Some prescription drugs are hard to fill. A pair of bills could make it easier.

A bill by Sen. Alana DiMario would quicken access for patients who take drugs scheduled by the Drug Enforcement Administration (DEA), by making Rhode Island follow a 2023 federal rule that OKs the electronic transfer of prescriptions for such drugs. Seen here is Ritalin, a Schedule II drug and at one time the most commonly prescribed treatment for ADHD. (Alexander Castro/Rhode Island Current)

Stimulants can make life calmer and easier for people with ADHD. But filling these prescriptions is often stressful for patients, thanks to a compound problem that’s one part drug regulatory, one part supply and demand.

Electronic prescribing confines stimulant prescriptions to a single pharmacy. Once a script is written and sent, it stays at the pharmacy that received it. If the drug is out of stock, the patient can call their doctor for a new prescription. Or they could wait, and go unmedicated.

“We have CVS’s all over the state,” Sen. Alana DiMario, a Narragansett Democrat, told Rhode Island Current. “We should be able to refill a prescription at one CVS just as easily as the other one without having to jump through a lot of extra hoops.”

The Rhode Island Senate agreed when on Thursday, May 23, it voted 36-0 to pass a bill by DiMario that would help patients get and take their ADHD medications, like Adderall, Ritalin and Vyvanse.

DiMario’s bill , which now goes to the House Committee on Health and Human Services, would require the Rhode Island Department of Health to adopt a July 2023 regulation revised by the federal Drug Enforcement Administration (DEA). The revised federal rule allows patients to transfer from one pharmacy to another their prescriptions for certain tightly regulated psychoactive drugs, including stimulants.

“I think this is something that a lot of people in my chamber, when I’ve explained the rationale behind the bill, understand,” DiMario said in a phone interview before the floor vote. “They have somebody in their family, they have somebody in their community, who has highlighted the difficulty that this poses for them.”

DiMario’s bill would take effect on Jan. 1, 2025, the same date a companion bill by Rep. Kathleen Fogarty, a South Kingstown Democrat, would take effect.

On Wednesday, May 29, every member of the House Committee on Health and Human Services agreed to send Fogarty’s bill to the House floor for a vote. The respective bills need to pass the opposite chamber before they can appear on Gov. Dan McKee’s desk. Fogarty’s bill will likely hit the House floor during the week of June 3, said Larry Berman, a spokesman for the Rhode Island House, with the DiMario hearing coming sometime after that.

The DEA first announced an Adderall shortage in 2022. As of February 2024, 87% of community pharmacists claimed they were still struggling to stock the amphetamine-based drug, according to a survey from the National Community Pharmacy Association.

The shortage has further pressured an already restrictive prescription process, as most ADHD medicines are scheduled by the DEA. Under the feds’ and most states’ regulations, most stimulants fall under Schedule II — the second-most restrictive tier, reserved for drugs that have accepted medical uses but can also be highly reinforcing or addictive to consume.

Prescriptions for ADHD meds are capped at a 30-day supply and can’t be refilled — although doctors can write up to three separate prescriptions, each for a one-month supply, at the same time. The prescription can’t be switched to a different pharmacy, even one within the same chain, so a doctor will have to write and sign an entirely new prescription.

Those hoops present an obstacle course for everyone involved: patients, pharmacies and doctors. Phone calls boomerang between pharmacies and patients as the latter try to find a place that can actually fill their prescriptions. The DEA seemed to agree that the hoops are too many for people already struggling with behavioral health issues.

“This rule is likely to benefit patients in many other ways, including reducing stress,” the DEA wrote in July 2023, and added that a major rationale for changing the regulation is “to prevent treatment delays and reduce patient burden.”

Said DiMario: “This is one of those no cost changes that can improve quality of life for people in our communities.”

In fact, the DEA estimated in its final rule that patients might even save money — $2.60 specifically, which the agency calculated as the cost of a five-minute phone call a provider for a new prescription.

Rhode Island pioneered treatment

Stimulants have not always been warmly received by the public, partly because of their widespread use among a vulnerable population: Children. Coincidentally, it was at East Providence’s Bradley Hospital in 1937 that psychiatrist Charles Bradley first discovered stimulants help kids be attentive and interested in schoolwork. Stimulants saw use in juvenile populations during the postwar years, but it wasn’t until after 1987 , when the ADHD diagnosis was revised and neuroscience revitalized psychiatry that pharmaceutical companies saw a new market — kids with ADHD — who could be served with updated versions of older drugs.

A DEA-commissioned report from 2023 found that overall dispensing of stimulants increased nearly 58% from 2012 to 2022. In that same time span, prescription rates nearly tripled for two specific age groups: people aged 31 to 40, and people 71- to 80-years old.

That’s a lot more people vying for Vyvanse and the like — some of them are DiMario’s constituents. One of them in fact first alerted DiMario to the 2023 change in DEA regulations, the senator explained when she introduced her bill at a March 5 hearing of the Senate Committee on Health and Human Services.

“That leaves a lot of families calling around,” DiMario testified on March 5.

Maura Cotoia is one of those parents glued to the phone. Some pharmacies will reveal if they have the drug on hand. Others will not. A not insignificant chunk of one’s day can be spent trying to find out. Cotoia testified for DiMario’s bill and said her family has been “chasing medications all over the state” for her 10 year-old son who has ADHD.

“We’ve traveled to Warwick, Newport, Hopkinton, just to ensure my son is properly medicated,” Cotoia said.

Since Cotoia’s son was diagnosed at age seven, there has not been a single pharmacy who could fill his prescription for three consecutive months.

“This is wild to me, as local pharmacy chains such as CVS can communicate with one another and transfer prescriptions internally. They can even transfer prescriptions across state lines,” Cotoia said.

Prognosis unclear for these bills left out of health care package. Their sponsors still have hope.

While the DEA is ready to relax regulations on prescription transfers, the Centers for Medicare and Medicaid Services (CMS) is not.

CMS regulates prescriptions for Medicare patients, and that includes choosing the information technology used for electronic prescriptions. CMS’ current standard can support the electronic transfer of non-scheduled drugs, but not scheduled drugs.

Dr. Utpala Bandy, who at the time was interim director of the Rhode Island Department of Health before she retired in March, submitted testimonies for both DiMario’s and Fogarty’s bills, advising that the legislation needed slight retooling.

“The health information technology industry is not yet able to support these transfers until further action is taken by [CMS],” Bandy wrote.

DiMario said before the May 23 Senate vote that she revised the bill per the recommendations of the health department. The department’s spokesperson, Joseph Wendelken, confirmed May 24 that the department supports DiMario’s revised bill.

Massachusetts pharmacy officials maneuvered quickly to accommodate the DEA change and issued a policy in October 2023 that allows prescription transfers.

But Massachusetts is not much farther ahead than Rhode Island, according to an email from Omar Cabreba, a spokesperson for the Massachusetts Department of Public Health: “The Board of Registration in Pharmacy does have a policy on the transfer of unfilled prescriptions, but the technology standard needed to transfer electronic prescriptions in accordance with DEA rules is currently not in place .”

The National Council for Prescription Drug Programs manages the SCRIPT standard used by CMS for electronic prescriptions. A May 2024 document from the Council noted that while a newer version of SCRIPT supports the updated DEA rule, the version still used by CMS does not.

The shortage, meanwhile, is seeing some signs of abatement after two years, with manufacturers like Teva having refreshed their supply of generic ADHD drugs as of May.

So DiMario’s and Fogarty’s bills could fast-track adoption of the necessary technology when it does arrive. But that doesn’t mean any changes for ADHD patients in the immediate future. They may have to keep waiting and calling.

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