Doc for ADD meds without office visits every month?
May 8, 2015 3:12 PM Subscribe
This may be a hopeless ask. But you, mefites, have astounded me before with your knowledge of such things.
I have ADD. No one has disputed that since college. I choose to take meds for that. The meds I am on are not controlled substances...Strattera. Going to the clinic monthly is inconvenient (I don't drive because medical reasons), but my doctor requires this monthly to get my Rx refilled.
It all seems ridiculous. Can I do this virtually? How?
I live in Minnesota. States have different rules, I suppose. Thanks!
That seems excessive. My 14-year old gets her controlled substance ADD meds filled with a visit every six months or so.
posted by Rock Steady at 3:43 PM on May 8, 2015
posted by Rock Steady at 3:43 PM on May 8, 2015
Your doctor's requirements strike me as ridiculous, but I don't live in Minnesota or have any familiarity with the regulations there. The reason they strike me as ridiculous is because I, an individual who also has ADHD, am on two different controlled substances and yet my doctor only has me visit once every 3 months. At which time he gives me three months' worth of Rx, each dated one, two and three months out.
Monthly visits should not be necessary for Strattera if it's the only Rx you're on, you're not looking to change dosage, add another medication or address a new or related issue that's come up.
If possible, I would shop around for a new doctor (not sure if you're referring to a PCP, psychiatrist or otherwise) and ask their office:
1) Due to medical issues, I do not drive and as a result I have limited travel mobility. How often does this doctor require current/regular patients to come in for follow ups on an existing but unchanged medical condition?
2) Again citing your limited travel mobility: will the doctor be willing to fax six months or more of my non-controlled substance Rx to a mail order Rx provider?
There's a good chance they'll duck and avoid answering your questions, if only because they don't want to set you up with an expectation that may not be fulfilled once the doctor examines you and determines how he or she thinks your treatment should be scheduled/administered. This is understandable.
Nevertheless, politely press for a straight answer. Really press on the fact that you have a medical condition that makes it very difficult for you to go to the doctor monthly. Ask them what they can do for you, to help you obtain the medication you need without being put through the monthly stress of traveling to an appointment when you are unable to drive. Ask if phone follow ups would be possible at times, in lieu of a physical, in-person appointment.
Good luck!
posted by nightrecordings at 3:44 PM on May 8, 2015 [1 favorite]
Monthly visits should not be necessary for Strattera if it's the only Rx you're on, you're not looking to change dosage, add another medication or address a new or related issue that's come up.
If possible, I would shop around for a new doctor (not sure if you're referring to a PCP, psychiatrist or otherwise) and ask their office:
1) Due to medical issues, I do not drive and as a result I have limited travel mobility. How often does this doctor require current/regular patients to come in for follow ups on an existing but unchanged medical condition?
2) Again citing your limited travel mobility: will the doctor be willing to fax six months or more of my non-controlled substance Rx to a mail order Rx provider?
There's a good chance they'll duck and avoid answering your questions, if only because they don't want to set you up with an expectation that may not be fulfilled once the doctor examines you and determines how he or she thinks your treatment should be scheduled/administered. This is understandable.
Nevertheless, politely press for a straight answer. Really press on the fact that you have a medical condition that makes it very difficult for you to go to the doctor monthly. Ask them what they can do for you, to help you obtain the medication you need without being put through the monthly stress of traveling to an appointment when you are unable to drive. Ask if phone follow ups would be possible at times, in lieu of a physical, in-person appointment.
Good luck!
posted by nightrecordings at 3:44 PM on May 8, 2015 [1 favorite]
I am in the US and manage my ADHD as best I can with generic Ritalin. Because my shrink is a dear and knows that I have no health insurance, he gives me a prescription for X pill, 4x daily. In fact, I take a pill twice a day, not four times per day, so each prescription is good for 2 months of pills.
Basically lying about frequency of dosage would never, ever have occurred to me because I'm a straight arrow kinda gal. The good doc himself suggested it because he knows I am strapped for cash. This way I to see him every other month instead of every month, which cuts my bill considerably. Hooray dear shrink! (And if anyone every needs a referral to a wonderful psychiatrist in the East Bay of the SF Bay Area, drop me a line.)
(I dream of one day living in a world in which my general practitioner is willing to write my prescription because why not? Fully 15 years ago I actually went to a neuropsychologist who specialises in diagnosing ADD in adults and shelled out a zillion dollars and took tons of tests and have my official diagnosis in black and white over many pages. And yet, it is still too scary for any GP to just write out the prescription I need. Sigh. Forgive me for this digression.)
In any case, nthing what the others have said. Ask your doc to be more flexible. If that fails, find another doc if you can. Also, I just tried out an online pharmacy that mails my anti-anxiety meds to me. An apparently legit operation in Kentucky, licensed, etc. Had my pharmacy tech sister check it out for me. Drop a line if getting meds via mail might be helpful and I'll share the details. Good luck!
posted by Bella Donna at 4:11 PM on May 8, 2015 [3 favorites]
Basically lying about frequency of dosage would never, ever have occurred to me because I'm a straight arrow kinda gal. The good doc himself suggested it because he knows I am strapped for cash. This way I to see him every other month instead of every month, which cuts my bill considerably. Hooray dear shrink! (And if anyone every needs a referral to a wonderful psychiatrist in the East Bay of the SF Bay Area, drop me a line.)
(I dream of one day living in a world in which my general practitioner is willing to write my prescription because why not? Fully 15 years ago I actually went to a neuropsychologist who specialises in diagnosing ADD in adults and shelled out a zillion dollars and took tons of tests and have my official diagnosis in black and white over many pages. And yet, it is still too scary for any GP to just write out the prescription I need. Sigh. Forgive me for this digression.)
In any case, nthing what the others have said. Ask your doc to be more flexible. If that fails, find another doc if you can. Also, I just tried out an online pharmacy that mails my anti-anxiety meds to me. An apparently legit operation in Kentucky, licensed, etc. Had my pharmacy tech sister check it out for me. Drop a line if getting meds via mail might be helpful and I'll share the details. Good luck!
posted by Bella Donna at 4:11 PM on May 8, 2015 [3 favorites]
A person with ADHD who lives in Minnesota is sitting about three feet away from me right now, and she says that having to go in every month for Strattera ("Strattera?? Really?") is toooooootal bullshit, unless your doctor has only been prescribing it to you for a short while and wants to check up on you. So yes, either talk to current doctor or find a different doctor.
posted by clavicle at 8:00 PM on May 8, 2015 [1 favorite]
posted by clavicle at 8:00 PM on May 8, 2015 [1 favorite]
I don't think that visit every month is a Minnesota rule. We are in MN; we would get 6 months of prescriptions postdated. Once she went to college, my daughter would talk by phone with the office, doc called her back, and she received three months of postdated prescriptions mailed to her (Adderall, which is controlled. MN doctor; filled in Chicago where she lived) without any question. She had a check-in in person every six months, but even that changed to an online consultation. So have the conversation or maybe find a new doctor. (She now has a doc in Chicago and does have to pick up prescriptions each month.)
posted by Nosey Mrs. Rat at 8:13 PM on May 8, 2015
posted by Nosey Mrs. Rat at 8:13 PM on May 8, 2015
Can I do this virtually?
Have you asked? What did they say? Have you asked why they want to see you monthly? Have you told your doctor about the hardship and asked if you can keep your prescription with fewer office visits? What did they say? You say it's a requirement, but without any detail about it or any conversations you've already had with doc it's going to be hard for us to be useful to you.
posted by space_cookie at 8:28 PM on May 8, 2015
Have you asked? What did they say? Have you asked why they want to see you monthly? Have you told your doctor about the hardship and asked if you can keep your prescription with fewer office visits? What did they say? You say it's a requirement, but without any detail about it or any conversations you've already had with doc it's going to be hard for us to be useful to you.
posted by space_cookie at 8:28 PM on May 8, 2015
This sounds nuts to me, especially since you aren't on Adderall or Ritalin. I don't know anything about Strattera, but I suggest finding a new doc, who will either give you refills on your prescription or give you "do not fill before" scripts. You state that your ADD diagnosis is old news, & I am assuming Strattera isn't a new med for you. If it is a new med or this is a brand new doc, then the monthly visits make sense and, given time, this requirement is likely to change. So, talk to your current doc, too, but if this protocol and patient-doctor relationship is well established, I vote for a new doc.
posted by katemcd at 8:36 PM on May 8, 2015
posted by katemcd at 8:36 PM on May 8, 2015
IANAD
The US Drug Enforcement Agency has strict regulations on prescriptions for stimulants. This includes any formulatiioon containing methylphenidate (Ritalin, Concerts) or mixed amphetamine salts (Adderall, Vyyvanse). Each prescription covers a 30-day supply, and a physician can give you 3 postdated prescriptions at any one time. I believe that states can choose to impose tougher regulations if they want to.
When my kid was first diagnosed 15 years ago, you could only get one prescription at a time, so once a month I'd call the pediatrician, then pick up the prescription, and then take it to the drugstore. Loosening the regs so I could get 3 months' worth of prescriptions was a great improvement.
The DEA does not regulate nonstimulants that are used for ADHD like Strattera or Intuniv. These are regulated by FDA like any other prescription medication.
A doctor might have any number of reasons to limit the amount of drugs being prescribed. If you are a new patient or if you have just started taking this medication, she might want to monitor your response to the drug as well as any side effects you may experience and then adjust your dosage. This may be inconvenient for you, but it's a sign of good care. Other doctors may be requiring office visits to make money off you, but these days most doctors are so busy this is unlikely. Or maybe, for some reason, this doctor is concerned about you and thinks extra monitoring would be a good idea.
If I were you, I'd talk to the doctor. Explain why these monthly visits are difficult for you and ask why he thinks they are necessary. If you are not satisfied with the answer, you may want to find a new doctor, but when you have ADHD, this can be difficult. Doctors are understandably concerned about people shopping around for ADHD meds. And you really can't ask upfront about how often the doctor will want to see you because it will depend on your individual situation. And any doctor with a new patient might want to monitor more frequently until he is sure the dosage has been optimized.
Good luck.
posted by islandeady at 10:42 AM on May 10, 2015 [1 favorite]
The US Drug Enforcement Agency has strict regulations on prescriptions for stimulants. This includes any formulatiioon containing methylphenidate (Ritalin, Concerts) or mixed amphetamine salts (Adderall, Vyyvanse). Each prescription covers a 30-day supply, and a physician can give you 3 postdated prescriptions at any one time. I believe that states can choose to impose tougher regulations if they want to.
When my kid was first diagnosed 15 years ago, you could only get one prescription at a time, so once a month I'd call the pediatrician, then pick up the prescription, and then take it to the drugstore. Loosening the regs so I could get 3 months' worth of prescriptions was a great improvement.
The DEA does not regulate nonstimulants that are used for ADHD like Strattera or Intuniv. These are regulated by FDA like any other prescription medication.
A doctor might have any number of reasons to limit the amount of drugs being prescribed. If you are a new patient or if you have just started taking this medication, she might want to monitor your response to the drug as well as any side effects you may experience and then adjust your dosage. This may be inconvenient for you, but it's a sign of good care. Other doctors may be requiring office visits to make money off you, but these days most doctors are so busy this is unlikely. Or maybe, for some reason, this doctor is concerned about you and thinks extra monitoring would be a good idea.
If I were you, I'd talk to the doctor. Explain why these monthly visits are difficult for you and ask why he thinks they are necessary. If you are not satisfied with the answer, you may want to find a new doctor, but when you have ADHD, this can be difficult. Doctors are understandably concerned about people shopping around for ADHD meds. And you really can't ask upfront about how often the doctor will want to see you because it will depend on your individual situation. And any doctor with a new patient might want to monitor more frequently until he is sure the dosage has been optimized.
Good luck.
posted by islandeady at 10:42 AM on May 10, 2015 [1 favorite]
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posted by rabbitrabbit at 3:15 PM on May 8, 2015