Amidst a shortage of prescription stimulants, concerns have been raised about the potential increase in illicit drug use. With many individuals relying on prescription stimulants to manage conditions such as attention-deficit/hyperactivity disorder (ADHD), the shortage has left many struggling to access the medication they need. This has led some individuals to turn to illicit drugs as an alternative, which can have serious health consequences.

The shortage of prescription stimulants has been attributed to a variety of factors, including supply chain disruptions in the fall of 2022 and increased prescribing and dispensing. Due to the shortage, it is essential that stimulants be prescribed responsibly. Prescribers should assess the risk of misuse, abuse and addiction prior to prescribing stimulant medication. To prescribe stimulant medications, providers must follow Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to confirm ADHD diagnosis. Prescribers must cross-reference prescription information with information available in state-run prescription drug monitoring programs (PDMPs), as well as limit the number of pills and frequency of pills prescribed. Patients and their family members should be educated on how to safely store and dispose of prescription stimulants and the potential risks of misuse, addiction and overdose.

It is important for providers to be aware that there is a greater risk of diversion when prescription stimulants are scarce. Approximately 56-80% of the population reported that stimulants were obtained from friends or family members. The most vulnerable population for nonmedical use of prescription stimulants was the 18-25 age group, and reported misuse of stimulants was for improving academic or work performance, followed by recreational or social use.

These drugs are easily accessible through the internet and social media, posing as prescription drugs such as Adderall and Xanax. Those websites are targeted at youth at risk of diversion, misuse and shortages. According to a report published by the Centers for Disease Control in December 2022, overdose deaths among youth aged 14-19 increased significantly from 2019 to 2021. Over 25% of the deaths were caused by counterfeit pills, which mimicked prescription medications but contained deadly fentanyl.

Illicit drugs can have a range of negative effects on both physical and mental health and can lead to addiction and overdose. Over 50.6 million fake pills were seized by the Drug Enforcement Administration in 2022. There was a potentially lethal dose of fentanyl in six out of 10 pills containing the drug. In Delaware, 85% of the 537 overdose deaths involved fentanyl. The number of overdose deaths caused by illicit stimulants is also on the rise. Last year, 44% of overdose deaths contained cocaine and 12% methamphetamine.

It is important to screen patients for stimulant use disorders. To find more information on screening and assessment go to HelpIsHereDE.com//health-care-providers.

It is crucial for individuals to prioritize their health and safety by seeking out alternative treatments or working with their healthcare provider to find a solution. For free 24/7 counseling, coaching, and support, as well as links to mental health, addiction, and crisis services call the Delaware Hope Line at 1-833-9-HOPEDE. To search for treatment and recovery services in Delaware or nearby states, visit HelpIsHereDE.com.

Department of Insurance will lead effort to rein in monopolistic behavior and excessive pharmaceutical costs

Insurance Commissioner Trinidad Navarro announced today that the Delaware Department of Insurance will begin the process of building and enforcing regulations regarding Pharmacy Benefit Managers (PBMs) as a new law goes into effect. The new authorities of the department will ensure consumer access to affordable medications and protect local pharmacies from the predatory behaviors exhibited by the PBM industry through measures of transparency and corporate accountability.

“Alongside members of the General Assembly, advocates, pharmacy representatives, and industry stakeholders, we have been working towards this goal for years. We have heard the voices of those who have had to travel hundreds of miles for their children’s medications. We have heard the plight of the local pharmacies, the way they have been financially devastated by PBM’s preference of their own chains. We have watched as other states were taken advantage of by these companies and cheered those states on as they took action to stop predatory practices. We have seen partners in this fight retaliated against by these companies, and we mourned as more and more neighborhood pharmacies had to close their doors,” said Insurance Commissioner Trinidad Navarro, referencing the work of the Pharmacy Reimbursement Task Force and other legislative initiatives and discussions. “Now, with these new powers, we say ‘No more.’”

HB 219, sponsored by Rep. Andria Bennett, Sen. Spiros Mantzavinos, Senate President Pro Tempore David Sokola, and Rep. Mike Smith, was passed by the General Assembly unanimously and recently became law, bringing Delaware’s oversight of the multi-billion-dollar industry on par with leading states.

PBMs act as intermediaries for prescription drug plans, influencing what medications will be covered and the costs of those drugs for both consumers and pharmacies. These companies bring in billions through manufacturer rebates, limiting generic drug offerings, and retaining negotiated savings, while costs for consumers continue to rise. The largest PBMs operate their own pharmacy chains, and their consolidated market power has, prior to this law, allowed them to pay unaffiliated pharmacies unsustainably low reimbursement rates – rates lower than it costs the pharmacy to dispense the drug to a consumer. PBMs’ move toward monopolization has contributed to waves of independent pharmacy closures across the nation, especially in rural, inner city, and under-served areas that already crave equity and access.

“I have worked on this issue for years and have seen firsthand how pharmacy benefit managers’ predatory practices have increased consumer costs while decreasing consumer access and driving out small, unaffiliated pharmacies. With healthcare cost emphasized throughout the pandemic, it is more important than ever to have these protections in place,” said Rep. Andria Bennett, the prime sponsor of HB 219 and chair of the Pharmacy Reimbursement Task Force. “This new law passed the General Assembly unanimously, and it did so because there are two things we all agree on: that the cost of prescription drugs is far too high, and that billionaire corporations should not be above the law.”

The new law aims to solve many issues of access and inequal treatment through use of the National Average Drug Acquisition Cost for pharmacy reimbursement, prohibiting inequal payments to unaffiliated pharmacies, and providing the Department of Insurance the ability to investigate PBMs, enforce consumer protection measures, and incentivize corrections through increased regulatory authority. In order to better understand PBM’s existing processes, the department recently began introductory Market Conduct exams on registered PBMs, known to be the first investigations of this kind in the nation. These initial examinations will not result in fines or enforcement actions, but will highlight areas for improvement, including those that are not compliant with the new law, and will require corrective action plans.

Rep. Mike Smith – a prime sponsor of HB 219 – stated, “This is an exciting moment for Delaware. This was a collaborative effort to support Delaware’s small, independent pharmacies and all Delawareans. At the end of the day, consumer protection won, and I’m proud of the work we did to bring accountability to PBMs.”

“Reducing prescription drug prices will directly improve the health and welfare of our neighbors,” said Sen. Spiros Mantzavinos, Senate prime sponsor of HB 219. “This new law will provide for greater oversight of the pharmacy benefit manager industry, allowing for more consistent prescription drug prices and ensuring expanded access to the medications Delawareans rely on. I am proud to have helped champion HB 219 alongside Rep. Bennett and look forward to Delawareans reaping the benefits of this expanded oversight.”

While independent pharmacies faced retaliation from the multi-billion-dollar giants, including through costly audits, they continued to advocate for change. Now, they are celebrating the new law and the protections it holds for their customers.

“The true beneficiaries of this new PBM oversight will be the patients. They have always deserved health care that is accessible, affordable and transparent – not barriers to care, higher costs and excuses while PBMs lined their pockets. Having the Delaware Insurance Commissioner’s office oversee PBMs will greatly assist underserved and vulnerable populations who struggle to afford their medications, and who have experienced barriers to patient care,” explained Kevin Musto, R.Ph., FAPhA, an independent pharmacist.

The Delaware Pharmacy Society also shared their enthusiasm for the new law. “We are tremendously delighted with enactment of HB 219, which increases transparency and equity in pharmacy benefit management. It is our belief that this law will result in increased access to health benefits for Delawareans, provided at the most accessible health care providers – pharmacies. This law makes Delaware a pioneer in controlling health care costs,” they stated.

In the coming months, the Department of Insurance will draft relevant regulations, receiving input from stakeholders during that process. After draft regulations are developed, they will be published, and the public will have 30 days to comment.