Q&A: End of COVID-19 public health emergency changes ADHD prescribing

Key takeaways:

• The COVID-19 public health emergency enabled greater access to medications.
• Clinicians will now need to meet with patients at least once to continue prescribing.

During the COVID-19 public health emergency, telemedicine increased access to prescriptions for patients with ADHD.

However, the end of the public health emergency (PHE) on May 11 has brought some changes to the prescribing requirements for both prescribers and patients. Healio spoke with Sussan Nwogwugwu, MSN, APRN-PMHNP-BC, MA, BSN, a psychiatric mental health nurse practitioner, to learn more about the impact on ADHD treatment.

Healio: What does the end of the PHE mean for the treatment of ADHD?

Nwogwugwu: The PHE was a federal declaration during the COVID-19 pandemic that allowed the waiving of certain strict health care governmental regulations to enable prescription of controlled medication and expanded coverage. The liberal prescription practices included allowing controlled medication to be prescribed through telemedicine. This includes medications such as Concerta (methylphenidate, Janssen Pharmaceuticals), Adderall (dextroamphetamine-amphetamine, DSM Pharmaceuticals) and Ritalin (methylphenidate, Novartis), which are used for the treatment of ADHD. The end of the public health emergency is bound to end or bring changes to the prescription practices adopted during the pandemic era. Arguably, patients would be required to make in-person visits to their physicians to obtain prescriptions for controlled medicines, as the risk for spreading COVID-19 through interpersonal engagement has diminished.

However, according to the American Academy of Family Physicians (AAFP), advocacy groups including the AAFP made strong arguments that the flexibility adopted during the PHE should continue even after PHE is lifted because of the multiple benefits realized by it. The advocacy efforts paid off, and legislation was established to continue the expanded health insurance coverage and telehealth prescription of specific drugs. This means that ADHD patients will continue obtaining prescriptions for controlled medications even after the lapse of the PHE period.

Healio: How can clinicians treating ADHD adapt to changes in their practice due to the end of the PHE?

Nwogwugwu: The clinicians treating ADHD patients online will need to adapt to the new practices when the PHE ends in several ways. First, they will need to notify their clients that the law requires them to meet their patients at least once before continuing to prescribe the medication to them. Second, they should identify patients who would benefit better from in-person visits instead of telehealth and encourage them to make frequent personal visits. Third, clinicians should ensure they remain updated on the legislation surrounding telehealth and the prescription of controlled medicines to avoid acting contrary to the governing laws. Last, they should give their patients at least 120 days’ notice regarding the new laws to avoid confusion and inconveniences. The alternative for continuing with telehealth after the end of PHE and the mandatory initial in-person visit includes requiring clients to make physical visits each time they require a prescription. Another alternative involves making home visits. However, this may be constrained by cost and time factors.

Healio: What work needs to be done to ensure people with ADHD who have been treated online during the pandemic continue to have accessible care?

Nwogwugwu: ADHD patients will have to meet some requirements first before they can continue obtaining prescriptions via online platforms from their health care providers. According to Circle Medical, the revised legislation requires all ADHD patients receiving telehealth prescriptions to make at least one in-person visit to their providers in a bid to continue receiving the online prescriptions. Nonetheless, health care providers may legally and justifiably demand more visits depending on the unique needs of each patient.

References:

• Public health emergency ending: 6 things to know. https://www.aafp.org/news/health-of-the-public/phe-end-6-things.html. Published March 20, 2023. Accessed May 4, 2023.
• Tuan WJ, et al. Brain Res Bull. 2022;doi:10.1016/j.brainresbull.2022.07.005.
• What the end of the public health emergency means for your ADHD treatment. https://www.circlemedical.com/blog-post/what-the-end-of-the-public-health-emergency-means-for-your-adhd-treatment?#:~:text=In%202020%2C%20the%20federal%20government,to%20ADHD%20patients%20via%20telemedicine. Published March 10, 2023. Accessed May 4, 2023.