ADHD Medication Shortage
Since October 2022, certain amphetamine salt products, including Adderall, Concerta, and their generics have been on a national shortage. We have received a surge of phone calls in the past month of concerned patients, parents, and providers seeking to find a medication they may have been on for a while and cannot abruptly stop. As an independent pharmacy who strives to help our community navigate through healthcare challenges, Skippack Pharmacy may not immediately have a solution or the medication for you but we want to do our best to keep our patients informed when supplies increase and/or we receive supply of a medication on shortage. You will be asked a few questions regarding your medication, history, and basic demographics. PLEASE DO NOT HAVE YOUR PRESCRIBER SEND A SCRIPT TO UNLESS WE REACH OUT TO YOU TO INFORM YOU WE HAVE THE MEDICATION AND QUANTITY IN STOCK. Your doctor may send in the script; however, it will be cancelled unless we approve you through this system / you receive an email from our team. By filling this form out you understand that this is only a request to be informed when we receive a medication and not a guarantee that we will receive it. Please do not call the pharmacy for updates as the pharmacy team will not have any additional information/updates. **We are currently not able to fill any controlled substances including ADHD medications from any telehealth providers or from patients residing outside of 20 miles from Skippack, PA**
Patient Status with Skippack Pharmacy
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I am currently a Skippack Pharmacy patient for prescriptions
I am currently a Skippack Pharmacy patient for vaccines
I am new to Skippack Pharmacy
Please select which applies to the patient.
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I live within 20 miles of the pharmacy & my prescriber for my ADHD medication is NOT a telehealth or online doctor.
I do not live within 20 miles of Skippack Pharmacy and/or my prescriber for my ADHD medication is a telehealth or online doctor. ***PLEASE DO NOT MOVE FORWARD AS WE WILL NOT BE ABLE TO FILL YOUR PRESCRIPTION***
Who is filling out this form?
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I am filling this out on behalf of my child
I am filling this out for myself
I am filling this out for my spouse, significant other, family member
Patient's Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
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Patient Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
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Area Code
Phone Number
Email
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Please double check and ensure this is accurate
Please list the name and city of your CURRENT PHARMACY
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Please list the name and city of the DOCTOR/PROVIDER who prescribes this medication for you
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Select the name of the ADHD medication you take ***we do not have access to any brand name ADHD medications, if filling this out for a brand name, please do not move fwd***?
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GENERIC - Amphetamine Salt Combo Tablets (generic of Adderall)
GENERIC - Mixed Amphetamine Salt ER Capsules (generic of Adderall XR)
GENERIC - Methylphenidate Tablets (generic of Ritalin)
GENERIC - Methylphenidate ER Tablets (generic of Concerta ER)
GENERIC - Dexmethylphenidate Tablets (generic of Focalin)
GENERIC - Dexmethylphenidate ER Capsules (generic of Focalin XR)
GENERIC - Methylphenidate ER Capsules (generic of Ritalin LA)
GENERIC - Methylphenidate ER Capsules (generic of Metadate CD)
Other
What strength of this medication do you take?
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How many tablets or capsules do you receive each month for this prescription?
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Do you take any other ADHD product(s)?
Yes
No, this is the only one
Which other ADHD medication do you take?
GENERIC - Amphetamine Salt Combo Tablets (generic of Adderall)
GENERIC - Mixed Amphetamine Salt ER Capsules (generic of Adderall XR)
GENERIC - Methylphenidate Tablets (generic of Ritalin)
GENERIC - Methylphenidate ER Tablets (generic of Concerta ER)
GENERIC - Dexmethylphenidate Tablets (generic of Focalin)
GENERIC - Dexmethylphenidate ER Capsules (generic of Focalin XR)
GENERIC - Methylphenidate ER Capsules (generic of Ritalin LA)
GENERIC - Methylphenidate ER Capsules (generic of Metadate CD)
Other
What strength of this medication do you take?
How many tablets or capsules do you receive each month for this prescription?
Do you take any other ADHD product(s)?
Yes
No, these are the only two I take
Which other ADHD medication do you take?
GENERIC - Amphetamine Salt Combo Tablets (generic of Adderall)
GENERIC - Mixed Amphetamine Salt ER Capsules (generic of Adderall XR)
GENERIC - Methylphenidate Tablets (generic of Ritalin)
GENERIC - Methylphenidate ER Tablets (generic of Concerta ER)
GENERIC - Dexmethylphenidate Tablets (generic of Focalin)
GENERIC - Dexmethylphenidate ER Capsules (generic of Focalin XR)
GENERIC - Methylphenidate ER Capsules (generic of Ritalin LA)
GENERIC - Methylphenidate ER Capsules (generic of Metadate CD)
Other
What strength of this medication do you take?
How many tablets or capsules do you receive each month for this prescription?
Please list any other medications you may be taking?
Any other information you would like to add?
Please upload a copy of your insurance card.
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Please input the numbers/letters from your Prescription Insurance card. You are looking at your prescription card if it has the letters RX on it otherwise, you are likely looking at your medical card. If you don't have insurance just put no insurance.
I confirm that I have a valid prescription for ADHD products NOT from a telehealth provider, reside within 20 miles of Skippack Pharmacy and will not use this information for any other purpose. I understand and acknowledge that I will have my prescriber send a script to Skippack Pharmacy only if I am informed to do so. I understand and acknowledge that this is only a request to be informed when Skippack Pharmacy receives a medication and not a guarantee that I will receive it. I understand and acknowledge that Skippack Pharmacy is trying their best to serve the community and this shortage; however, I will not call or email the pharmacy for updates as all updates will come via email/text from the pharmacy.
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