Current Market Access to ADHD Therapies (Stimulants)

The FDA on April 2 approved Supernus Pharmaceuticals, Inc.’s Qelbree for the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 6 to 17. While Qelbree is the first non-stimulant to enter the ADHD market since 2010 (see story, p. 1), payers favor older, methylphenidate and amphetamine-based drugs, with all of these medications holding covered or better status for at least 50% of all insured lives under the pharmacy benefit. Among these therapies, Takeda Pharmaceutical Company’s Vyvanse is greatly advantaged, holding preferred status for 72% of all covered lives under the pharmacy benefit. No ADHD medications are classified as medical benefit drugs. Utilization management restrictions are common in this class as most providers recommend behavioral therapy as a first-line treatment for children newly diagnosed with ADHD, and stimulants pose addiction risks.

NOTES: Access that requires prior authorization and/or step therapy is represented by the abbreviation (PA/ST). Daytrana, QuilliChew ER, Quillivant XR and Vyvanse are each classified as specialty drugs for fewer than 0.5% of all covered lives. Under the pharmacy benefit, the covered lives under commercial, health exchange, Medicare and Medicaid formularies are 170.0 million, 11.7 million, 47.8 million and 69.8 million, respectively.

SOURCE: Managed Markets Insight & Technology, LLC database as of April 2021.

© 2024 MMIT
Carina Belles

Carina Belles

Carina has been covering public-sector health care since 2018. As a data reporter for Radar on Medicare Advantage, she creates infographics and data stories on issues impacting Medicare, Medicaid and Part D. She also develops AIS Health Daily, a free daily newsletter that showcases AIS’s strong reporting across our four publications and parent company Norstella’s suite of market access and data solutions. Prior to joining the editorial team, she managed Medicare and Medicaid data for the Directory of Health Plans, AIS’s industry-standard health coverage database. She graduated from Ohio University with a B.S. in Journalism.

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