Home delivery for prescription stimulant medication—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.
Home Delivery: Who Benefits, Who Might Not?
Home delivery might not be an option for everyone; check your health insurance plan. And, it 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.
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 all the way around.
Patients Who Have Difficulty Locating A Pharmacy that Has 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?
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!
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 potential benefits:
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?
- Nothing says stress like having to run around to pharmacies, seeking one that has your medication in stock.
- 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.
- 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.
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 with green envy in their eyes. It’s that simple? Yes. Because 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!]
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, rarely had it, instead filling 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.]
[Update 6/19: Due to the roller coaster of continuing changes with the authorized (or branded) generic for Concerta, Walgreen’s seems to be bowing out, too. From what I understand, pharmacies can’t afford to fill these prescriptions; they actually lose money. Why? Because they are reimbursed the price of the lowest-cost generic.]
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.
And if you’re not 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.
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:
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.]
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 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.
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.