Xanax and Adderall Access Is Being Blocked by Secret Drug Limits
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Patients diagnosed with conditions like anxiety and sleep disorders have become caught in the crosshairs of America’s opioid crisis, as secret policies mandated by a national opioid settlement have turned filling legitimate prescriptions into a major headache. Bloomberg reports:
In July, limits went into effect that flag and sometimes block pharmacies’ orders of controlled substances such as Adderall and Xanax when they exceed a certain threshold. The requirement stems from a 2021 settlement with the US’s three largest drug distributors — AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp. But pharmacists said it curtails their ability to fill prescriptions for many different types of controlled substances — not just opioids. Independent pharmacists said the rules force them come up with creative workarounds. Sometimes, they must send patients on frustrating journeys to find pharmacies that haven’t yet exceeded their caps in order to buy prescribed medicines. It’s unclear how the thresholds are impacting major chain pharmacies.
The Drug Enforcement Administration regulates the manufacturing, distribution and sale of controlled substances, which can be dangerous when used improperly. Drugmakers and wholesalers were always supposed to keep an eye out for suspicious purchases and have long had systems to catch, report and halt these orders. The prescription opioid crisis, enabled by irresponsible drug company marketing and prescribing, led to a slew of lawsuits and tighter regulations on many parts of the health system, including monitoring of suspicious orders. One major settlement required the three largest distributors to set thresholds on orders of controlled substances starting last July.
The “suspicious order” terminology is a bit of a misnomer, pharmacists said. The orders themselves aren’t suspicious, it’s just that the pharmacy has exceeded its limit for a specific drug over a certain time period. Any order that puts the pharmacy over its limit can be stopped. As a result, patients with legitimate prescriptions get caught up in the dragnet. Adding to the confusion, the limits themselves are secret. Drug wholesalers are barred by the settlement agreement from telling pharmacists what the thresholds are, how they’re determined or when the pharmacy is getting close to hitting them. The exact limit for each pharmacy is kept secret in order to prevent pharmacists from gaming the system, according to Krista Tongring, leader of the DEA compliance practice at Guidepost Solutions and a former agency attorney. The purpose, she said, is to keep pharmacies from manipulating “their ordering patterns so as to get around the thresholds.”
According to a Cardinal Health document, limits are “calculated on a daily, monthly, and quarterly basis,” reports Bloomberg. “But without more detailed information, it’s impossible for pharmacists to predict when they are going to have to turn patients away.”
“Pharmacies can request increases to their thresholds, but those take time to adjudicate, leaving patients scrambling to find their daily medicines elsewhere in the meantime.”