How to find a doctor for prescriptions outside your healthcare plan?
December 8, 2014 11:51 AM Subscribe
My PCM says she wants to prescribe me a drug that is in common usage, but she is not allowed to do so. She says that I should find a doctor outside my health plan that can prescribe it. Is this a good idea, and if so, how do I do this? I don't want to waste time or money, or do something idiotic.
The drug in question is phentermine for weight loss- she says that I have such a high likelihood of diabetes that it would really help improve my overall health/life chances if I can get my weight down swiftly before my prediabetes gets fullblown. However, the VA and military, from whom I get my medical care, are emphatically against any sort of weight-control drugs. (I'm not sure why, I suspect it's something on a moral scale about feeling like it's cheating) She said that it wasn't even in the system for her to prescribe, and suggested I find an outside provider.
Concerns I have are:
1) If I get a prescription outside the system, it will not be tracked by any of my VA providers, which opens me up for negative drug interactions.
2) How do you find a doctor just to prescribe you something your doctor can't, with a minimum of visits? I have a sense that patients who are thought of as "drug-seeking" are usually blown off or redirected by providers.
Any help or advice in finding me a successful outcome would be appreciated.
The drug in question is phentermine for weight loss- she says that I have such a high likelihood of diabetes that it would really help improve my overall health/life chances if I can get my weight down swiftly before my prediabetes gets fullblown. However, the VA and military, from whom I get my medical care, are emphatically against any sort of weight-control drugs. (I'm not sure why, I suspect it's something on a moral scale about feeling like it's cheating) She said that it wasn't even in the system for her to prescribe, and suggested I find an outside provider.
Concerns I have are:
1) If I get a prescription outside the system, it will not be tracked by any of my VA providers, which opens me up for negative drug interactions.
2) How do you find a doctor just to prescribe you something your doctor can't, with a minimum of visits? I have a sense that patients who are thought of as "drug-seeking" are usually blown off or redirected by providers.
Any help or advice in finding me a successful outcome would be appreciated.
Best answer: The DoD has specific guidelines on prescribing weight loss medicines because of the possible interactions between rigorous training and amphetamines. You can read them here. Basically, shady recruiters would get every fat 18 year old hooked up with some speed and wind up with the kid having a heart attack at Basic.
But I also can't see any reason why your doctor couldn't get out an RX pad and write it herself. I'm assuming you're not active duty, and I don't think the prescription guidelines apply to you.
That said, for point #1, the pharmacist filling your prescription will, (or should), ask what other medications you are taking if its not in their system, or you can ask about possible interactions in person when you fill your script. And when seeing a doctor, you should pretty regularly be asked if your list of medications is up to date.
posted by fontophilic at 12:06 PM on December 8, 2014 [3 favorites]
But I also can't see any reason why your doctor couldn't get out an RX pad and write it herself. I'm assuming you're not active duty, and I don't think the prescription guidelines apply to you.
That said, for point #1, the pharmacist filling your prescription will, (or should), ask what other medications you are taking if its not in their system, or you can ask about possible interactions in person when you fill your script. And when seeing a doctor, you should pretty regularly be asked if your list of medications is up to date.
posted by fontophilic at 12:06 PM on December 8, 2014 [3 favorites]
If I get a prescription outside the system, it will not be tracked by any of my VA providers, which opens me up for negative drug interactions
Perhaps you have a good reason to know this is true, but many electronic health records have the ability to input other drugs you are taking that weren't prescribed by your provider. That's how they manage interactions with over the counter medication, for instance. If you get a phentermine prescription, mention it next time you're back at a VA location and see if they can input it into your chart. This may not be a problem at all.
posted by deludingmyself at 12:06 PM on December 8, 2014
Perhaps you have a good reason to know this is true, but many electronic health records have the ability to input other drugs you are taking that weren't prescribed by your provider. That's how they manage interactions with over the counter medication, for instance. If you get a phentermine prescription, mention it next time you're back at a VA location and see if they can input it into your chart. This may not be a problem at all.
posted by deludingmyself at 12:06 PM on December 8, 2014
my city of ~300k population has docs that don't take insurance. fwiw you don't have to put your SS# on medical intake forms [using your benefits card gives that info, used to track you, to the provider.] Going to a doc that does not take insurance should keep you from being tracked if that's a concern.
as for phentermine I took it for years for hyper-somnolence [sleeping >12hr/night and still falling asleep driving and at other dangerous times.] I took it on work days+skipped weekends and holidays. I didn't have the need to up-the-dose, likely due to using only on work days. I did not become addicted. Later my physician prescribed ritalin which wasn't so good--in that I enjoyed it.[You d/N ask wrt sleep but now I take provigil. That might help you, discuss it with your insurance-provided doc. Provigil's expensive.]
I would certainly tell Any Physician what's been prescribed, of course you want your primary care physician to know. best of luck!
posted by Twist at 12:36 PM on December 8, 2014
as for phentermine I took it for years for hyper-somnolence [sleeping >12hr/night and still falling asleep driving and at other dangerous times.] I took it on work days+skipped weekends and holidays. I didn't have the need to up-the-dose, likely due to using only on work days. I did not become addicted. Later my physician prescribed ritalin which wasn't so good--in that I enjoyed it.[You d/N ask wrt sleep but now I take provigil. That might help you, discuss it with your insurance-provided doc. Provigil's expensive.]
I would certainly tell Any Physician what's been prescribed, of course you want your primary care physician to know. best of luck!
posted by Twist at 12:36 PM on December 8, 2014
Best answer: We've also had to deal with non TriCare approved medications* for our daughter and my PCM just wrote it on a prescription pad and I took it to my pharmacist and paid out of pocket. Could you ask your PCM about doing this? Tricare can be dumb sometimes.
*It was either try a drug was she technically 1/2 a pound too small for and scale the dosage or not give her anything and eventually end up on the transplant list for a new liver. Thanks Tricare.
posted by julie_of_the_jungle at 1:25 PM on December 8, 2014 [3 favorites]
*It was either try a drug was she technically 1/2 a pound too small for and scale the dosage or not give her anything and eventually end up on the transplant list for a new liver. Thanks Tricare.
posted by julie_of_the_jungle at 1:25 PM on December 8, 2014 [3 favorites]
Best answer: I agree with julie_of_the_jungle:
She said that it wasn't even in the system for her to prescribe, and suggested I find an outside provider.
As a former military wife, my understanding is that this means it is not something you can get for free at the military pharmacy. I see no reason she can't write you a prescription to be filled at a civilian pharmacy at your expense. I had to do that with a few special items for my condition. The fact that the military pharmacy did not carry it was not a big problem. I took my prescription in town, paid my co-pay and it was no big deal.
Given the cost suggested above, if your military doctor can write the prescription, this should not be a real big expense. FWIW, I think you are probably overestimating the importance of where it gets filled and who wrote the prescription. You can get it into your records by just telling them you are on it. Medical personnel sometimes overlook drug interactions and the like even when everything is in the record. There is no foolproof way to avoid stuff like that.
posted by Michele in California at 2:13 PM on December 8, 2014 [1 favorite]
She said that it wasn't even in the system for her to prescribe, and suggested I find an outside provider.
As a former military wife, my understanding is that this means it is not something you can get for free at the military pharmacy. I see no reason she can't write you a prescription to be filled at a civilian pharmacy at your expense. I had to do that with a few special items for my condition. The fact that the military pharmacy did not carry it was not a big problem. I took my prescription in town, paid my co-pay and it was no big deal.
Given the cost suggested above, if your military doctor can write the prescription, this should not be a real big expense. FWIW, I think you are probably overestimating the importance of where it gets filled and who wrote the prescription. You can get it into your records by just telling them you are on it. Medical personnel sometimes overlook drug interactions and the like even when everything is in the record. There is no foolproof way to avoid stuff like that.
posted by Michele in California at 2:13 PM on December 8, 2014 [1 favorite]
Best answer: FWIW, I know the VA's computer system specifically has a place to input non-VA meds, so let your VA doctor know when you start/stop taking phentermine (or any other medications, herbals, OTCs, etc.).
posted by smangosbubbles at 8:17 PM on December 8, 2014 [1 favorite]
posted by smangosbubbles at 8:17 PM on December 8, 2014 [1 favorite]
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1. It can elevate blood pressure
2. Used in conjunction with Fenfluamine, it can cause pulmonary hypertension.
3. As with all speed, it only works for so long, then you need to up the dose.
There are ALL kinds of problems with it. However, my sister and a friend of mine use it to control weight. So there is anecdata that says that some people can deal with it.
You can go to Minute Clinic and ask for a prescription and fill it at your own cost. It's about $10 a month generic.
posted by Ruthless Bunny at 11:56 AM on December 8, 2014 [1 favorite]