Intesting. First, I am so envious of you it is crazy. I LOVE treating ADHD. And, having patients switch to me because their doctor can't write it correctly or won't even write it. It's funny though about the reasons. I have talked directly with the DEA, and they claim they didn't change the rule nor do they even know much about the rule. They just know that you can't write for refills WHICH WOULD SOLVE THE WHOLE FRIGGIN' PROBLEM AND IS FRANKLY STUPID. Sending three scripts at a time (you can send 20 if they fill them within 90 days -- well maybe not 20) and having the pharmacy keep them on file is the same thing. I am on the pseudo-advisory board for NewCrop and still need to send in my comments to them. A few of their higher-ups fought their policy of not allowing it. They think it is a DEA rule,and they are basing it on a 2008 statute. The DEA told me that they haven't set a regulation since 2011. I believe that Allscripts and Dr. First allows it.
The other interesting thing is when we used the Star Printer and printed three on tamper-proof paper, we just had a stamp that send Don't fill prior to August 1, then September 1, etc. We could change one stamp at the end of the month. Typing do not fill before August 29th and then doing it for a different date on the third one is just way too much work. A pharmacy at Shaw's where I go taught me to just write 1 of 3, 2 of 3 and 3 of 3 and let them handle it just like they do with any script. ALL PHARMACIES ACCEPT THAT EXCEPT HANNAFORD. We had ALL of our patients switch away from Hannaford. Literally told them we don't send ADHD scripts to Hannaford and blamed Hannaford. I would love to see your way. Previously my MA set it up this way:
Concerta 54 mg tablets ER, 1 tablet po daily 1 of 3
Concerta 54 mg tablets ER, 1 tablet po daily 2 of 3
Concerta 54 mg tablets ER, 1 tablet po daily 3 of 3
Methylphenidate tablets 10 mg, 1 tablet po noon, 1 of 3
Methylphenidate tablets 10 mg, 1 tablet po noon, 2 of 3
Methylphenidate tablets 10 mg, 1 tablet po noon, 3 of 3
Methylphenidate tablets 10 mg, 1 tablet po q Afternoon, 1 of 3
Methylphenidate tablets 10 mg, 1 tablet po q Afternoon, 2 of 3
Methylphenidate tablets 10 mg, 1 tablet po q Afternoon, 3 of 3
Clonidine 0.1 mg tablet po qHS prn insomnia, dispense 30 with 2 refills.
I would see the patient. How are things. Are you eating OK. How is your sleep. Can you focus on this dose. What grades are you getting? BP, Wt, Ht
Click on transcribe, then the stupid authetication code, then the actual send code. The whole visit was a) much quicker and b) safer.
Now, I have to step up 6 of them. Errors. Frustration. Stupidity.
The main three controlled that we sent and I think would be considered that are Benzodiazepines, ADHD meds and opiates. (btw, the whole MME thing and coming down on doctors) has led to more deaths.
Most of these are three. Opioids once monthly. Period. Med check every three months.
ADHD meds. Can see every three months but send three at a time.
Benzos CIV can call in, fax in or EPCS with 5 refills, although we do 2 to keep everything at three per month.
IF THE STUPID DEA AND OTHERS WOULD JUST TALK TO DOCTORS AND MAKE THE RULE THE SAME FOR THE BIG THREE. One script, two refills. With EPCS, it is still being controlled by the pharmacies. And, once they received the script, they will record two refills. Pharmacies don't f.... that up.
The other thing about all this is you have to train your patients to NEVER call the pharmacy and ask for a refill of Adderall. Always say do I have one "on file." Otherwise the new tech will just tell them no. Because they hear refill.
Everything don't in medicine like this just makes it harder for patients and doctors. Maybe even the brilliant pharmacists who don't have telephones in their stores.
