This statement is intended to inform you about proposed and potential upcoming changes in the rules and regulations surrounding the prescription of stimulant medications, such as but not limited to: Adderall, Vyvanse, Ritalin, Focalin, Concerta etc., and how they may impact your treatment and care at Kansas City Psychiatric Group. These anticipated changes, both at the state and federal level, are part of ongoing efforts to ensure the safe and effective use of stimulant medications and to help mitigate the risks associated with misuse or overuse. Although these changes have been proposed and not finalized, our practice intends to adhere to updated internal policies in anticipation of this. These changes will be implemented with the goal of providing the highest standard of care; while also protecting the well-being of our patients and ensuring that stimulant medications are used appropriately.
The following outlines our key updates:
- Improvement of diagnostic evaluation
- Psychiatrists have extensive training in diagnosing and treating mental health conditions, including Attention Deficit Hyperactivity Disorder (ADHD).
- Psychiatrists adhere to a structured clinical interview guided by DSM-5 (Diagnostic and Statistical Manual of Mental Disorder) criteria as well as the use of standardized rating scales and neuropsychological testing to make the diagnosis.
- Our office will now offer on-site neuropsychological testing that may be clinically required for patients who have never been diagnosed with ADHD. Patients with a long-standing diagnosis of ADHD on regimens greater than the FDA approved maximum dosing guidelines may also be required to complete testing. This is up to the discretion of your psychiatrist. Patients can also seek neuropsychological testing at other facilities and referrals will be provided, if needed.
- Evaluation of efficacy
- The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act) mandates an in-person medical evaluation before prescribing controlled substances. The general rule under the Ryan Haight Act is that a provider must conduct at least one in-person medical evaluation of a patient prior to issuing a prescription for a controlled substance.
- To remain in compliance with this requirement, you will be seen for an in-person evaluation, for either an initial or follow-up visit, per the discretion of your psychiatrist. Additional requirements for in-person visits will be communicated to patients individually.
- Prescriptions for stimulant medications require more frequent follow-up visits and documented assessments to ensure continued medical necessity. This includes ongoing evaluations of your symptoms and overall progress every three months.
- Your psychiatrist can only provide up to a 3-month supply of your prescription at each appointment. If you run out early, let your refill lapse, or have not met with your psychiatrist within the last 90 days, a refill may not be provided until you have been seen for an appointment.
- To receive a prescription of any controlled medication from psychiatrists in our practice, you must have a permanent address in either Missouri or Kansas. For each telehealth appointment you must be physically located in either state.
- Controlled Substance Monitoring
- The proposed ruling also mandates providers check the state Prescription Drug Monitoring Program (PDMP) in the states where both the patient and the provider are located, as well as in any state that has a PDMP reciprocity agreement with those states prior to providing a prescription for a controlled medication.
- This allows physicians to verify medications are being used as prescribed and to ensure there are no concerns for misuse, repetitive early refills, filling similar medications from multiple providers or over-prescribing of multiple controlled medications that may interact and harm the patient.
- A patient cannot opt out of allowing the physicians access to their prescription history. If they choose to do so, psychiatrists at our practice will not prescribe them any controlled medications and may choose to terminate care
- Although there is no standard requirement, you may at any time during your care be requested by your psychiatrist to provide a urine toxicology screen.
- Limited Quantities and Refills
- Prescriptions for stimulant medications will not be eligible for refills sooner than 28 days from the last fill.
- Prescriptions will only be sent to pharmacies in states where the psychiatrists are licensed.
- If a stimulant prescription or medication fill is lost/stolen, a police report must be filed prior to requesting another prescription from your physician.
- Your psychiatrist may be unable to prescribe greater than FDA recommended maximum dosing for stimulants.
- Proposed ruling may mandate electronic prescribing for all stimulant prescriptions.
- Utilizing stimulants with alcohol or other controlled substances can heighten the risk of serious adverse effects, including overdose and death. If an individual is on other controlled substances, this could influence your psychiatrist’s recommendations for treatment.
Please feel free to contact our office if you have any questions or concerns regarding how these changes might impact your current treatment plan. We are here to support you through this transition and work together to manage your health in the best way possible.