Provider Briefing: The Adderall IR Shortage in 2026

The mixed Amphetamine Salts immediate-release (Adderall IR) shortage has persisted since the FDA's initial declaration in October 2022, making it one of the longest active drug shortages in the United States. For prescribers managing patients with ADHD and narcolepsy, the supply disruption continues to create clinical challenges — even as recent policy changes begin to ease production constraints.

This briefing covers the current state of the shortage, regulatory developments, prescribing considerations, and practical tools to help your patients maintain access to treatment.

Shortage Timeline

Understanding the trajectory of this shortage provides useful context for clinical decision-making:

• October 2022: FDA officially declares Adderall shortage following manufacturing delays at Teva Pharmaceutical Industries, the primary brand-name manufacturer
• 2023–2024: Shortage intensifies as ADHD prescription volumes continue to rise — driven in part by expanded telehealth access — while DEA Aggregate Production Quotas (APQs) remain insufficient to meet demand
• October 2025: DEA raises the 2025 APQ for d-amphetamine from 21.2 million grams to 26.5 million grams (a 25% increase), responding to sustained advocacy from clinicians, patients, and professional organizations
• January 2026: DEA finalizes 2026 APQs with additional increases — d,l-amphetamine (racemic) quota raised 14.3% above the initial proposal, reflecting public comment input

While these quota increases are meaningful, the lag between quota adjustment and pharmacy-level availability means patients may continue to experience intermittent access issues through mid-2026.

Prescribing Implications

The shortage raises several clinical considerations for providers:

Treatment Continuity Risks

Unplanned treatment interruptions can lead to ADHD symptom relapse, functional impairment, and patient distress. For patients stable on Adderall IR, maintaining supply continuity should be a clinical priority. Consider:

• Writing prescriptions with flexible fill dates to give patients a wider window
• Discussing contingency plans proactively during appointments
• Documenting shortage-related treatment disruptions in the medical record

Dose and Formulation Flexibility

Availability varies by dosage strength. The 20 mg and 30 mg strengths are most frequently back-ordered. When clinically appropriate:

• Consider prescribing lower-strength tablets that the patient can combine (e.g., two 10 mg tablets instead of one 20 mg tablet)
• Discuss whether Adderall XR (extended-release) could serve as a suitable substitute if IR is unavailable
• Consider Dextroamphetamine IR (Dexedrine) as a close pharmacological alternative within the amphetamine class

Alternative Agent Considerations

When Amphetamine Salts IR is persistently unavailable, the following alternatives may be appropriate depending on patient history and clinical profile:

1. Dextroamphetamine IR (Dexedrine): Closest pharmacological match — pure dextroamphetamine vs. Adderall's mixed salts. Similar onset, duration, and side effect profile.
2. Lisdexamfetamine (Vyvanse): Amphetamine prodrug with once-daily dosing and lower abuse potential. Generic now available, improving cost accessibility.
3. Methylphenidate IR (Ritalin): Different mechanism (reuptake inhibition without release promotion) but well-established efficacy. Widely available and inexpensive as generic.
4. Atomoxetine (Strattera): Non-stimulant option. Not a controlled substance — no DEA quota constraints. Appropriate for patients with comorbid anxiety or substance use history. Requires 4–6 weeks to reach full efficacy.

For a patient-facing version of this information, see alternatives to Adderall IR.

Current Availability Picture

Availability remains inconsistent across regions and pharmacy types:

• Large chain pharmacies (CVS, Walgreens, Rite Aid) often face corporate-level controlled substance ordering caps that limit their ability to maintain consistent stock
• Independent pharmacies typically have more flexibility in ordering from multiple wholesalers and may maintain better supply
• Regional variation is significant — some metropolitan areas have adequate supply while others remain constrained

Directing patients to check availability through tools like Medfinder for Providers can reduce the burden of pharmacy calls on both your staff and your patients.

Cost and Access Considerations

The financial landscape for Adderall IR in 2026:

• Generic Amphetamine Salts IR: $15 to $70/month with discount programs; $30 to $80 retail cash price
• Brand-name Adderall IR: $220 to $400+/month — rarely prescribed given generic availability
• Insurance: Generic is covered by most plans including Medicare Part D and Medicaid. Some plans impose quantity limits (typically 60 tablets/month)
• Patient assistance: Teva Cares Foundation provides qualifying uninsured/underinsured patients with Teva medications at no cost. NeedyMeds and RxAssist can help patients identify additional programs.

For patients struggling with costs, see the patient-facing guide on saving money on Adderall IR.

Tools and Resources for Your Practice

Several resources can help streamline medication access for your patients:

• Medfinder for Providers: Help patients locate pharmacies with Adderall IR in stock, reducing phone tag and treatment gaps
• FDA Drug Shortage Database: Official source for current shortage status and estimated resolution timelines
• ASHP Drug Shortage Resource Center: Additional shortage tracking and clinical guidance from the American Society of Health-System Pharmacists
• GoodRx / SingleCare: Discount programs your staff can recommend to uninsured patients to reduce out-of-pocket costs to as low as $15–$40/month

Looking Ahead

The regulatory and supply environment is moving in the right direction. The DEA's substantial quota increases for 2025 and 2026 represent a meaningful policy shift, and multiple generic manufacturers are expanding capacity. However, systemic issues remain:

• The DEA quota-setting process still lags behind real-time demand signals
• Ongoing legislative proposals to reform the quota system have not yet been enacted
• Distributor allocation models continue to disadvantage newer or growing pharmacies

Providers should anticipate continued improvement through 2026, with the most significant supply gains expected by mid-year as increased quotas translate to pharmacy-level inventory.

Final Thoughts

The Adderall IR shortage has tested the resilience of patients and providers alike. While resolution is underway, the transition period requires continued vigilance in clinical practice — maintaining treatment continuity, communicating proactively with patients about contingency plans, and leveraging available tools to navigate supply constraints.

For a complementary guide on practical steps you can take in your practice, see how to help your patients find Adderall IR in stock.