ADHD and Narcolepsy Medications Subject to Quantity Limits
Effective Aug.1, 2019, medications for attention deficit hyperactivity disorder (ADHD) and narcolepsy will be subject to a quantity limit. To view the quantity limit for each medication, visit the Prescription Guidelines.
The Drug Enforcement Administration classifies most ADHD and narcolepsy medications as Schedule II substances due to the medication’s high potential for abuse when not taken as prescribed which may lead to severe psychological or physical dependence.
The quantity limit criteria ensure safe use of the medications and are consistent with product labeling, U.S. Food and Drug Administration guidance, standards of medical practice, evidence-based drug information and published guidelines.
If a higher quantity of medication is appropriate for your patient, you may request a prior authorization. On or after Aug. 1, 2019, you can complete a prior authorization request online through the Provider Portal. Log in at carefirst.com/providerlogin and navigate to the Prior Auth/Notifications tab to begin your request.
Follow-Up Care for Children Who Have Been Prescribed ADHD Medications
According to the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set, it is recommended that patients between the age of 6 and 12 receive a follow-up visit within 30 days after an initial prescription of an ADHD medication. Afterwards, patients should receive at least one office visit in the following nine months to monitor learning and behavior.