How to avoid multiple office visits for prescriptions?

October 20, 2010 7:24 PM

I'm prescribed 30mg of Adderall XR for my adhd. I was diagnosed and prescribed it from the psychiatrist that my job's health insurance uses. He says he can only prescribe it to me one prescription at a time. My high co-pays are adding up and its becoming costly to have to go every time. My doc tries to help by giving me two scripts at a time (one with the correct date and one a month out) but I'm still shelling out a lot six times a year to get my prescribed medication. I completely understand that Adderall is abused in the US and there needs to be controls on how its dispensed. I wouldn't mind going every six months so he can check up on me and monitor my use of it. Usually our appointments are 15 min chats about my mood and any side effects I may be experiencing. I'm no MD but that hardly seems worth an in office visit. Has anyone else dealt with this issue? Is there a way around this?
posted by my_thai to Health & Fitness (20 answers total)

What state do you live in? Different states have different regulations about how often prescriptions for controlled substances of that sort have to be refilled in person. It's highly possible that your doctor is simply following state law.
posted by decathecting at 7:25 PM on October 20, 2010

I don't actually see my doctor every time I get a refill. Instead, I call when I need the refill, and he mails it t the pharmacy. (I could go pick it up at the doctor's office, but it's a pain in the neck to get there.) I don't know if your doctor would be willing to do this, but presumably it's legal.
posted by craichead at 7:26 PM on October 20, 2010

OK, just looked up the regulations for PA, which is where your profile says you are:

No prescription for a controlled substance in Schedule II may be refilled.
(b) Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user,
no controlled substance in Schedule III or IV, may be dispensed without a written or oral
prescription. Such prescriptions shall not be filled or refilled more than six months after the
date thereof or be refilled more than five times after the date of the prescription unless renewed by the practitioner.

So it looks like you have to go at least every six months. Ask your doctor why the frequent visits are necessary. If you aren't satisfied by the answer, shop for a new doctor. It's possible that these visits are the standard of care, but your doctor should be able to articulate why that's the case in a way you can understand.
posted by decathecting at 7:31 PM on October 20, 2010

Some mail pharmacies that do 3 months at a time have either a weird exception or some other arrangement where they can do 3 months of ADHD meds at a time. My husband was having to get a new script every month (calling the office then picking it up, not seeing the doc each time) but they managed to work out a 3-month supply with the pharmacy by mail.

If you have access to pharmacy by mail it's worth looking into.
posted by galadriel at 7:32 PM on October 20, 2010 [2 favorites]

Wait, sorry, I misread the formatting in there. Apparently, PA only allows one prescription at a time, no refills. So your doctor is following the law by making you come in every time you need more. Sorry.
posted by decathecting at 7:33 PM on October 20, 2010

Best answer: My doctor required visits every six months. He'd give me a prescription for one month's worth of pill, and I had to pick up a new prescription each month for the next five months. (I just had to call, and they'd have it for me. I only needed an appointment and copay every six months.) I'm also in PA.

You may want to find out if your GP can prescribe it, instead of your psychiatrist. My original prescription was from a psychiatrist; after the first three months, it was from my GP.

It sounds like your doctor is sympathetic to your situation; could you ask him or her?
posted by punchtothehead at 7:36 PM on October 20, 2010

I just want to echo the whole 1-month at a time for a schedule II drug. However, I would imagine after you've established yourself to your dr, you should be able to phone in and ask for a refill and then pick it up at the office. I know my brother-in-law does this. Also, I know of a dr who wrote 6-months of one-month-each scripts for a friend, but I'm not sure how legal that is.
posted by lizjohn at 7:40 PM on October 20, 2010 [1 favorite]

If you have recently gotten a diagnosis/prescription your doc is going to want to see you on a reasonably frequent basis until he's confident that it's working for you. After awhile, with some medications, you can extend the time between visits. Adderall being what it is, however, you may not be able to avoid going in as often as you are because of state regulations. If it's getting to be unworkable, you can always talk to your doctor about other medications that don't have the same rules for getting the actual meds.

That said, most doctors won't be too comfortable seeing you every six months while you're taking stimulants. But he might agree to 3-4 months...that's worth something, right?
posted by corey flood at 7:43 PM on October 20, 2010

Could your dr prescribe 60 mg tablets with the understanding that you would split each tablet in half, so that each prescription covers 2 months?
posted by Majorita at 7:46 PM on October 20, 2010

My doctor just lets me come in and pick up my Ritalin script once a month without charging me. Would yours be amenable to this?
posted by lunasol at 8:12 PM on October 20, 2010 [1 favorite]

Also, you wrote it's becoming costly: How about generic rather than XR?
posted by artdrectr at 8:17 PM on October 20, 2010 [1 favorite]

You should be able to simply pick up the prescription slip at the office without being charged for a visit. You could also have your doc mail the script to your house, if your mail is secure and you remember to call and ask for it well enough in advance.

As to the ridiculosity of obtaining Schedule II drugs for ADD people, here are some words of wisdom from Allie Brosh: "You shouldn't have to overcome your disorder to get medication to help you overcome your disorder. That is the kind of thing that causes the universe to implode."

Also, if you have any interest in generic ADD meds, do look into it with your doc or pharmacist. They save me about $100 a month.
posted by Fui Non Sum at 8:32 PM on October 20, 2010 [3 favorites]

Could your dr prescribe 60 mg tablets with the understanding that you would split each tablet in half, so that each prescription covers 2 months?

1. As stated above, Adderall XR is an extended release capsule that should not be cut in half.
2. For other drugs that you could split in half, the pharmacy has to report its actual usage (one-half tablet once daily for a 60 day supply). Some insurance companies limit patients to only getting 30 day supply at a time and charge you the same copay for every 30 days, regardless of the patient splitting the pills or not.
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For your current predicament, I agree with the above, try to ask your doctor if he/she can write you a script without coming in for a scheduled office visit. (Unfortunately, ADHD meds are all Schedule II and require a new handwritten/hardcopy prescription for each fill)

Also, are you more concerned about the office visit copays or the medication copays? Cutting down office visits would lessen your office visit copays. For Adderall XR, a generic form of it does exist and could save you money at the pharmacy if you're filling for the generic.
posted by watch out for turtles at 8:46 PM on October 20, 2010

For my Vyvanse, my doctor requires every six months (as far as I can tell), but I can call and get a refill page signed by her. She leaves it at the desk.
posted by Madamina at 8:52 PM on October 20, 2010

My Psychiatrist had me come in every 4 months, but each time I left with 4 prescriptions, appropriately postdated. But we were also doing tweaking with the medication dosage and the like. (This was in WA State).
posted by spinifex23 at 9:52 PM on October 20, 2010

Poor man's XR: take a smaller dose of the generic more often, with food. Otherwise you're paying a crapload extra just to have it release into your system slower on its own.
posted by Jacqueline at 10:15 PM on October 20, 2010 [1 favorite]

Perhaps modafinil would work for you. It's Schedule IV, instead of Schedule II.
posted by jingzuo at 10:33 PM on October 20, 2010

Someone I know has the EXACT same issue. Their solution was to first make sure that the doctor understands the situation. Then convince the doctor to prescribe 2/day and a bottle of 60, with the knowledge that they would only take one per day and just not come back for two months.

Two advantages, you go to the doctor half as often and pay half as much for the script each time because insurance charges for a monthly supply despite the number of pills that actually includes.

Also, yes, Adderall XR now has a generic. Chances are, insurance will cover more of the cost of that than of the name brand stuff. My, uh..., friend's insurance has a co pay of $10 instead of $40.
posted by milqman at 10:55 PM on October 20, 2010

Perhaps modafinil would work for you. It's Schedule IV, instead of Schedule II.

Modafinil isn't currently approved for ADHD. That isn't to say that things aren't prescribed off label all the time, but my understanding is that the efficacy of Modafinil for treating adult ADHD has not been established.
posted by Justinian at 9:22 AM on October 21, 2010

my understanding is that the efficacy of Modafinil for treating adult ADHD has not been established.

Efficacy of Modafinil Compared to Dextroamphetamine for the Treatment of Attention Deficit Hyperactivity Disorder in Adults

Modafinil improves cognition and response inhibition in adult attention-deficit/hyperactivity disorder

Modafinil as a treatment for Attention-Deficit/Hyperactivity Disorder in children and adolescents: A double blind, randomized clinical trial
posted by jingzuo at 1:23 PM on October 21, 2010 [1 favorite]