Actionable Insights Newsletter

Translating research to power whole health

Issue 8    |    March 2024

A rising tide: ADHD medication prescribing in adults

Adult use of ADHD medications increased dramatically between 2017-2021. Even more concerning: one in five medication users did not have an ADHD diagnosis.

Enterprise Analytics Core domain(s): Behavioral health, quality of care

Summary

Background
Pharmacy trend reports have indicated a sharp growth in the use of attention-deficit/hyperactivity disorder (ADHD) medications within our membership. There has been an interest in a deeper understanding of factors driving this ADHD medication utilization trend.

Objective
To describe and explore trends and driving factors of ADHD medication prescribing from 2017-2021.

Methods
Carelon Research analyzed data from commercial and Medicare insured Elevance Health members with integrated medical and pharmacy benefits receiving one or more ADHD prescriptions between 2017-2021. Stimulants included amphetamine, dexmethylphenidate, dextroamphetamine, dextroamphetamine and amphetamine, lisdexamfetamine, methamphetamine, and methylphenidate; non-stimulants included atomoxetine, clonidine, guanfacine, and viloxazine. Utilization of ADHD medications was standardized to facilitate meaningful comparisons across years.

Results

• Between 2017-2021, an increasing proportion of our membership used ADHD medication, up from 2.9% in 2017 to 3.3% in 2021. The rate of increase in ADHD medication use was driven by adults, particularly those aged 25-44 years (31%). From 2017 to 2021, ADHD medication use in adults aged 65 years and older nearly doubled (Figure 1).
  
• ADHD non-stimulant medication use increased in children and dramatically so in adults, driven by atomoxetine use, while the use of stimulant medications increased in adults and remained stable in children.
• Approximately 1 in 5 members filing a claim for an ADHD medication did not have an ADHD diagnosis claim between 01/01/2016 - 05/31/2022. This increased to nearly 1 in 2 adults aged 65 years and older.
• Most ADHD medication users without an ADHD diagnosis did not have claims for non-ADHD indications of medications used to treat ADHD, such as narcolepsy.

• Real-world evidence indicates ADHD medication use grew considerably between 2017-2021, especially among 25–44-year-olds.
• Many adult members were found to be receiving ADHD medications without diagnoses for ADHD, especially adults aged 65 and older. This group had the fastest relative growth in ADHD medication use.
• As a result of these findings, a pilot policy was implemented requiring submission of documentation of an ADHD diagnosis or approval of off-label use for coverage of stimulant medications.
• Development of quality programs for education of providers with questionable stimulant prescribing patterns are currently under consideration.

• Nicole Thomas, Vincent Willey, Jay Visaria, Aaron Haynes
• The team at Carelon Research would also like to acknowledge significant contributions to this study from Jeff White and Collette Manning at CarelonRx, Dheeraj Raina at Carelon Behavioral Health, and the Addiction Medical Directors Workgroup.

Carelon Research conducted this study in collaboration with CarelonRx. Dissemination and sharing of the Newsletter is limited to Elevance Health and its subsidiaries and included findings and implications are for Elevance Health and its affiliates’ internal use only.