GOODRX HOLDINGS, INC. Key takeaways:
Shortages of Adderall (and its generics) have led to an increase in fills for other types of ADHD medications.
The FDA approved lisdexamfetamine, a Vyvanse generic, in August 2023.
Lisdexamfetamine, along with many other ADHD medications, is currently also in shortage.
Since the FDA first announced a shortage of Adderall in October 2022, patients have struggled to obtain their medications for attention-deficit hyperactivity disorder (ADHD). Manufacturers, as well as the FDA and DEA, have pointed to several factors contributing to the shortage, including manufacturing delays, record-high prescription rates, and unfulfilled production quotas.
While some people have turned to other medications, it appears that an increasing number of those options are also in short supply.
The FDA recently approved lisdexamfetamine. It is a generic for Vyvanse, a popular ADHD medication. While this move looked like it could increase access for patients seeking Adderall alternatives, the medication is also now in shortage.
We'll review how ADHD prescription fills have changed because of the shortage, and why lisdexamfetamine's approval hasn't been able to resolve the situation.
Fills for Adderall dipped while fills for other ADHD medications roseFor adults, medication is the first line of treatment for ADHD, and there are many options.
ADHD medications can be broadly classified as stimulants or nonstimulants. Stimulants come in short-acting or long-acting versions. They typically are more effective and start to treat symptoms faster than nonstimulants. But they have a potential for misuse due to their active ingredients.
To analyze prescribing trends, GoodRx Research looked at fills by active ingredient for the most popular ADHD medications (both stimulant and nonstimulant). For example, amphetamine salt combo is the main active ingredient in both Adderall and Adderall XR, the long-acting version of Adderall. Methylphenidate is the active ingredient for multiple brand-name medications such as Concerta, Adhansia XR, and Ritalin.
We found that the mix of ADHD prescriptions was relatively stable until the shortage. In the third quarter of 2021, before the shortage, half of prescription fills for ADHD medications were for amphetamine salt combos, with most other fills consisting of other types of stimulants. In the third quarter of 2022, the last full quarter before shortages were first announced, the share was roughly the same.
After the Adderall shortage began, the landscape changed, with fills for other types of ADHD medications rising. Lisdexamfetamine saw an increase in fill share by 4 percentage points, from 13% to 17% of all ADHD prescription fills. Other types of stimulants, like methylphenidate and dexmethylphenidate, also saw a slight uptick.
Vyvanse generic falls into shortageAfter 16 years of patent protection, Vyvanse, a stimulant ADHD medication, finally went generic as lisdexamfetamine in August 2023. Following its approval, fill rates for the generic quickly rose. In October 2023, the generic accounted for 71% of prescription fills for ADHD medications with lisdexamfetamine as the active ingredient.
However, fills for the generic saw a steady decline as it went into shortage at the beginning of 2024. But even though the shortage is still active, fills for lisdexamfetamine have since seen a slight uptick.
With the shortage announcement, several manufacturers reported that medications were on backorder. However, a few manufacturers now say they have the generic in a limited supply, though some only have certain strengths of the medication.
At its peak market share at the end of March 2024, Vyvanse accounted for 66% of fills between it and its generic counterpart. Like other ADHD treatments in shortage, the decrease in fills for lisdexamfetamine reflected the dwindling supply of the medication.
While lisdexamfetamine fills are trending upward, Vyvanse still has the majority of market share likely due to its better availability. That means patients are unable to take advantage of the generic's lower price. While Vyvanse costs an average of $495 per 30-day supply without insurance, the generic version costs an average of $313 without insurance.
Additionally, most patients will pay for these medications using insurance. Most insurance plans will likely have better coverage and lower copays for the generic compared to the brand name. Insurance plans may also place restrictions on the brand name, such as step therapy or prior authorizations.
Summing it all up
As the FDA tries to address the ongoing Adderall shortage, patients must make do by rationing their medications or finding alternatives. Even with the introduction of a new generic, it seems that manufacturers still can't keep up with the demand for ADHD medications. While the DEA has increased medication quotas for 2024, many people are still waiting for their preferred medications to become available.
This GoodRx analysis is based on a representative sample of U.S. prescription fills (not GoodRx fills) and comes from several sources, including pharmacies and insurers. All medications with an indication for ADHD were included for this analysis, and grouped based on the active ingredient. The reported prices are based on average retail prices, the so-called "usual and customary" prices or retail prices at the pharmacy (not including insurance copays or coinsurance). Prices for Vyvanse and lisdexamfetamine were calculated using data from January 2024.
ADHD medications included in analysis:
Amphetamine salt combo: Adderall, Adderall XR, amphetamine salt combo, amphetamine salt combo XR
Methylphenidate: Adhansia XR, Aptensio XR, Concerta, Cotempla XR, Daytrana, Jornay PM, Metadate CD, Metadate ER, Methylin, Methylin ER, methylphenidate, methylphenidate CD, methylphenidate ER, methylphenidate LA, methylphenidate SR, methylphenidate XR, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA, Ritalin SR
Other stimulant: Adzenys ER, Adzenys XR ODT, amphetamine ER, amphetamine sulfate, Azstarys, Desocyn, Dexedrine, Dexedrine Spansule, dextroamphetamine, dextroamphetamine ER, Dextrostat, Dyanavel XR, Evekeo, Liquadd, methamphetamine, Mydais, Procentra, Xelstrym, Zenzedi
Dexmethylphenidate: Dexmethylphenidate, dexmethylphenidate ER, Focalin, Focalin XR
Lisdexamfetamine: Lisdexamfetamine, Vyvanse
Nonstimulant: Atomoxetine, Clonidine ER, Guanfacine ER, Intuniv, Kapvay, Qelbree, Strattera
American Society of Health-System Pharmacists. (2024). Lisdexamfetamine dimesylate capsules.
American Society of Health-System Pharmacists. (2024). Methylphenidate extended release oral presentations.
U.S. Food and Drug Administration (2023). FDA announces shortage of Adderall.
U.S. Food and Drug Administration (2023). FDA approves multiple generics of ADHD and BED treatment.
U.S. Food and Drug Administration (2023). Joint DEA FDA letter.
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GoodRx Holdings Inc. published this content on 27 June 2024 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 27 June 2024 18:34:10 UTC.
