Medication Reviews
The National guidance and local shared care agreements clarify that in order to take ADHD Medication, you need to have regular reviews by an ADHD Specialist.
Whether you receive your medication from us, or from your GP (as a shared care arrangement), you would have to book regular medication reviews when receiving medication through our service.
This is to supervise your care, monitor progress and make any adjustments required. Your clinician will monitor your blood pressure, pulse, and weight (height in children) to ensure there are no adverse effects cause by your medication.
Medication review appointment length is based on what you, as a Patient feel you need. Most people choose the 20-minute review at £80.00.
If starting medication, we would suggest that it is best to budget for 2-3 medication (£80 per review) reviews for the first year. If all goes well with your treatment and your response to medication, the medication reviews would be reduced to 1-2 reviews per year (free of charge).
However, everyone is unique in how they respond to medicines, and so at times it may be necessary to change medications or change the dose etc… in those cases, the number of reviews may increase slightly. However, we never recommend any additional medication reviews unless they are absolutely necessary
Once stabilised on medication our policy is that medication review appointments are free of charge as we don’t believe Patients should be charged indefinitely for a service that they cannot get on the NHS.
ADHD IN WOMEN
Have you recently received a diagnosis of ADHD? You’re not alone! Join our “ADHD Diagnosis – What now?” webinar, specially crafted for individuals like yourself, ready to navigate the journey ahead.
How Do I Get A Prescription?
ADHD Direct is an assessment, diagnosis and treatment service of attention deficit hyperactivity disorder (ADHD) in children, young people and adults.
Any decision to prescribe medication will always form part of a comprehensive, holistic shared treatment plan that addresses psychological, behavioral and occupational or educational needs
If you have been diagnosed with ADHD, we will always discuss our recommendations and at times this may mean that one such treatment option is medication
Medication can be prescribed in one of 2 ways:
1. Private Prescription
ADHD Direct can prescribe and monitor all ADHD Medication as part of a comprehensive package of care.
This means that our Patients will pay for the cost of:
- the medication review appointment
- a prescription processing fee
- And on taking the prescription to your chosen Pharmacy, the Pharmacist will charge you for the cost of the medication itself
- ADHD Direct partners with the Private Pharmacy Group who will process Patient prescriptions and deliver them securely and directly to your chosen address
2. NHS Shared Care
The other option is to share care with your GP, this means that:
- the GP prescribes the medication as an NHS prescription
- but ADHD Direct take responsibility for the monitoring your response to treatment and seeing you for regular reviews.
- We would also provide the prescribing advice to your GP. Please note that in ADHD Direct we will not prescribe any medication unless this information is shared with your NHS GP, this ensures safe prescribing and holistic joined-up care across health care services.
Not all GPs will prescribe for patients attending private ADHD service or in fact for private services as a whole; and you will find that there will be a lot of variability in this.
When we write to your GP, we do explain what our shared care service is, and how we will monitor you. We also given them information on the type of medications used and what our monitoring will be for each type of medication.
However, a GP is not obliged to prescribe on behalf of the Private ADHD Service and if they choose not to, then you will still be able to get your medication from ADHD Direct but at a private cost.
For these GPs who will prescribe for you, we write to them regularly with updates to ensure them of your ongoing monitoring and care.
Cost of Private ADHD medication (Methylphenidate and Elvanse)
In the following we will lay out the cost of Methylphenidate & Elvanse in an example calculation. Please note that medication prices are variable and can change in time.
ADHD Direct does not provide medication itself and has no influence on medication prices. The prices below are only estimates.
cost for Methylphenidate Hydrochloride
The cost Of Methylphenidate Hydrochloride MR (which is one of the cheapest ADHD medications) is purchased by the pharmacy usually at a minimum of £15.38
All Pharmacies will then also charge a dispensing fee for all private prescriptions.
This means that they will charge you 50% of the cost as their ‘dispensing fee’.
So, this takes the cost to £23.07
So, for a 1 Month supply of Methylphenidate Hydrochloride MR – regardless of which chemist you go to, the minimum will likely be £23.07
Cost of Afendid XL (Methylphenidate Hydrochloride)
On a positive front though, there are also newer types of Methylphenidate coming out as the ADHD Market becomes more competitive.
Recently a new and cheaper version of Methylphenidate called Afendid XL has been released. Currently this doesn’t seem to be available in all Pharmacies- but in the ones where it is. the cost for a starting dose is lower still at £10.90. And so again adding on the Pharmacy tax this could cost you £16.35/ Mont
cost for Elvanse (Lisdexamfetamine Mesilate)
The other medication is Elvanse.
This is still on patent – meaning that it is only provided by one drug company – which may be why it is a little bit more expensive. It costs £58.24 for 1 month.
And so, with the 50% Pharmacy dispensing fee, this would mean a monthly costs of around £85.
Receiving your medication from PPG (Private Pharmacy Group)
PPG is a private pharmacy that specialises in supplying controlled drugs and thus this includes ADHD Medications. They will source and deliver it to you for an additional £10. The medication is delivered by a courier.
For anyone who uses PPG we reduce our own prescription issue fee from £20 to £15 so as to offset some of the delivery cost- so effectively you are paying them an extra £5-6 for the additional service of them delivering your prescription.
We offer them as an option as we do find that frequently ADHD Medications go out of stock due to national shortages, and as PPG are a specialist Pharmacy, they usually get access to the medications quicker when they restock.
However, there is absolutely no obligation to use them. A lot of our Patients do as they find it easier – but some don’t. The choice is always the Patients.
ADHD Medication FAQ
Whether we are going down the ‘shared care’ route to prescribing or prescribing purely on a private basis, we always follow what’s in the national guidelines for ADHD and in the UK, we follow the NICE Guidelines, which states that, ‘All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD’, which would NOT be your GP. Our Clinical Specialists with Prescribing Qualifications will always write your prescriptions until your treatment is stable.
Let’s break the costs down for you. There are 2 options for a private prescription.
Option 1: You receive your private script from ADHD Direct in the way of a paper prescription posted to you or we can post the prescription to your pharmacy of choice. This option costs you £20 for the prescription. This covers the prescription cost and postage, which is sent via royal mail recorded delivery. You then will purchase the medication at your pharmacy. This will include the price of the medication and the pharmacy’s private dispensing charge.
Option 2: This involves ADHD Direct posting your prescription to a Private Pharmacy Group (PPG) in London and they will deliver your medication directly to your home address via DPD. PPG will then invoice you for the cost of the medication and their dispensing fees. This option cuts out the need to take your prescription to the pharmacy, meaning less steps in the process for you. To offset PPG’s dispensing fees, we reduce the cost of the prescription to £15.
If the medication that we choose for you works well and there are no complications, then from starting your treatment and getting it to the optimum dose, you will require at least 3 private prescriptions over 3-6 months. For the first month’s prescription, we only ever issue 28 or 30 days supply. However, if there are complications, such as side-effects or perhaps the medication does not work as well as we had hoped, then unfortunately, you will need more prescriptions and the process will then take longer.
Please don’t worry, PPG are UK wide and will process your prescription through their own processes, rest assured this will still be delivered to you.
Our prescribing team will hope to process your prescription in a few days from the time it has been requested for you but it can take up to a maximum of 10 days.
The national guidance and local shared care agreements stipulate that the private service (that’s us) must regularly review your medication to ensure it’s effective, safe and make any adjustments as required.
Good news is that we will only see you when we have to and if you’re stable on your treatment, this means we’ll see you for review either 6 monthly for a child and 6 monthly or 12 monthly for an adult. More good news, these appointments could be free of charge. If you’re stable on your treatment at your medication review appointment and you and your clinician don’t anticipate any changes to your treatment in the next 6 to 12 months, then you may be advised to book your next review with one of our Clinical Assistants and these appointments are FREE.
However, if you develop any side-effects or any other complications, then you will need to have a review appointment with one of our Specialists.
At ADHD Direct, we are committed to your well-being. We understand that once you have achieved stability with your medication, the ongoing costs of medication review appointments can be challenging. That’s why we offer these appointments to you free of charge. We recognise that the NHS may not always have the capacity to fully take over your care, and our aim is to make this aspect of your healthcare as accessible as possible for you.
Our medication review appointments a booked up very quickly and for months in advance. So, we want to ensure that we are able to review you in the recommended time frame to ensure the continued safe prescribing and monitoring of your medication. We are aware that from time to time, things may crop up, so appointments that are booked well in advance can always be rescheduled to another time/date that suits as per our cancellation policy. By booking in advance, this allows you to be seen at the correct time by the clinician of your choice where possible.
The guidelines state that an ECG should not be carried out routinely before starting ADHD medications unless
you have a significant family history suggesting a Potential underlying cardiac condition, this would be:
- history of congenital heart disease or previous cardiac surgery
- history of sudden death in a first-degree relative under 40 years suggesting a
- cardiac disease
- shortness of breath on exertion compared with peers
- fainting on exertion or in response to fright or noise
- palpitations that are rapid, regular and start and stop suddenly (fleeting
- occasional bumps are usually ectopic and do not need investigation)
- chest pain suggesting cardiac origin
- signs of heart failure
- a murmur heard on cardiac examination
We will always carry out a systematic enquiry of your cardiac history and we will also take baseline measurements of your blood pressure, pulse, weight and height for children. These measurements are recorded at agreed intervals for the duration that you take your ADHD medication.
If we think that you do require further cardiac assessment, then in the first instance, we will ask you to consult your GP.
Yes, this is absolutely fine. There are many different companies that make Methylphenidate. Here are some common names you may coma across: is Xaggitin, Xenidate, Concerta, Matoride, Delmosart. This list is not exhaustive and new brands could be added at any time.
Shared care is an agreement between your GP and your private healthcare provider that covers each of their roles and responsibilities. It also describes the patient’s roles and responsibilities in the shared care arrangement. Shared care allows ADHD Direct to continue to review you when necessary and update your GP with the outcome of your reviews and recommendations for ongoing treatment. This then allows your GP to write your recommended prescription and this process ensures safe prescribing and best practice. GPs are not under any obligation to engage in shared care, so it’s best to speak with them in person to clarify if they will be happy to engage in shared care once you are stable on your treatment.
No, you don’t have to see the same clinician each time. Any one of our highly trained clinical specialists can see you to review your ADHD medication. However, you may wish to see the same clinician and that is absolutely fine also.
