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How Are Payers Responding to ADHD and Chemo Drug Shortages?

By Carly Nicholas

In the wake of the COVID-19 pandemic, drug shortages, caused by increased demand, supply chain difficulties, and supplier issues have plagued payers and patients alike, making it harder for patients to access the therapies they need and causing delays in treatment. Drug shortages hit a record five-year high in 2022, according to a U.S. Senate report.

To learn more, in August we asked payers about the impact and challenges they face due to drug shortages, focusing on ADHD therapy and chemotherapy drug shortages in particular. Here’s what we found.

Impact of ADHD drug shortages

After nine months of difficulty finding and filling prescriptions for Adderall, ADHD patients are now facing shortages of other medications, particularly other variations of methylphenidate like Ritalin and Concerta. Now, these other ADHD drugs that patients have turned to as alternatives have only been intermittently available themselves.

According to our research, only half of payers have taken steps to address the ADHD drug shortage. One pharmacy director/clinical pharmacist said their pharmacy hasn’t experienced shortages, and patients and providers haven’t yet expressed concern. Those who are making adjustments are implementing more lenient prior authorization (PA) criteria and allowing coverage for non-formulary drugs, with 67% of payers loosening PA restrictions or covering agents with a lower-tier status, according to our survey. Focalin, Vyvanse, and Strattera were cited as the three most used drugs in place of Adderall, Ritalin and Concerta, with 69% of payers reporting Vyvanse as the most frequently prescribed replacement.

ADHD drug shortages have had a negative impact on both patients and payers, our survey showed. Eighty-four percent of payers said the ADHD drug shortage has had a moderate to high impact on patients, with patients experiencing confusion, higher co-pays from switching to a branded drug, and symptom flairs. The majority of payers (84%) said the ADHD drug shortage has resulted in increased costs for their organization, with 17% saying that costs have increased significantly. On a more positive note, 83% of payers cited no challenges in managing higher-risk patients during the ADHD drug shortage, such as pregnant women, children, or people with comorbidities.

Payers placed the responsibility on manufacturers and suppliers for preventing future shortages, suggesting that fixing supply chain issues or stockpiling and keeping lists of acceptable alternatives, as well as having more generic drugs, could help alleviate the problem.

Impact of chemotherapy drug shortages

Chemotherapy drugs are also experiencing shortages, as most ingredients used to produce chemotherapies are made abroad, typically in India and China. During the pandemic, imports from these foreign suppliers were cut off, setting a growing supply chain issue in motion. Furthermore, recent quality control problems at an Intas Pharmaceuticals factory in India resulted in an additional shortage of cancer drugs cisplatin and carboplatin, which don’t have substitutes.

To address these shortages, payers in our survey are providing more flexible treatment regimens and coverage criteria to minimize impact on patients, with half of payers reporting changes in authorization or reimbursement policies related to chemotherapy. Payers changed PA protocols to cover out-of-network sites of care and alternative agents, and increased support to cancer patients by allowing use of alternative therapies, including targeted therapies such as Avastin, Gleevec and Imbruvica, immunotherapies, and hormone therapies. Sixty percent of payers said targeted therapies are being prescribed most frequently as a chemotherapy alternative, followed by immunotherapies at 20%.

As for the shortage’s impact on patients, 83% of payers saw a moderate effect on patients so far. One pharmacy director/clinical pharmacist said patients are experiencing anxiety as a result of the shortage, while another reported “not very many missed chemo cycles” as a result. Similarly to the ADHD drug shortage, 84% of payers saw increased costs as a result of the chemotherapy shortage, with 17% of payers saying costs have increased significantly. However, all of the payers we surveyed saw no challenges in managing high-risk cancer patients during the shortage.

To address this shortage, payers suggested better communication between all stakeholders, including drug manufacturers, payer organizations, and dispensing pharmacies. Fixing supply chain issues or increasing domestic manufacturing also were cited as potential solutions, as well as producing more generic drugs.

As payers and patients both continue to be impacted by these drug shortages, implementing these changes across the healthcare ecosystem could both reduce costs for payers and improve timely access to the medications and therapies that patients need.

Access the full report and learn more about MMIT’s Biologics & Injectables Index here.

© 2024 MMIT
Carly Nicholas

Carly Nicholas

Carly Nicholas is a senior market research analyst who works on the MMIT Indices team. Over the years, Carly has conducted market research for a wide span of treatment areas and access management topics. She currently conducts research for the Rapid Event Primer, a monthly report that provides high-level insights on specific market access events or trends. Carly earned her B.S. in Psychology with a minor in Marketing and Autism Behavioral Studies at Saint Joseph's University in Philadelphia.

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