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David W. Goodman MD

CVS Carmark Medication Authorization Criteria January 1, 2018

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CVS CAREMARK CRITERIA

Starting January 1, 2018, these patients may not be able to fill their current medication at the pharmacy, based on the plan’s coverage changes.

Please visit caremark.com/highvalueplan to review the coverage details of this pharmacy benefit plan.

 

PA                                    = Prior Authorization                                    There must be a satisfied PA on file or a PA must be requested.

Please call 1-877-203-1681

 

ST                                    = Step Therapy                                                      The patient must have already satisfied the step therapy

requirements through previous medication use.

 

QL                                    = Quantity Limits                                    The medication to be dispensed must be for less than the quantity

limits restriction. No further action is necessary if the quantity dispensed for this prescription is below the limit.

 

 

QLWPA                                    = Quantity Limits With                                    The medication to be dispensed must be for less than the quantity

Prior Authorization                   limits restriction. A PA must be requested for quantities greater than the limit restriction. Please call 1-877-203-1681. No further action is necessary if the quantity dispensed for this prescription is below the limit.

 

FE                                    = Formulary Exclusion                                    Patient’s formulary does not cover the medication. You may request

A formulary exception based on medical necessity. Please call

1-877-203-1681.

 

BE                                    = Benefit Exclusion                                    Patient’s pharmacy benefit design does not cover this medication.

 

Dr. David W. Goodman on CHADD Webinar Ask the Expert April 18, 2019 at 2pm LIVE

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“What can I expect as an adult from my ADHD treatment in the first 6 months?”

I have been invited to speak online LIVE for the Children and Adults with ADHD Association Webinar Series “Ask the Expert”. I will discuss the benefits of ADHD treatment as they unfold over the first 6 months of treatment. If effectively treated with the sequence of medication and psychotherapy, there is a predictable pattern of improvement that can be expected. Understanding this pattern will help you discover what gets better and when. Patients and families are often amazed that I can predict what will happen over the first 6 months and you may be too.

Register for the Webinar at CHADD.org and find out what you can expect from treatment. I’ll post the link as soon as CHADD sets it up.

ADDitude Magazine Webinar ADHD in Older Adults David W. Goodman, MD

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On May 1, 2018 I presented the first webinar for ADDitude Magazine on ADHD in adults over the age 50. The presentation with audio and slides is available to be hear for free. This is a rare discussion of prevalence, diagnosis, impairments, and treatment of older adults. Complaints of cognitive symptoms are common in older adults, however, ADHD is rarely considered in the diagnostic considerations. Rarely are adults with ADHD diagnosed in childhood because in the 1960s-70s, only hyperactive, disruptive boys were diagnosed. Therefore, clinicians, not trained to identify ADHD, often miss the diagnosis especially in older adults.

Listen to the webinar and learn how ADHD persists for a lifetime in many adults.

ADDitude Magazine Webinar “ADHD in Older Adults” David W. Goodman, M.D. May 1, 2018

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Technology is not always a cooperative servant. My ADDitude Magazine webinar scheduled on Febuary 27, 2018 was interrupted by a technical problem after 10 minutes. No one was more upset about this than I. However, good news. the webinar has been rescheduled for May 1 Tuesday 1pm for 1 hour. This will be a 30+ minute presentation with slides followed by Q and A live. You can register for the webinar and, if not available for the time, watch it at a convenient time for you.

In this webinar, you will learn:

  1. how to identify and understand ADHD symptoms in adults over age 50
  2. the importance of an accurate diagnosis in older adults who are experiencing mental changes
  3. why clinicians don’t consider that ADHD might be the reason for “thinking problems” in older adults
  4. signs that clinicians and older adults should be aware of in the diagnosis process
  5. how stimulants might fit into a treatment regimen for adults who are taking multiple medications
  6. how medication and organizational skills can improve daily functioning and quality of life
  7. how to approach a parent who you suspect has had lifelong inattention and disorganization

Hope you can join us…and tell anyone who might benefit….like your parents who have had symptoms for as long as you can remember. While the webinar is billed for clinicians based of the research basis of the presentation, it will not be beyond the scope of the general public to understand.

David W. Goodman, M.D.

Dr. David W. Goodman Interview by NPR Morning Edition May 29, 2017

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National Public Radio recently posted my interview (click on “Heard on Morning Editon”) from April 2017 about a research publication reviewing a revised adult ADHD screener developed in coordination with the World Health Organization. What the journalist didn’t know at the time that I will share with you is that I was a pre-publication peer reviewer on this study. That means I was very knowledgeable about the details of the study and had offered my critique to the publisher prior to publication. For additional background on this screener, see my previous blog.

 

Now, let’s address the audio quotes.

Dr. Lawrence Diller says “I don’t know what ADHD is anymore” referring to changes over the past 3 decades of changes in the Diagnostic and Statistic Manual used to establish diagnostic criteria for psychiatric disorders. I’m surprised by his comment given 20+ years of international research (tens of thousands of scientific publications from around the world) that has better defined the symptoms and impairments of ADHD. It is this research that has contributed to better defining ADHD in children and the progression of ADHD into adulthood  therefore accounting for the evolution of changes in the current DSM 5. The diagnosis of ADHD is not based on a cluster of symptoms at one point in time. The diagnosis is based on the cluster of symptoms as they impair the person over the course of their life. Everyone has some inattention and distractibility at some point but few have the symptoms since childhood that have never gone away and are observed by others as a problem.

How about Alan Schwarz’s comments who disqualifies published peer reviewed science by indicting the experts and researchers who have conducted research with and without pharmaceutical support. To indict the international ADHD research community would be to suggest an international conspicacy of hundreds, if not thousands, of physicians and psychologists across 7 continents. This is a basic journalistic method (shoot the messager) to distract readers from the merits of an issue. I have personal experience with Mr. Schwarz who took to indicting me in his New York Times article when he conveyed to readers that I was advocating teaching primary care physicians how to diagnosis ADHD based on a short video clip. What he deliberately chose not to include in his article was the fact that the video was a visual representation accompanying a 2500 word, 168 scientific references, and peer reviewed article. Focused only on his agenda to act as “educator” to save the “victims” of ADHD medications from the “villians” of doctors, he deliberately misrepresented information for his self-serving purposes.

So, I’ll leave you with my saying, “The credibility of information is dependent on intent of the provider”. A salesperson gives you only information he/she wants you to have to close the sale. An educator gives you information so that your interest is best served first. You need to carefully discern this for yourself.

I will continue to present science in the halls of opinions.

Thank you for your interest….and focused attention.

David W. Goodman, M.D., FAPA

Dr. David W. Goodman interviewed by Vox.com Misdiagnosis of ADHD

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Dr. David W. Goodman was video interviewed by Vox.com on misdiagnosis of ADHD as a counterpoint to Dr. Allen Francis, psychiatrist, who believes ADHD is overdiagnosed. The video is excellently edited and very engaging. While it is easy to say ADHD is overdiagnosed because of the extensive media coverage, it is not overdiagnosis. The basis for my opinion lies in the research facts: 4.5% of US adults ages 18-44 are believed to have ADHD, a diagnosis whose basis is the persistence of symptoms since childhood of which 75% were never diagnosed as children. Of the adults with ADHD in the U.S., only 25% have been treated in the last year. With the prevalence rate of ADHD internationally ranges from approximately 2-10%, appallingly few adults outside of the U.S. are identified and treated.

Setting aside those adults who are accurately diagnosed  with a comprehensive evaluation, there are patients who are given the diagnosis of ADHD and don’t have it. Inadequate clinician training, little time spent obtaining the history, and strong patient demand for ADHD can lead to misdiagnosis. These patients who do not have ADHD should not be placed on stimulant medication. More often, primary care clinicians are prescribing short-acting stimulants which can be abused, misused, and sold/given away to friends/customers.

SOME FACTS:

65% of all stimulants prescribed in the U.S. are prescribed primary care clinicians; 55% of all stimulants prescribed are short-acting; four international guidelines for the diagnosis and treatment of ADHD recommend long-acting stimulants as first line medication, not short-acting.

Well, that’s enough science for today. I provide this information so that if you are in a conversation about this topic, you are armed with meaningful data, beyond opinion.

As I have said before in my blogs, let science be the designated driver on the highway of opinions.

Dr. David W. Goodman interviewed by NPR April 4, 2017

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National Public Radio  interviewed me this week to comment on a research publication about a revised adult ADHD screener developed in coordination with the World Health Organization. What the journalist didn’t know at the time, that I will share with you, is that I was a pre-publication peer reviewer on this study. That means I was very knowledgeable about the details of the study and had offered my critique prior to publication.

As background, my colleagues just published a research paper revising the adult ADHD screener developed in coordination with the World Health Organization. Because of the diagnostic changes from DSM-IV to DSM-5, the previous adult ADHD screener needed to be revised accordingly.  While the six question screener looks rather basic, the article details the rigorous methodology and statistical factors that contributed to the selection of each of the six ADHD questions.

It should be enphatically stated that the screener simply allows clinicians to identify adults who may have ADHD, but it in no way makes a diagnosis. Because primary care clinicians are increasingly requested to provide mental health diagnoses and treatment. Because their time spent with patients is limited, the screener simply highlights someone who has some symptoms.  This encourages a further evaluation by someone with adult ADHD expertise.

Given that ADHD is a world wide disorder, the World Health Organization has been very interested in developing a preliminary screener to be performed in the offices of clinicians around the world. The previous screener has been translated into many languages to be used internationally.

To those who follow my blog, I apologize for the delinquency in posting any recent material.  My time has been consumed taking care of patients, developing slide decks to educate clinicians, serving on the national boards of directors for APSARD ( American Professional Society for ADHD and Related Disorders Association) and CHADD (Children and Adults with ADHD Association),  and working with journalists in order to present the latest science of ADHD.

Thank you to those who continue to read my blogs.

A Randomized, 6-week, Placebo-Controlled Study of Treatment for Adult Attention-Deficit Disorder: Individualized Dosing of Osmotic-Release Oral System (OROS) Methylphenidate With a Goal of Symptom Remission

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Goodman DW, Starr LH, Yi-Wen M, Rostain AL, Ascher S. Armstron RB. J ClinPsychiatry 2017;78(1):105-114.

click to read abstract

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