive (45 minutes) to pick up the paper scrip each month and then drive an hour to fill it; and then usually another trip to pick up the order. I am at my wit’s end and my son will likely have to delay college and work this semester so that he can make enough money to pay for his medication.
    Thank you,
    Veronica

    1. Hi Veronica,

      You didn’t mention any of that in your previous message—at least regarding during the transition from Teva to Patrio as the distributor—so you can understand why I suggested to keep looking after seemingly trying one store.

      If I assumed these things were “easy,” I would not spend days researching information to share freely on my blog in order to help.

      Obviously, I sympathize and have done my best here.

      It might be that your insurance is not the best.

      But it might also be that you were looking for the authorized-generic during the transition time—before Patriot got its act together (if it does at this point) and made its presence known.

      I had to dig for the information then. Nobody seemed to know anything, including Patriot when I contacted the company.

      It might be that the supply lines are settling into place now, as evidenced by other readers having success.

      So, you might want to re-try the Walgreen’s you used before, where you have a history.

      If you can’t get it, by all means, try another methylphenidate formulation. There are plenty of them, and some trying to gain market share offer discount cards.

      If you know that Wal-Mart uses McKesson, then you might not want to waste time on Wal-Mart.

      Yes, as I mentioned in the post — and in every post on this topic for about 5 years — it might be easier to get through the home-delivery benefit if you have it. It also involves jumping through some hoops — checking first if they can get it, asking for specifics as to how the prescription should be written, etc. But it can reduce hassles and cost.

      Good luck,
      Gina

  9. I am fed up with my mail carriers. I have reported one a couple of years ago to the Post Master and after a few days of having a temporary carrier, he was back and he would actually knock to get the required signatures. But now, I have a new carrier. I know when I am expecting my Adderal delivery and I work from home. The front porch and mailbox are right below my window at my desk and I can hear the mail carrier and their scanner every day. I heard the carrier so I get up and go to the front door and open the door as he is putting the package on my mailbox, I believe I surprised him. He never knocked. He hands me the package and I say I need to sign and point to the label. He mumbles something which sounded like “I did” and then says ‘It won’t upload” and rushes off my porch. Checking the deliver confirmation it shows it was delivered a minute before I opened the door. Just love the ‘Smart’ world and its data. I H
    have requested the signature image from USPS and I would bet a hefty amount the signature is forged once again. Besides going to the Post Master again, are there any other things that can be done? This is forgery which is a felony and it is a Schedule II drug. If the package were to go missing from my mailbox I would have a difficult time getting a replacement, especially since it was released with a ‘signature’. Plus he lied to my face.

    1. Hi Liz,

      Typically, I hear the opposite: People frustrated that their USPS mail carrier will NOT leave the package without a signature.

      I’m not sure what suggestions to offer.

      I know that postal carriers are increasingly pressured to get more done in less time. Trump has been trying to “reform” the USPS by privatizing it. In other words, another profiteer move against a government institution.

      Perhaps you could aim higher up the food chain and support the USPS in its quest for survival and continued service.

      Gina

  10. Thanks so much for suggesting this route! I just got off the phone with my insurance company and it looks like this will work–they use Caremark (CVS) so we’ll see if I actually get the Teva.

    1. Kris — I had lots of trouble with Caremark (we just this month moved to Aetna; previously, Blue Shield was great).

      Here’s what I recommend: Call the pharmacy rep and ask EXACTLY HOW the script should be written so as to receive the authorized generic (Actavis/Teva).

      With Aetna, the pharmacist said to specify on the prescription “Actavis/Teva authorized generic.” Maybe it will be the same.

      For many years with Blue Shield, I asked the doctor to specify “OROS only”. That meant the authorized generic. The OROS technology is what makes Concerta Concerta. It’s an osmotic pump.

      But with CVS, that resulted in receiving the Trigen.

      I called a pharmacy manager…what the heck?

      He said, “Trigen DOES have OROS.”

      Me: “WHAT? Who told you that?”

      Pharmacist: Trigen. :-0

      He’d confused Trigen’s osmotic delivery system with the patented OROS osmotic pump delivery system.

      Gotta watch these folks every minute….

      good luck!
      g

  11. I’ve been struggling with home delivery issues for years! I even changed doctors because my first one required me to come in for a new prescription every month, saying, “that’s the law,” and there’s nothing he can do about it. When I finally did some research and pushed back, saying he had discretion over how often I came in (NYS law does not require monthly visits) and he could write 3-month prescriptions for home delivery, his answer was, “maybe you should find another doctor.” My GP, a friend of many years, wouldn’t even consider writing a prescription for Vyvanse to cover the period between leaving that doctor and finding another.

    I do understand that doctors and pharmacists are under a lot of scrutiny for schedule II prescriptions.

    After several failed attempts, I was finally able to order a 90-day supply of Vyvanse from OptumRx. Unfortunately it has taken so long that I’ll have a gap of about a week between when I run out and when the mail order arrives. OptumRx and United HealthCare were great about it and–after only one transfer to another customer service agent!!–gave me an override to get a prescription (up to 30-days) filled locally.

    Now, my (new) doctor says he can’t legally write another prescription because it is too soon. I’m 99% sure that, once again, the law gives him discretion to do whatever he thinks is appropriate. But his prescriptions do get scrutinized, and he’s scared of getting a reprimand. Worst case, I know he can orally provide an emergency prescription to my pharmacy for up to a five-day supply.

    So my experience is that the agencies, while probably thwarting some bad actors, have scared the rest of the doctors and pharmacists to the point of not being able to serve their customers.

    I’m waiting to hear my doctor’s solution. He might write a short prescription or one for another dosage.

    What do you think is the right solution?

    Thanks,

    Doug

    1. Hi Doug,

      First of all, congratulations on doing an excellent job of plowing through unnecessary obstacles!

      I do not know NYS law. But in general, the “system” is on the watch for stimulant abuse. (Too bad they weren’t as vigilant with opiods, eh? Then thousands of people wouldn’t be dying or developing addictions as I write.)

      Red flags come up when there is an overlap resulting in double-supply. And MDs don’t have a lot of wiggle room on this. Especially in over-riding insurance companies and pharmacies.

      If I am understanding correctly, you have a 90-day supply on the way. And, you have in hand a 30-day supply. So that’s a four-month supply.

      Obviously, I’m misunderstanding something if that’s the case.

      Generally, the physician can date the prescription to the first date the mail-order pharmacy will fulfill the prescription. You can send it in a few days earlier. But not too many, in my experience. They’ll just send it back!

      So you want to calculate when your current supply runs out, and double-check with the mail-order company….”When should I send in my next order and how should it be dated?” Because really, all that matters is their rules.

      As for the bad actors, I’ve had it up to here with prescribers STILL — after my 20 years of doing this work —— sending lives off the rails with carelessly prescribed Adderall.

      The DEA controls the amount of raw materials for stimulants. That’s why we often run out of supply by the end of the years. The quota has been met, and you’ll just have to wait until next year for more!

      g

  12. Thank you for mentioning how you should consult with your insurance company to see if you qualify for home delivery medication. It is important to remember that taking the time to do some research and read online reviews can help you find the best way to get your medicine delivered. We are looking for ways to help our mom get the medication she needs to be delivered to her house, so I’m glad I found your post.

  13. I have medicaid and it doesn’t cover my Vyvanse prescription, so even with a Vyvanse coupon it costs me over $200 a month. I looked at the site you mentioned and it’s only for those insured through that group. I’ve seared for other sites for home delivery and cheaper price to no avail. Do you have any suggestions? Any ideas would be greatly appreciated.

    1. Hi Kelly,

      I’m not sure how to advise you. Have you contacted Shire’s program (“Shire Cares”)? You can call or e-mail:

      Contact Us
      For information about Shire Cares benefits and eligibility, please call 1-888-CARES-55 (1-888-227-3755), or email ShireCares@shire.com.

      Shire Cares is available from Monday through Friday from 8 AM to 8 PM Eastern Time, except holidays.

      If that proves fruitless, I wonder if you have tried other stimulants? Though I’m usually not a fan of generics, it might be that a generic Ritalin or Adderall would be a lot cheaper and might work almost as well (after you’ve tweaked the dosage and timing).

      best,
      Gina

  14. I have a question. I have an ongoing prescription for ritalin. I have taken it for 4 years. Is it safe for me to order from on online pharmacy? I don’t want to get into trouble.
    Thanks,
    Den

    C

    1. Hi Den,

      I’ve steered clear of online pharmacies. They seem too fraught with problems. There is a chance of getting inferior or counterfeit medications, I understand.

      I think it’s best to stick with legitimate drugstores or mail-order pharmacies associated with health insurance.

      Good luck!

      g

  15. Pingback: Consumer Q&A on Concerta Generics - ADHD Roller Coaster with Gina Pera

  16. Pingback: A Pharmacist Explains Generics and More - ADHD Roller Coaster with Gina Pera

  17. I really had no idea that home-delivery was an option for pharmaceuticals, but I guess since you have been using one for 15 years it must not be a far-fetched idea. I imagine a pharmacy supply company would have information on what sorts of services like that are available in your area. My dad is getting older and it’s hard for him to get out to the pharmacy, I’ll have to suggest that he look into this option.

    1. Hi Luke,

      Yes, definitely! It’s so much more convenient. Especially when it comes to stimulant medications, for the reasons I detailed.

      g

    2. Hi Luke,
      My mail order pharmacy is a benefit through my health insurance. You might want to start there.
      Good Luck!
      -Deb

  18. First, I just have to say I love your site. So relieved to have found reliable information from someone who actually gets it. You’re a godsend.

    Second, I just wanted to share a few observations and tips from my own medication refill experiences with Adderall in NYC over the last 10 years:

    1. Electronic “E-Scripts” have been a game changer for me. As of 2016, my doctor was able to submit my prescription electronically to my pharmacy each month, saving me the hassle of emailing, picking up and dropping it off each month. Prior to 2016, I was told schedule II class drugs could not be sent electronically (I didn’t fact check this so I don’t know if that’s accurate). But apparently something changed as of this year as my doctor’s office is now able to and have heard the same thing from others in the city who see different doctors.

    2. Doctors still are not allowed to call these prescriptions in over the phone however, which I’m sure we all assumed but just making a note.

    3. I have yet to find a doctor in NYC that is willing to prescribe more than a 30 day supply at one time, so I still have to submit a new refill request each month to my doctor and schedule an in-person visit with him every 4 months. Both of which can still be a huge pain.

    4. Avoid chain drug stores in NYC — Over the past 10 years I’ve tried them all (CVS, RiteAid, Walgreens, Duane Reade) and my experience with each has always been consistently awful, especially at their larger midtown locations. If you go to any of these chains with an Adderall prescription you will more than likely get treated like a drug addict and be told to come back in 2-3 days for pickup as its on backorder. You can’t get your order delivered. Many of the chains won’t even fill your prescription until the day AFTER your previous prescription expired and have even void a few of my past prescriptions because I wasn’t able to pick them up within 24 hours (in both instances they told me I would have to give them a NEW prescription note from my doctor to get it filled, rudely I might add). I’ve heard dozens of similar accounts from others who’ve had the same or worse experiences filling their ADHD prescriptions in the city at one of these chains. So again, my personal advice is to try and avoid these chains all together.

    5. Better Alternative — Small, Family Owned Local NYC Pharmacies: SO MUCH BETTER. My experiences with this these smaller mom and pop pharmacies in the city has been the exact opposite of what I just described. Of course I can’t speak to every one of these establishments but based on the three different businesses I’ve been a pharmacy customer at thus far — I’ve been treated warmly and respectfully, been able to arrange for my prescriptions to be delivered to my home (often for free) with my insurance and credit card information kept on file, never had issues getting my Electronic E-Script filled and the one time they didn’t have my medication on hand, it was only a 1-day turnaround to back order and was delivered directly to my office the next day without hassle. Basically they treat you like a human.

    1. Hi JC — Thanks for the report from the front lines!

      I agree about independently owned pharmacies.

      I have to say, CVS was the worst with the Concerta debacle, continuing to foist the downgraded generics on customers. Walgreen’s did a MUCH better job.

      I’m glad you found a workable solution.

      g

    2. My Dr in Indiana is being a complete rude jerk and threatened to take me off my Adderall!! I need an e script I am so sick of dealing with Drs and just want my Adderall. Any suggestions how to get a Dr online to e script me one?

    3. HI Aubrey,

      No, sorry. I do not recommend these “online doctors.”

      Perhaps it’s time to try something other than Adderall.

      good luck,
      g

  19. Pingback: A Recap: Consumer's Guide to Generic Concerta - ADHD Roller Coaster with Gina Pera

  20. Our insurance has a mail order pharmacy and the cost savings are small. However, the convenience is HUGE. If I could only get my ADHD partner to do it…..he’s still running to Walgreens at the last minute every month. 🙁

    1. Hi Deb,

      If I hadn’t set up the system, my husband would probably still be scrambling every month.

      I take care of it, as a favor to him—and to me! 🙂

      g

  21. Well, our HMO here in Washington State will NOT let him get his stimulant by mail although they have a big mail order pharmacy. Since this HMO just joined hands with Kaiser Permamente, against the wishes of many of the HMO members, we are considering changing insurance carriers during open season. I’d probably be looking at Blue Cross.

    But, one question. DH is on medicare/medicaid. If we get his prescription filled through our current HMO pharmacy, he has to pay a co-pay of about $35 per scrip. If he walks into the pharmacy at our grocery store, he pays $1.25.

    Do you know if you can get medicare/medicaid prices and still get mail order meds with Blue Cross? I think you mentioned that was who you had. And, yes, I know, my mileage may vary.

    We will be looking closely this year at changing health carriers after about 30 years at the HMO that I *was* happy with for the most part. 🙁

    1. Hi Penny,

      You asked:

      But, one question. DH is on medicare/medicaid. If we get his prescription filled through our current HMO pharmacy, he has to pay a co-pay of about $35 per scrip. If he walks into the pharmacy at our grocery store, he pays $1.25.

      I am assuming that he does not use any kind of insurance card or medicare card at the grocery store pharmacy, right?

      Here’s the thing most people don’t understand (I should write a blog post): Insurance companies and pharmacies sometimes MAKE MONEY from co-pays on generic drugs. Some generics are very cheap. Which is why Wal-Mart and Costco and other “Big Box” stores sell them cheap to people without insurance.

      That’s why I advise that people shop around, compare the cost of the generic among pharmacies AND with/without using insurance or Medicare.

      Sorry, but I know nothing about Medicare/aid might dovetail with Blue Cross. I thought it was one or the other, not both. Except in the case of supplemental policies to Medicare.

      Who knows. You might like Kaiser. Many people do. For Adult ADHD, though, here in the Bay Area, people have to claw their way to getting treated. It’s gotten a bit better, with some locations being more pro-active than others. Still, it can be an uphill climb at others.

      g

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