Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021

Abstract

Prescription stimulant use, primarily for the treatment of attention-deficit/hyperactivity disorder (ADHD), has increased among adults in the United States during recent decades, while remaining stable or declining among children and adolescents (1,2). MarketScan commercial claims data were analyzed to describe trends in prescription stimulant fills before and during the COVID-19 pandemic (2016-2021) by calculating annual percentages of enrollees aged 5-64 years in employer-sponsored health plans who had one or more prescription stimulant fills overall and by sex and age group. Overall, the percentage of enrollees with one or more prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021. The percentages of females aged 15-44 years and males aged 25-44 years with prescription stimulant fills increased by more than 10% during 2020-2021. Future evaluation could determine if policy and health system reimbursement changes enacted during the pandemic contributed to the increase in stimulant prescriptions. Stimulants can offer substantial benefits for persons with ADHD, but also pose potential harms, including adverse effects, medication interactions, diversion and misuse, and overdoses. Well-established clinical guidelines exist for ADHD care, but only for children and adolescents* (3); clinical practice guidelines for adult ADHD could help adults also receive accurate diagnoses and appropriate treatment. CDC analyzed claims data from the Merative MarketScan Commercial Database, a national convenience sample of dei-dentified health care claims from enrollees in employer-sponsored insurance plans. CDC accessed 2016-2021 MarketScan data using Treatment Pathways 4.0, an online analytic platform that includes plans with complete data on prescription drug * https://chadd.org/for-professionals/clinical-practice-guidelines/ fills, to calculate the annual percentages of persons continuously enrolled throughout the calendar year with one or more prescription stimulant † fills. All prescription stimulants were included in the analyses, regardless of whether the enrollee had any claims with an ADHD diagnosis code present. Percentages and annual percent change (APC) were calculated for enrollees aged 5-64 years overall and by sex and age group; primary results were calculated by 5-year age groups, but some results were summarized by wider age groups to describe broader patterns. Among persons with one or more prescription stimulant fills during the calendar year, the mean number of prescription stimulant fills during that year and the percentage of persons † Prescription stimulants included in this analysis were amphetamine and mixed amphetamine salts, dexmethylphenidate, dextroamphetamine, lisdexamfetamine, methamphetamine, and methylphenidate.