Doctor's Visit frequency for long term SSRI medication prescriptions

January 27, 2016 8:52 AM

How often am I required to see my doctor so that he can write me another script (with refills) for paroxetine? I've been taking it for about ten years and anticipate needing it for another ten years but I believe I need to see him every year. Is that a law, or is it at his discretion?
posted by qsysopr to Health & Fitness (7 answers total)

It's not a law, but most doctors want to see you frequently enough to assess your overall health to determine if the meds they're prescribing are still appropriate.
posted by Ruthless Bunny at 9:06 AM on January 27, 2016 [6 favorites]

It's at his discretion, but typically most doctors' offices want to see patients at least once a year if they're on chronic medication. Sometimes more often. The issue is that if they are treating you without re-evaluating you, they won't be able to see if you've had a change in status, developed other medical problems in the interim, need routine age-appropriate preventive care, etc.

That said, if you're an otherwise healthy person with a good track record of showing up to appointments and you get to the end of a 12 months' supply and say "Oh crap! I need an appointment!" most doctors will give you refills for an extra month or so in order to continue your meds while you make an appointment.
posted by The Elusive Architeuthis at 9:08 AM on January 27, 2016 [4 favorites]

My doc also likes to see me once a year to check in, and this is when we do renewals of my asthma inhalers, etc. My sense is that it's mostly to make sure everything is still working right, see if I'm having concerns, etc. I have also done that thing Elusive Architeuthis mentions where I messed up, my presciption was running out, and they extended me for a couple of months while also scheduling the appointment for sometime within that time frame.

I'm not sure of the legality what's required, etc. but I will say I have never ever had a prescription written that would last for more than one year, so I think there might be some limit on how far in advance prescriptions can be written for (i.e. probably not "able to be refilled an unlimited number of times until you die.")
posted by rainbowbrite at 9:15 AM on January 27, 2016

Best answer: If a patient is on a chronic medication and are stable an annual appointment is adequate. I will not issue prescription refills for patients other than a single 30 day supply if it has been over a year since their last visit. That isn't me being a jerk or trying to inconvenience my patients. It is me exercising my clinical judgment and saying that in order to make sure this medication is still appropriate for you that I must talk with you and/or examine you. People change over the course of a year. As was just mentioned in the answer to another medication question here earlier today, patients start and stop medications and we, as prescribers, don't always get this information. That can make a huge difference in whether or not it remains safe for you to continue with a medication.

Some people may also ask the question, but what if nothing (including medication) has changed? To that I say 1) It is my license on the line every time I sign a prescription. There have been successfully litigated lawsuits against prescribers for adverse outcomes because patients were not seen in follow up frequently enough. This is my livelihood and I want to maintain that as well as keeping my patients safe. 2) This is something patients don't often think about but we only get paid by insurances when we see patients. That means everytime I review someone's chart to safely complete a refill, every time I review a chart so I can fill out a prior authorization to get a med approved by insurance, every time I have to call an insurance or write a letter of appeal for coverage denial, every time I talk to a pharmacist or another prescriber, these are not generally billable services. Prescribers do not get paid for all the time we put into taking care of our patients outside of their appointments. To put this into perspective reimbursement for an annual follow up can be somewhere between 100-130 dollars. But this covers our salary, pays staff salaries, building rental, equipment...Most private practices are not making a killing. Most are just maintaining. It's just the way our healthcare system works. Unless you are talking about concierge practices (or systems outside the US, of course).

So all that is to say that this is why most providers will say annual appointments are the bare minimum.
posted by teamnap at 9:40 AM on January 27, 2016 [6 favorites]

Best answer: As an aside. This is one benefit of centralized managed care like that offered by Kaiser Permanente. In my experience, I can email my provider and they are more likely to waive an appointment in a case like this. I think that's in part because all of the records are centralized, and so they have a higher certainty that there aren't new medical conditions or medications the're unaware of, but also because they have a system that includes time and salary for patient interaction and counselling out side of an office setting.
posted by mercredi at 2:23 PM on January 27, 2016

Response by poster: All good answers really.
I have a very good rapport with my doctor and see him annually for a physical but even that is getting to be like going through the motions for both of us. I'm in excellent, excellent health and I've told my doctor several times that I plan on being on the first and only SSRI I've ever taken, and which he prescribed for me initially, for the rest of my life. It's Paxil for what it's worth.

I think it's kind of a waste of resources to go in because I have nothing to talk to him about, I just want another year's worth of scripts and would be willing to sign a waiver stating that there has been no change in my physical or mental status since last year.

I just called his office and the MA is giving me a 30 day script but I'm due to come in for what she calls a "med check". This sounds like it's his whole office's or even group's protocol and I'm not going to fight it.
posted by qsysopr at 3:11 PM on January 27, 2016

Best answer: I think it's worth having an annual doctor's appointment generally, even if just to check in. But especially if you have depression or another mood disorder, I think it's important to, at least once a year, see someone whose job it is to check in on you. One of the really nasty things about mood disorders is that it's easy for your symptoms to creep up on you, and one of the symptoms can be denial that your mood is a brain trick. So, you could at some point start slipping back into depression, and your brain would tell you, you're not having symptoms of depression, you're feeling bad because everything in your life is bad and you are bad and nothing will ever get better, so it's rational to feel bad. And your brain can make you fall for that trick, thinking that it's a bad mood when in fact it's your illness. Someone who knows you and knows how your treatment affects you can assess you and ask you questions to make sure your medication is still working, even if you're having symptoms subtle enough that you haven't noticed, or tricky enough that you haven't realized it's a new symptom. That's why the check-ins, even just annually, are really important.
posted by decathecting at 6:10 PM on January 27, 2016 [1 favorite]