I read an online article today from Benzinga, a financial media company that empowers its readers with daily actionable market analysis and commentary. It reported on a new ADHD drug that the FDA had just approved, called Cotempla XR-OTD, a methylphenidate extended release orally-disintegrating tablet for treating ADHD in kids aged 6-17. According to BMO Financial Services: ”Management believes it can leverage the existing ~125 reps and generate considerable synergies, particularly with Cotempla . . . it will be the only company promoting both amphetamine and methylphenidate products to high-prescribing ADHD physicians in a category with a lot of switches back and forth, and comfortably covering a wide age range.” [italics mine].
This italicized phrase troubles me in that it seems to imply that there are high-prescribing ADHD physicians and low-prescribing ADHD physicians, and my question is, if ADHD is a biomedical disorder and physicians are trained to diagnose and treat it, and ADHD as a disorder is spread out relatively evenly from region to region (as ADHD experts claim), then shouldn’t there be just ”prescribing ADHD physicians?”
What are the factors that make for a high-prescribing physician versus a low-prescribing physician? Are low-prescribing physicians being negligent, or conversely, are high-prescribing physicians being profligate? Are there other, psycho-social or economic factors that go into determining whether a physician will be high or low prescribing?
The other item that caught my eye in the note was the reference to ~125 reps, which I’m assuming means sales representatives for the company. Is there a relationship between sales representatives and whether or not a physician will be high-prescribing or low-prescribing? For more information on the relationship between sales reps and ADHD prescribing physicians, see Alan Schwarz’s book: ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic.
Just for fun, I thought I’d include this NEOS graphic (below) on how Cotempla XR-OTD is made, taken from its 10-K filing (a form required by the federal securities laws). It takes a lot of work to medicate a child into submission!
For lots of non-drug interventions for ADHD-related behaviors, order my book: The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span without Drugs, Labels, or Coercion.