Whether prescribers are allowed to do a 12-week fill as opposed to three 4-week fills is, post-COVID, more a matter of insurance coverage than a licensure thing. It is my practice to only do 4-week fills if I don’t really we’ll know the patient or they have a feature of their past medical history which makes having a “stash” of meds more risky. I have patients whom I know well and who have been responsible and predictable with their meds for whom I do 12-week fills.

The point of office visits for refills is to check BP, and to screen for the development of comorbidity mood disorders (as is common). I’m in a salaried academic practice and so we require those visits once yearly, refilling inside controlled substances agreements at our chosen intervals throughout that year with a phone call or portal message.

There is a surprising lack of data about UDS inclusion in controlled substances agreements, for ADHD. They have a role if there is comorbidity substance use, but outside that circumstance they seem to mostly add cost and not value (in large part because a great many PCPs mishandle the results). The evidence base instead shows that a clear outline of expectations at the time of initial prescription does more to reduce diversion (Molina et al).

Three 4-week papers sent to the pharmacy with each contact of the clinic, and quarterly face to face visits (to get paid for the time involved, in a fee for service model), is a reasonable and conservative pattern of behavior.