Home delivery of stimulant medications? That’s legal? Yes, it is, in most of the U.S. at least.
Imagine: Instead of playing “drug store roulette” every 30 days, some folks get a 60 or 90-day stimulant prescription delivered. Yes, stimulants, the first-line medication treatment for Attention-Deficit Hyperactivity Disorder (ADHD). Delivered to your home. If you have this benefit but never 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. They’ve said 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. It is often so much more convenient. The home-delivery pharmacies also tend to have more choices of generics and greater supply than storefront pharmacies.
Is home-delivery available on your insurance plan? That depends on the terms of your coverage. Is it a workable option for you? That depends on other factors, discussed below.
Update: New “Digital” Pharmacies Add Confusion
Readers report using a new kind of “home delivery” pharmacy. Examples include Capsule and Alto. These are venture-capital-funded “digital pharmacies”—new kids on the block.
They are not like the big national “warehouse”-type home-delivery pharmacies—the ones I refer to in this post (e.g. ExpressScripts and Alliance Rx). These new outfits do “home delivery”, but it’s by private courier. Also, you can’t get a 60- or 90-day supply. So, a different type of thing entirely.
I’ve heard about these companies mainly in the context of readers not being able to get what they need from them, such as the Concerta authorized-generic or Adderall. So, buyer beware.
Home Delivery: Who Benefits, Who Might Not?
Home delivery of prescribed stimulant medications might not be a great option for certain situations — or types of patients.
—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 likely don’t want to pay for large quantities of a medication (typically 60-90 days) that you’ll end up not using.
—Difficulty Finding A Pharmacy with Stimulants 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.
Moreover, there typically 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.
In that case, home-delivery might save you huge amounts of time, money, and stress.
First, let’s examine the benefits and then learn about guidelines.
Benefits of Stimulant-Medication Home-Delivery: The Four Cs
I count at least four categories of potential benefits:
Has this happened to you? You realize that you have one pill left. You leave work early and scramble to your doctor’s office. If you’re lucky, you can pick up the script. Then, where to fill it?
- Nothing says stress like having to run around to pharmacies, seeking one that has your medication in stock.
- Local pharmacies are often out of the stimulant medications, such as Ritalin, Vyvanse, and Concerta. In such case, you might receive 10 pills and are told to come back next week for the remaining 20.
- I’ve heard stories about pharmacist giving customers the hairy eyeball, as if they abusing the stimulant medication. (Catch 22: The more you get rightfully 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 Medication Update
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. Or hairy eyeballs.
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 in wonder. But I don’t have time to waste—nor do we need more fodder for conflict. 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 fewer paper scripts from your physician. Or, the prescriber can send the script electronically (see below).
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. Sometimes there is a narrow legal window.
Caveat: Someone Has To Sign For Delivery
You typically have to sign for the delivery (USPS or UPS).
Someone must be home to sign for it. COVID work-at-home trends made this more practical. You might have to make other arrangements (delivery to office, your doctor’s office if that is convenient, etc. Ask for the rules).
New-ish: Electronic Prescribing
A quick word about electronic prescribing. Of 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!
Let’s say there are three manufacturers of the generic medication you take. (For example, there seem to be dozens of generic version of Concerta now, but only one is the authorized-generic, from Patriot.)
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. Some will even note your preference in your record — if your prescriber specifies it. Sometimes this requires pre-authorization.
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? Those gaps can be huge. It’s within those gaps that life can spin out of control. You might not even realize what is the problem. In fact, weeks might go by while you keep asking yourself…why have things gotten so hard?
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: 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
Below, ExpressScripts spokesperson Luddy answered my questions on this topic:
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.
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.]
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.
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.
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 latest report showed that 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.
I welcome your experiences, good or bad, with home delivery of prescription stimulants for ADHD. Your tips can help others!
Please note: I have no business relationship with Express Scripts or any pharmacy—or any entity. This information is strictly a reader service.