A pair of bills passed by the Rhode Island General Assembly would help people who take drugs scheduled by the Drug Enforcement Administration (DEA), by making their prescriptions easier to access via adoption of a 2023 DEA regulation. Seen here is methylphenidate, a Schedule II drug and ADHD med that has seen frequent supply issues in the last few years (Alexander Castro/Rhode Island Current)
Want to transfer your Adderall prescription from one pharmacy to another?
Legislation passed by the Rhode Island General Assembly Tuesday night would allow just that. The bills by Democrats Sen. Alana DiMario of Narragansett and Rep. Kathleen Fogarty of South Kingstown now head to Gov. Dan McKee for final approval, and would take effect January 1, 2025.
The legislation authorizes the Rhode Island Department of Health to adopt a new federal rule that allows patients to request their medicine be transferred from one pharmacy to another. DiMario’s bill was motivated specifically by the stimulants used to treat ADHD, which have been in shortage since 2022.
“This is one of those no-cost changes that can improve quality of life for people in our communities,” DiMario previously told Rhode Island Current.
Some prescription drugs are hard to fill. A pair of bills could make it easier.
The bill is currently under review by McKee’s legislative and policy teams, Olivia DaRocha, a spokesperson for the governor, said via email Wednesday, and added: “We will make a determination in the coming days.”
People with ADHD can use stimulants to achieve calm or get through daily activities more reliably. But stimulants are also notorious as drugs of abuse, which means they are controlled substances, subject to a strict regulatory scheme known as scheduling, which limits the quantity and frequency of their prescription. Opioids, sleeping pills and muscle relaxants are all examples of controlled substances.
Most stimulants fall under Schedule II, the second-most restrictive tier. Until recently, the federal Drug Enforcement Administration (DEA) required that these scripts be filled at the receiving pharmacy. If the drug was out of stock, a doctor would need to issue a new prescription at a different pharmacy.
DEA revised its rules in July 2023 to allow the electronic transfer of controlled substance scripts after determining it could reduce costs and frustration for patients and providers alike. The DEA projected an annual net cost savings of $29.0 million over five years.
Could handwritten prescriptions solve the problem? If one pharmacy can’t fill a prescription, a paper slip could always be carried to a different location. But prescription pads are becoming antiques — 94% of prescriptions nationwide were filed electronically in 2021 — and a doctor’s chicken scratch can’t be used to dispense controlled substances in Rhode Island anymore. In 2020, Rhode Island became one of what are now 35 states that require digitally sent scripts for controlled substances. Some states strap this restraint onto opioids alone, given their role in the ongoing overdose crisis, but Rhode Island applies the rule to all controlled substances.
That can leave patients’ scripts held hostage at a pharmacy that can’t fill them that day or even that week. So people with ADHD, or the parents of kids with ADHD, have to pick up the phone and call pharmacies until they find a location that has ample stock. Services like Insito Medfinder can find the drug for you: $50 for a one-time search, which is costlier than a month’s supply of even high doses of generic amphetamines.
“People aren’t able to get their medications at one place, and then have to go through a lot of song and dance and a lot of time to get their prescription, and some people need it that day,” Fogarty said when she introduced the bill at a Feb. 29 committee hearing.
Maura Cotoia, a constituent of DiMario who testified on the senator’s bill at a March 5 Senate Committee on Health and Human Services hearing, said her 10-year-old son’s meds are commonly out-of-stock due to shortages. Sometimes the pharmacist calls to let her know, sometimes they don’t.
“When I am notified, I’m then directed to my son’s doctor to have them call the medication to a new pharmacy,” Cotoia testified. “I work full-time. I have two kids. So typically I run my errands on Saturdays and Sundays. I’m not finding my doctor in the office on either of these days. So then we wait.”
Some manufacturers’ ADHD meds have made it off shortage lists, while other companies’ supplies remain on backorder with little explanation offered. The origins of the supply issues are intricate, with the DEA directing blame at manufacturers for not filling production quotas set by the agency. But pharma companies like Novartis and Teva shot back and alleged the DEA was inconsistent in its approval of quota increases, Bloomberg reported in 2023.
One more federal barrier walls off patients from quicker access, something the health department noted in written testimony on Fogarty’s bill. The health department said it wasn’t a problem to embrace the new DEA rule, but it can’t be implemented yet because of another federal agency, the Centers for Medicare and Medicaid Services (CMS), which sets the technological standards for digital prescribing.
CMS currently uses an older version of a standard called SCRIPT that doesn’t allow transfer of controlled prescriptions. A CMS spokesperson wrote in a June 3 email to Rhode Island Current that the Medicare overseer proposed a rule change in November 2023 that included a provision to retire the old SCRIPT and adopt the new version which allows the transfer of controlled prescriptions.
If the proposal is finalized, there would be a transition period in which prescribers could use either version of SCRIPT until Jan. 1, 2027, when the new version would become standard.
That’s well after DiMario’s and Fogarty’s bill would take effect, but if and when the federal change is approved, Rhode Island is one step closer to being ready.
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