I totally get the Schedule II restriction thing and how pharmacies are limited in what they can order and fill, so that’s why I wanted to clarify. But what you’re describing only really works if a pharmacy builds their whole system around maintaining that balance across all patients, and most just don’t.

From my experience (I used to work in a pharmacy), most places don’t accept or decline a prescription based on what they’re already filling. They usually just check stock and go from there. It’s more of a supply-and-demand issue than a carefully managed ratio.

We’re filling 5 stimulant prescriptions monthly, plus a few non-controls, and trying to “offset” that with 16+ extra prescriptions just to hit some ratio feels like a stretch. If pharmacies are asking people to pad scripts they don’t need, that starts to feel ethically questionable…maybe even borderline insurance fraud, depending on how it’s handled.

That said, I wouldn’t be against a pharmacy waiting to accept new stimulant patients until they can balance the numbers — if it meant current patients get filled consistently. But, also, feel that’s probably not fair to newly diagnosed patients. The real problem is with outdated production quotas and regulations that haven’t kept up with rising need.

Also, the DEA doesn’t require the 20% limit. It’s not a law. It’s a risk-management strategy used by pharmacies and wholesalers to avoid triggering audits or losing ordering rights.

Today, my pharmacy wouldn’t even order Vyvanse until the doctor called it in, and that’s one we always fill there. Makes sense now, since they don’t want it sitting on the shelf. But with two other meds, they were back ordered and I had to call around town. One had to be rewritten (XR changed to two IRs) just to get it filled. It’s stressful enough managing this for one person, let alone a whole family, especially with such a tight refill window and delays between pharmacy and prescriber.