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  1. #1
    Join Date
    Aug 2020
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    1

    Default Primary Care Physician Has New Rule of Mandatory Appointment for Refill

    My question involves malpractice in the state of:

    Hello live in state of Alabama.

    I have a well documented genetic skeletal disorder. I do regular checkups at dates requested by my physician. Just had an appointment recently and he was very happy with my blood work and weight and said come see me in January. Because of my condition I've had the same Norco perscription at the same level refilled every 30 days for 5 years. They called me yesterday and now require a mandatory appointment to charge me a co-pay and charge Blue Cross just to get a refill. Told them I was just there and wasn't scheduled till January. They didn't care.
    I went in and it did not go so well. Paid my co-pay waited for 15 minutes, called in for weight check and blood pressure check, filled out a new form saying I would not sell my perscription and what pharmacy I use. Then I was stuck sitting in a room for 20 minutes before I just got up and left. Sent them a message saying I did everything they wanted but did not have time to just sit there for a refill. They have refused and want me to come back. This is going to be a major pain to get there every 30 days and work is going to wonder about me having a doctor appointment every 30 days, I'm 55 so maybe they just would expect it.
    What really bothers me is they say it's a rule they decided. I can't help but think about the money they are going to generate from patients and their insurance company. I have Blue Cross and my wife has Medicare, she is disabled. I always thought if your doing your regular checkups refills are bundled under what the doctor prescribes.
    Stuck in a rock in a hard place. Already trying to reduce and wing my self off but it's been a miserable two days. I could probably complain to my insurance company but I'm sure it will be near impossible to find a doctor to continue the prescription. Never had any issues with them or record of any kind of misuse. Just feel insulted paraded around in a fake appointment and charged just to get a refill. Definitely feel it's unethical but not sure if it's illegal in anyway to all the patients he will force to do this.

  2. #2
    Join Date
    Oct 2006
    Posts
    16,441

    Default Re: Primary Care Physician Has New Rule of Mandatory Appointment for Refill

    Quote Quoting Mommymaker
    View Post
    My question involves malpractice in the state of:

    Hello live in state of Alabama.

    I have a well documented genetic skeletal disorder. I do regular checkups at dates requested by my physician. Just had an appointment recently and he was very happy with my blood work and weight and said come see me in January. Because of my condition I've had the same Norco perscription at the same level refilled every 30 days for 5 years. They called me yesterday and now require a mandatory appointment to charge me a co-pay and charge Blue Cross just to get a refill. Told them I was just there and wasn't scheduled till January. They didn't care.
    I went in and it did not go so well. Paid my co-pay waited for 15 minutes, called in for weight check and blood pressure check, filled out a new form saying I would not sell my perscription and what pharmacy I use. Then I was stuck sitting in a room for 20 minutes before I just got up and left. Sent them a message saying I did everything they wanted but did not have time to just sit there for a refill. They have refused and want me to come back. This is going to be a major pain to get there every 30 days and work is going to wonder about me having a doctor appointment every 30 days, I'm 55 so maybe they just would expect it.
    What really bothers me is they say it's a rule they decided. I can't help but think about the money they are going to generate from patients and their insurance company. I have Blue Cross and my wife has Medicare, she is disabled. I always thought if your doing your regular checkups refills are bundled under what the doctor prescribes.
    Stuck in a rock in a hard place. Already trying to reduce and wing my self off but it's been a miserable two days. I could probably complain to my insurance company but I'm sure it will be near impossible to find a doctor to continue the prescription. Never had any issues with them or record of any kind of misuse. Just feel insulted paraded around in a fake appointment and charged just to get a refill. Definitely feel it's unethical but not sure if it's illegal in anyway to all the patients he will force to do this.
    Norco is an opioid and that is likely why the doctor has instituted the procedures. Many, if not most, doctors are requiring those kinds of procedures for those types of drugs. I do not believe that you are going to find anyone who will do it any differently.

  3. #3
    Join Date
    Oct 2014
    Posts
    8,238

    Default Re: Primary Care Physician Has New Rule of Mandatory Appointment for Refill

    Quote Quoting Mommymaker
    View Post
    Definitely feel it's unethical but not sure if it's illegal in anyway to all the patients he will force to do this.
    It's not illegal. And it may help to understand why doctors do this. First, federal law prohibits the refilling of any Schedule II controlled substance, which includes Norco. What federal regulations do allow doctors to do is write multiple prescriptions at once that allow a patient to get up to 90 days of the drug, so long as certain conditions are met. Specifically, the regulation states:

    1306.12 Refilling prescriptions; issuance of multiple prescriptions.

    (a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.

    (b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met:

    (i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;

    (ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;

    (iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;

    (iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and

    (v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law.

    (2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.

    21 CFR 1306.12. Note in particular what the regulation says in subsection (b)(2). The regulation leaves it up to doctors to "determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so." So, the doctor is permitted to require patients to come in every 30 days before issuing new prescriptions.

    And while you think it pointless for the doctor to do that, the doctor may indeed want to see you that often to ensure that you are not either becoming too dependent on the drug and that you are not diverting the drug to others. Doctors and pharmacies both have obligations under federal law to have in place procedures to help prevent abuse/diversion of controlled substances. Doctors who fail to do that can lose their DEA licenses, which then would mean they cannot prescribe many drugs; have to pay fines; or may face criminal prosecution depending on the details of what the doctor did. The opioid drug addiction crisis in this country has lead the states and DEA to clamp down on on what they see as excessive prescriptions of these drugs, and that in turn has made doctors much less willing to write these prescriptions as freely as they did 5-10 years ago. The unfortunate side effect of that effort is that it makes patients who legitimately need the drugs either jump through more hoops to get them or not get them at all. You are not the only one facing these kinds of requirements.

    So while it may be irritating to have to go in every 30 days, and cost you a co-pay, that's likely what you're going to need to do to get this drug if you need it. Unless, of course, you can find another doctor more willing to go with the old routine of every 90 days.

  4. #4
    Join Date
    Jul 2018
    Posts
    2,730

    Default Re: Primary Care Physician Has New Rule of Mandatory Appointment for Refill

    Quote Quoting Mommymaker
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    not sure if it's illegal in anyway to all the patients he will force to do this.
    It's not.

  5. #5
    Join Date
    Jun 2014
    Posts
    3,210

    Default Re: Primary Care Physician Has New Rule of Mandatory Appointment for Refill

    It is not illegal or unethical. Most primary care doctors that prescribe opiates long term are encouraged to see those patients every 30 days. Look up the CDC Guidelines for primary care physicians prescribing opiates for chronic pain 2016.

    You could try a pain management doctor. Some of them only require patients to come in every 90 days. You might have to have routine drug screens and possibly go in for random pill counts in addition to signing a pain contract.. It does not matter than you have never had a problem with drugs. A pain management doctor or new PCP will require copies of your medical records before prescribing opiates. It is possible a new doctor will not prescribe you the Norco, prescribe you a different dose or fewer pills a day.

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