Examining Regulatory Classifications and Social Determinants of Health in Telehealth-Mediated ADHD Prescription Fulfillment Barriers

Background: Telehealth has expanded remote access to ADHD care, yet a prescription issued remotely must still be filled at a pharmacy—and whether telehealth resolves these downstream fulfillment barriers remains unclear. Federal regulatory distinctions between Schedule II controlled stimulants and non-controlled ADHD pharmacotherapies create structurally divergent procurement experiences, particularly under ongoing nationwide stimulant shortages. This study examined whether prescription fulfillment difficulty differs by medication regulatory classification among adults using telehealth for ADHD care, and identified social determinants of health (SDOH) associated with access difficulty. Methods: Data were drawn from Round 2 of the NCHS Rapid Surveys System (RSS-2; October–November 2023). The analytic sample comprised 141 adults with a current ADHD diagnosis who reported pharmacotherapy use and telehealth utilization for ADHD care, classified as controlled-exposed (n = 95) or non-controlled-exposed (n = 46) by medication regulatory class. Chi-square tests, multivariable logistic regression, and five machine learning algorithms were applied across 19 SDOH variables. Results: Prescription access difficulty was substantially more prevalent among controlled-exposed than non-controlled-exposed participants (75.8% vs. 45.7%, p < 0.001). Multivariable logistic regression identified controlled medication exposure (coefficient = 2.155, p < 0.001), difficulty paying medical bills (coefficient = 1.409, p = 0.034), and income (coefficient = 0.145, p = 0.042) as significant correlates. Random Forest permutation importance ranked controlled medication exposure and having a usual place for care as the two strongest predictors, although these exploratory rankings warrant caution given the small held-out test set (n = 28). Notably, all 13 participants reporting non-prescribed online medication purchases also reported access difficulty through formal channels, a pattern consistent with displacement toward unregulated supply chains. Conclusions: Prescription fulfillment barriers were strongly stratified by medication regulatory classification, with financial strain further compounding access difficulty. As federal telemedicine flexibilities approach their 31 December 2026, expiration, regulatory deliberations should weigh downstream fulfillment constraints—including the Schedule II refill prohibition under shortage conditions—alongside upstream telehealth access.