Cerebral and Done Health have at times struggled to fill prescriptions. A legal pill mill for stimulants without any significant evaluation.

Some of the nation’s largest pharmacies have blocked or delayed prescriptions over the last year from clinicians working for telehealth startups that have sprung up to treat attention-deficit hyperactivity disorder, according to pharmacies and people familiar with the issue.

The pharmacies in certain cases have expressed concerns that clinicians at Done Health and Cerebral Inc. are writing too many prescriptions for Adderall and other stimulants, the people said. The federal government considers the drugs controlled substances because of their potential for abuse and places them in the same category as cocaine.

Many pharmacies have procedures for reviewing prescriptions of controlled substances after concerns that the ease of acquiring highly addictive pain medications contributed to the country’s opioid crisis. Pharmacies might have various reasons for not completing a prescription, including that a medicine is out of stock or was prescribed before a previous prescription ran out.

Among those questioning prescriptions from Done is Walmart Inc., WMT -0.68%▼ which has blocked some of Done’s clinicians to prevent pharmacists in its stores from filling prescriptions, Walmart confirmed in a statement.

Individual locations of CVS Health Corp. CVS -0.57%▼ and Walgreens Boots Alliance Inc. WBA -1.43%▼ have also blocked or delayed prescriptions from Done providers, as have some pharmacies attached to grocery store chains and others, according to people familiar with the actions. CVS has interviewed at least two Done doctors over prescription concerns, the doctors said in interviews. The pharmacy startup Capsule Inc. has also blocked prescriptions for a Done provider in recent weeks, according to the provider.

Done declined to comment. Spokesmen for Walgreens and Capsule outlined the company’s prescribing practices but wouldn’t discuss the decision to block prescriptions. A CVS spokesman said its controlled-substance compliance group interviews clinicians it flags for potentially excessive prescribing practices.

Online mental-health companies Done and Cerebral have grown quickly since they were founded in 2019 and serve tens of thousands of patients between them. Both companies charge patients monthly subscription fees to manage their prescriptions, rates that are higher than what they pay nurse practitioners to manage the patients. They reinvest profits in advertising on Instagram, TikTok, and Google to attract new patients.

Some Cerebral clinicians have similarly had their prescriptions blocked or delayed for Adderall and other controlled substances, including benzodiazepines used to treat anxiety, due to pharmacists’ concerns about the prescriptions, according to people familiar with the company’s operations.

“There have been incidents where prescriptions have been temporarily delayed by pharmacies due to confusion around today’s telehealth policies,” Cerebral said. “This is an industrywide issue that we’ve seen and experienced with pharmacies across the country.”

Cerebral didn’t respond when asked which other companies in the telehealth industry it believes are experiencing similar problems with pharmacies.

Four of the largest general telemedicine companies—Teladoc Health Inc., American Well Corp., MDLive and Doctor on Demand—as well as four of the largest online mental-health companies—Lyra Health Inc., Ginger, Spring Health and Modern Health—don’t prescribe controlled substances via telemedicine, according to the companies.

Ahead, a telehealth provider focused on ADHD treatment, recently said it plans to shut down.

Pharmacists more frequently delay Cerebral prescriptions for administrative reasons such as when the medication is out of stock or not covered by a patient’s insurance, said people familiar with the issue at the company. Cerebral has a team of clinical administrators to work with pharmacies to resolve delays.

When pharmacists delayed or refused to fill prescriptions for Cerebral patients due to controlled substances concerns, the company’s staff sometimes encouraged patients to use a different local pharmacy or to use its mail-order pharmacy partner Truepill Inc., according to a person familiar with the process.

Some nurse practitioners at both Cerebral and Done have felt pressured to prescribe stimulants like Adderall, even though they feel the companies’ 30-minute evaluations aren’t long enough to properly diagnose ADHD, The Wall Street Journal reported last month. The companies said they encourage clinicians to use their best clinical judgment and follow evidence-based best practices.

Done has roughly 130 clinicians treating patients in more than 20 states primarily for ADHD, said a person familiar with its business. Cerebral lists nearly 1,600 prescribers on its website and treats ADHD in 24 states, though its staff also treats other mental health conditions for which they sometimes prescribe controlled substances, including depression and anxiety. A Cerebral spokesman said that “our ADHD business is a very small part of our overall client base.”

NEWSLETTER SIGN-UP
Coronavirus Briefing and Health Weekly
Get a weekly briefing about the coronavirus pandemic and a Health newsletter when the crisis abates.



Adderall and other stimulants are a primary treatment for ADHD and can provide substantial benefits to people who are properly diagnosed with the condition, psychiatrists say.

At the same time, Adderall is classified by the Drug Enforcement Administration as a schedule-two controlled substance due to its potential for abuse. For instance, the stimulant is widely misused by college students who don’t have ADHD but want to stay focused for extended study sessions, surveys show. It is also abused by alcoholics looking to counter the effects of drinking, say addiction recovery specialists.

Demand for telehealth services exploded in the early days of the pandemic when many patients couldn’t see their doctors in person. It has since receded for many specialties, yet remains very popular for mental-health-related issues.

The rise of Cerebral and Done coincides with increasing demand for online health services and stimulants such as Adderall. Prescriptions of the medication dispensed in the U.S. jumped to 41.4 million last year, up 10.4% from 2020, according to Iqvia Holdings Inc., a data and research services provider for the pharmaceutical industry.

Individual pharmacists can block controlled substance prescriptions they view as inappropriate, for instance because prescription-drug monitoring databases show a patient has already received the same drug elsewhere. Large chains including CVS have also established compliance teams that monitor their pharmacy networks for excessive prescribing of controlled substances.

Some Done clinicians had prescriptions blocked by Walmart starting last summer, and the company had enough trouble with Walmart’s pharmacies that it stopped its clinicians from sending prescriptions to the retailer, said people familiar with the internal policy.

“Some Done-affiliated prescribers have been blocked by Walmart, and individual pharmacists have refused to fill prescriptions from Done-affiliated prescribers,” Walmart said. “To date, Walmart has not yet made a decision to block or unblock all Done-affiliated prescribers.”

Around early March, Done permitted other clinicians who haven’t been blocked by Walmart to submit prescriptions to the retailer again, and those have been filled, said a person familiar with Done’s operations.

CVS recently interviewed a Texas doctor who works for Done over concerns about the volume of stimulant prescriptions he is writing. The doctor, Christopher Lucchese, writes prescriptions for patients seen by Done nurse practitioners with whom he collaborates, because Texas doesn’t allow nurse practitioners to write Adderall prescriptions themselves. Those nurse practitioners see slightly more than 1,000 patients among them, said the person familiar with Done’s operations.

Dr. Lucchese confirmed CVS interviewed him and said the company asked him about why he suddenly began prescribing a large amount of Adderall. Dr. Lucchese said he didn’t treat a significant number of ADHD patients before he started working for Done in 2021. Speaking of the volume of patients he sees, Dr. Lucchese said stresses from the pandemic and the nation’s political and financial environment are leading more people to seek treatment for ADHD. “Telemedicine can reach more people,” he said. “These companies make it user friendly.”

CVS interviewed another Done doctor, Yolanda Whyte, in December. Dr. Whyte confirmed the interview and said CVS asked her about her prescriptions because she prescribes more stimulants than her peers. She has since left Done but estimated she was handling more than 300 patients for the company.

Dr. Whyte said she told CVS that she was prescribing more stimulants because she saw exclusively ADHD patients for Done. She said that the interview resolved the issue and that CVS never declined to fill prescriptions for her.

LINK: https://www.wsj.com/articles/w...31?mod=hp_lead_pos11

This message has been edited. Last edited by: ZSMICHAEL,

Cliff notes?

quote:

Originally posted by sgalczyn:
Cliff notes?

No more stimulant drugs for Telehealth prescriptions. Come back, one year!

Additional Cliff notes. Highly addictive drug often abused by college students to stay up all night or remain awake while passed out drunk. Prescription cost pennies, sells for ten bucks per pill on the street. Government foolishly allowed telehealth scripts in the beginning of the pandemic. Previously required in person office visit and followup in the office. Profiteers moved in.

Put 55 gallon drums of meth, coke, heroin, stimulant's, depressants, you know, the really heavy hitting shit, on every street corner and keep them full.

I figure in 30 days, this drug problem will work itself out.

And the heck with "defund the po-leece", give them all a two month paid vacay starting the first day.

Can we spike the drums and give Darwin a hand?

quote:

Originally posted by sigmonkey:
Put 55 gallon drums of meth, coke, heroin, stimulant's, depressants, you know, the really heavy hitting shit, on every street corner and keep them full.

I figure in 30 days, this drug problem will work itself out.

And the heck with "defund the po-leece", give them all a two month paid vacay starting the first day.

quote:

Originally posted by sgalczyn:
Can we spike the drums and give Darwin a hand?

You forgot the booze … might as well kill “all” our kids who don’t know so much as you.

I’m going to add one more thing.

I spoke to my twentysomething son today, and the reality is for him is that he sees these folks die each week. One a week.

It’s a real person, with a real life with a real family.

I’m a cold person; I save it for my enemies.

But my fellow Americans who are sick w/ a disease (being greatly promoted and facilitated by China and Mexico)?


Have you never needed redemption? Christ almighty already.

Shit like this makes me so sad for this forum.

I get it, a lot of y’all are adult children of alcoholics and the resentments are deep.



Gentlemen - only way to cure this is not genocide, but love.

quote:

Originally posted by sigmonkey:
Put 55 gallon drums of meth, coke, heroin, stimulant's, depressants, you know, the really heavy hitting shit, on every street corner and keep them full.

I figure in 30 days, this drug problem will work itself out.

And the heck with "defund the po-leece", give them all a two month paid vacay starting the first day.

My Man

Cornpop … a tough dude …

quote:

Originally posted by SIGnified
Gentlemen - only way to cure this is not genocide, but love.

You’re right of course. Speaking strictly for myself, my love is finite. I see this and a growing, indifferent, secular society as a problem so large and complex that no un-devine individual can significantly make a positive impact it. We’re tired of the stories of drugs and violence daily...I think all you’re witnessing is some venting.

Genocide is a deliberate killing of a group. Allowing a group to commit a self inflicted death of their own choosing and manner does not even approach genocide.

Saying love is the cure is a psychological bandaid that is meaningless. If you know the disease then you know the only cure that even stands a slim chance is the addict deciding they have to change. Without that you end up with a thread that rh just had.

Your view also conveniently ignores the very real cost to the rest of society. The murders, the crimes, the accidental deaths, the horrible sludge that accompanies these people as they destroy everything around them as they seek their next high.

I’m ok with sigmonkeys idea. You want love? With every barrel there is also a free pass into rehab. Take your choice and live with your choice.

I teach at a local police academy when I'm not busy being a steely-eyed Fighter of Fraud.

Last class, I had a reason-- first time in over a decade-- to actually look at the "emergency info" cards each trainee fills out with medical info, allegergies, meds, etc.

The percentage of the class on psychotropic/anti-anxiety/anti-depressants/ADHD meds was staggeringly high. Often, more than one of the above.

Mentioned this to academy leadership, who basically (but diplomatically) asked me where they hell I've been for the past ten years. Yeah, this a thing now.

“I’m ok with sigmonkeys idea. You want love? With every barrel there is also a free pass into rehab. Take your choice and live with your choice.”

Agreed. Hugs and kisses and a huge amount of effort to best a family members addiction are just that- for family members. The vast majority of drug addicts out there would gladly pick silver and gold fillings out of your mouth for a fix.

Getting back to the original thread. It is refreshing to see these pharmacies clamping down on what is clearly a for profit pill mill. In the past they were all too ready to fill these prescriptions. It is interesting to see that NPs are being used. They are obviously cheaper but really do not have expertise in diagnosing ADHD.

quote:

Originally posted by ZSMICHAEL:
Highly addictive drug often abused by college students to stay up all night or remain awake while passed out drunk. Prescription cost pennies, sells for ten bucks per pill on the street.

When I was in college a few decades ago, the university health clinic was basically an amphetamine pill mill.

Any students could make an appointment, tell the clinic doctor that they were having trouble concentrating on their studies, and 5 minutes later walk out with an Adderall (amphetamine) prescription.

They would then fill the Rx, hoard some of the pills for use when staying up all night cramming for exams and/or partying, and sell or hand out the rest.

It was rampant.

More clif notes: Some college programs like engineering, med school and such have brutal competition. Students don't know a lot about getting good sleep, exercise, and nutrition and look for any advantage like Adderall.

There are constant discussions in my area about how seeing a mental health professional is either not available (no appointments, no new patients allowed) or cost prohibitive. Telehealth is offered by many employers to cut their insurance costs as well as for employees. Can it work for mental health appointments? It likely depends.

Meh, if it's a prescription from someone with prescription authority they need to go ahead and fill it. I want my Dr. (whoever that may be) to be the one I make medical decisions with, not the corporate pharmacist making that decision arbitrarily after the fact.

I would make a sizeble wager that most of these people on amphetamines were placed on them early on in their lives by their parents (prompted by a shrink or some school teacher because 33% of boys act like boys).

There isn’t any problem in the world that we’re going to solve globally, individually.

It takes everyone living their best lives, making their own small world/life better to improve everything.

That’s all we can do.

Any other excuse… It’s just that; a lame self-emolument excuse.

quote:

Originally posted by Perception:
Meh, if it's a prescription from someone with prescription authority they need to go ahead and fill it. I want my Dr. (whoever that may be) to be the one I make medical decisions with, not the corporate pharmacist making that decision arbitrarily after the fact.

How about if the pharmacist filled the prescription but then flagged it for review for any irregularities by the board responsible for licensing the prescriber?