Telehealth prescribing did not boost ADHD drug initiations

New research suggests that telehealth did not cause overprescribing of prescription stimulants for attention-deficit/hyperactivity disorder, or ADHD, among Medicaid and CHIP enrollees.

Study authors noted that this finding supports extending pandemic-era telehealth prescribing flexibilities for controlled substances. Currently, virtual prescribing of controlled substances without a prior in-person examination, including Schedule II controlled substances for ADHD, such as Adderall and Ritalin, is allowed through Dec. 31, 2025.

However, instances of stimulant overprescribing connected to telehealth prescribing, culminating in million-dollar settlements, have fostered concerns about making the flexibility permanent.

The new research, published in Health Affairs, offers a more positive outlook for telehealth prescribing. U.S. researchers analyzed claims data from the CMS Transformed Medicaid Statistical Information System Analytic Files (TAF) for all 50 states and Washington, D.C. They used the data to examine Medicaid and CHIP enrollees who began using stimulant medications before the COVID-19 public health emergency (PHE), measured between January 2019 and February 2020, and during the PHE, from March 2020 to December 2022.

The study shows that the beginning of the PHE was linked to an immediate increase of 24.7 telehealth-only stimulant initiations per 100,000 enrollees per month and a simultaneous decrease of 53.5 in-person initiations per 100,000 enrollees per month.

By the end of the study period, in-person initiations decreased to 78.6 per 100,000 enrollees per month, while telehealth-only initiations increased to 12.5 per 100,000 enrollees per month.

"Telehealth served as a partial substitute, offsetting some, but not all, of the drop in in-person initiations," the researchers wrote. "As a result, the overall rate of stimulant initiations among Medicaid/CHIP enrollees decreased at the beginning of the pandemic and, through 2022, never fully recovered to the levels and trends observed pre-public health emergency."

Additionally, as telehealth-based initiations of stimulants declined between May 2020 and December 2022, researchers observed that female and young adult enrollees did not experience a significant relative decline compared with males and enrollees 18 and younger.

Thus, researchers stated that telehealth prescribing may have helped close some historical gaps in stimulant initiation. However, further study is warranted to determine why these populations were able to take advantage of telehealth and maintain stimulant initiation levels closer to what the researchers would have predicted in the absence of the PHE.

Still, the researchers concluded that overall initiation rates remained below pre-PHE levels through the end of 2022, which suggests "that extending public health emergency telehealth flexibilities is important to maintaining stimulant initiation levels of care for Medicaid/CHIP enrollees and seems unlikely to have resulted in overprescribing of stimulants through 2022."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.