Let’s talk for a moment about mental illness and medication. Specifically, ADHD and stimulants and how the process of obtaining said stimulants is the least ADHD-friendly process in the world (at least in the US).
Yesterday, I had an especially frustrating experience trying to get my meds from CVS Pharmacy. After a 10 a.m. appointment with my psychiatric nurse practitioner (‘doctor’ for brevity in all future references), we agreed that I should up my dose of Vyvanse, the long-acting form of Adderall, which I take to manage my ADHD. She submitted the new prescription to CVS and instructed me to stop taking my current dose and begin taking the new one the following morning.
Because ADHD medication is a controlled substance, people with ADHD have to jump through a few hoops to obtain them. First, my prescription is not eligible for auto-renewal, which means I have to remember to call my pharmacy each month to fill my prescription before I run out. Then, instead of being able to have my meds shipped to me, I need to physically go to the pharmacy and show my ID to get them.
“Many medications for treating ADHD work by increasing dopamine and stimulating focus…These medications increase dopamine levels in the brain by targeting dopamine transporters and increasing dopamine levels. Some people believe that taking a high dosage of these medications will lead to greater focus and attention. This is not true. If your dopamine levels are too high, this can make it difficult for you to focus.” (ADHD and Dopamine: What’s the Connection?)
I want to note here that substance use disorders are very often connected to mental illness so while obtaining ADHD meds each month is harder for me due to the fact that it’s a controlled substance, this process also exposes another very important issue that is largely unaddressed in our healthcare system: addiction. Yet another reason help should be more accessible and affordable to all.
Jumping Through Hoops
So, yesterday morning, after speaking to my doctor, I called CVS to fill my prescription. I waited on hold for over 15 minutes before I hung up and tried again. I waited another 10+ minutes before I gave up and decided I’d try again later in the day.
That afternoon, after running some errands, I decided to call the pharmacy again on my 15-minute drive there so that my medication might be ready for me when I arrived. Again, no answer. I arrived to at least eight cars in front of me in the drive-thru line. I briefly contemplated going inside but decided it was safer due to COVID to just wait in my car since I had the time. More than 20 minutes later, I pulled up to the window and had the pharmacist tell me I wouldn’t be able to pick up my medication until December 14. I told her that my doctor wanted me to start taking it right away and she shrugged and said, “you’ll have to call them and sort it out.”
I pulled into a parking spot and immediately called my doctor’s office but since it was 4:30, everyone had gone home for the day. I emailed my doctor directly and waited in the parking lot for a response, thinking that I could possibly wait in line again to get my meds. Again, I’m lucky enough to have a flexible schedule and could afford to wait.
15 minutes later I had a reply from my doctor apologizing for the inconvenience and informing me that apparently, my insurance won’t let the pharmacy fill the prescription early even though it’s a dose change prescribed by my doctor. I left CVS frustrated and upset. Not only did I not have the meds I need for my mental illness, but I had to call my insurance to convince them that my prescription is medically necessary.
I know that this is not just a problem with ADHD meds. I’ve heard countless stories of insurance companies refusing to approve necessary treatments and prescriptions. A mammogram my doctor ordered in 2018 because she felt a lump in my breast was not covered under my insurance because they didn’t feel it was medically necessary since I was under 40 years old. It’s unacceptable that insurance companies that employ absolutely zero medical professionals can refuse to cover treatments that are prescribed by actual doctors. It’s especially disgusting when these treatments and/or medications can be the difference between life and death.
Too Many Steps
Most people with ADHD have trouble with executive function, meaning that completing tasks that require multiple steps, short-term memory, and planning ahead is nearly impossible. ADHD meds help tremendously but when the process to obtain said meds becomes the source of the problem, something needs to change.
To summarize, here are the steps I need to take to complete one simple task: fill a prescription my brain needs to function:
- Meet with a doctor
- Call the pharmacy to fill the meds my doctor specifically prescribed
- Go to the pharmacy and show my ID
- Call/email my doctor or insurance if there are any issues
- Go back to the pharmacy and wait again to get my prescription
- Remember to call again in a month to fill the prescription again because my medication is ineligible for auto-refill or receiving a three-month supply by mail
I felt the need to write all this to shine a light on how ridiculous and unacceptable the process of obtaining ADHD medication tends to be. Additionally, the process of receiving an accurate ADHD diagnosis tends to be lengthy and expensive as well making it inaccessible to many.
Why Is This OK?
At 10 a.m., I will call my insurance and ask for approval for a medication I’ve now spent 24 hours trying to obtain and was instructed by my doctor to start this morning. I will survive until December 14 if they do not approve my request. Many people in similar situations will not be able to get the help they need, their health will suffer immensely because of it, and that is not OK.
At this moment, I don’t know what actions I can take to reform this system but I plan to research and share my findings when I do. Stay tuned.
As always, thank you for reading!