In this article, we discuss Adderall and its treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) as well concerns expressed by Federal agencies regarding Adderall drug shortages including a range of factors leading to such shortages such as off-label use.
What is Adderall?
Adderall is a brand name medicine and belongs to a class of drugs known as stimulants. Adderall contains amphetamine and dextroamphetamine which are central nervous system stimulants that affect chemicals in the brain and nerves and contribute to hyperactivity and impulse control. Adderall is considered a Schedule II controlled substance, is taken orally, and is used to treat Attention Deficit-Hyperactivity (ADHD) and narcolepsy. It is available by prescription only and has a high potential for abuse and dependency.
ADHD is a neurobehavioral condition and can significantly impair an individual’s ability to manage daily tasks and various areas of life. People with ADHD typically have trouble with staying focused, struggle with inattentiveness, impulsivity, or both. Individuals may also have difficulty adapting to change. 
It is estimated 8.4% of children and 2.5 % of adults are diagnosed with ADHD. Treatment for ADHD typically involves a combination of therapy and medication intervention. Medicines like Adderall aim to help individuals maintain focus and better manage areas of life such as school, work, relationships, and overall daily functioning. A comprehensive diagnostic evaluation provided by a licensed mental health care professional or physician can determine whether a diagnosis of ADHD is appropriate. 
A diagnosis of ADHD Is based on the number and severity of symptoms, the duration of symptoms and the degree to which these symptoms cause impairment in various areas of life. While ADHD can be diagnosed at any age, according to the American Psychiatric Association (APA), symptoms must be present before the individual is 12 years old and have caused difficulties in more than one setting. 
There are three main types of ADHD:
· Predominantly inattentive presentation
· Predominantly hyperactive/impulsive presentation
· Combined presentation
How is Adderall prescribed?
Adderall IR (immediate release) is commonly prescribed one to three times daily for children and one to two times daily for adults. Adderall XR (Extended Release) is a longer lasting form and typically is prescribed once a day. Children aged 3-17 take this medication at lower doses typically ranging from 2.5mg to 20mg daily while Adults 18 years and older typically start this medication at 20mg daily. 
Why is there a concern of off-label use for Adderall?
In October 2022, the US Food and Drug Administration (FDA) announced there is an Adderall shortage . A rise is demand for stimulant medications coupled with manufacturing delays are just some of the many factors contributing to this problem. In 2023, The US Centers for Disease Control (CDC) published a CDC Report which highlighted a surge in demand for prescription stimulants occurred during the COVID-19 pandemic, especially among adults.  In a Joint Letter (August 2023) , the CDC and Drug Enforcement Agency (DEA) urged manufacturers to increase production of medications such as Adderall. They also highlighted an increasing concern associated with “widespread misuse”.  noting a SAMHSA Advisory that was released November 2021.
What to look for?
Payers should review claims submitted to ensure they are properly billed. HCFS recommends reviewing for:
1) appropriate diagnosis
2) appropriate CPT codes
3) documentation in medical records to determine if ADHD symptoms were present prior to 12 years of age or documentation indicates rationale for off-label use
4) prescription frequency, dosage amounts, unusual pharmacy-related activity
If you are using the HCFSPlatform™, HCFS has you covered. Our 1650+ library of alerts that is used in combination with our artificial intelligence includes the following alert as an example
[5291-01] – OFF-LABEL USE OF ADDERALL: This Alert identifies providers prescribing Adderall for members without a diagnosis of ADHD or Narcolepsy.
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