Reliable remote ADHD prescription options
January 17, 2022 11:56 AM   Subscribe

My partner's prescription renewals ran out; she needs to speak to a psychiatrist to get it restarted. The telemedicine service my partner used to get her initial diagnosis keeps rescheduling the appointment. With 10 minutes' notice it was rescheduled from today to March. Looking for recommendations for services that might be viable for this.

Taking our insurance would be nice but we are absolutely willing to just throw money at this to fix it.

(I'm sure many of the folks answering this question have been in a similar position but I would appreciate not offering sympathy here or reinforcing how broken the system is, just give us recommendations or actionable alternatives if you have them. Similar for any suggestions for handling ADHD that are not explicitly tied to getting the damn meds that worked well for her already.)
posted by Tomorrowful to Health & Fitness (12 answers total) 4 users marked this as a favorite
 
Response by poster: In case it's relevant, we're in Pennsylvania.
posted by Tomorrowful at 12:03 PM on January 17, 2022


I "see" an someone on LifeStance Health, which appears to have many US states covered, if not all. The video conferencing platform they use is sometimes wonky (had an appointment today with no audio), but it mostly works OK. My provider is an APRN, not a psychiatrist, and medication management is all she does, so it's worth looking for that if full-on psychiatrists are are to come by.
posted by libraryhead at 12:03 PM on January 17, 2022


Maybe check out CVS? I know that they do one time medication refills providing it’s a medication they’re allowed to refill by whatever regulations they have to follow.
posted by hazel79 at 12:26 PM on January 17, 2022 [1 favorite]


Does your insurance have a dedicated "Member Services" phone line or similar? It should be on the back of the card if so. I work for a health insurer and this is definitely the kind of thing they would want to know about and be able to help with.
posted by anderjen at 12:42 PM on January 17, 2022 [2 favorites]


Sorry for asking instead of assuming you've explored this avenue already, but are you certain she needs to speak with a psychiatrist to get a new/renewed prescription? Primary care doctors and NPs can prescribe ADHD and other psychiatric medications in the US, and mine was willing to do this for me when I was between psychiatrists. It may have been easier because I already had the diagnosis on record, but I have several friends who got their initial diagnosis and ongoing prescriptions from their primary care doctors as well.

If she has an established relationship with a doctor/NP and there's not some specific requirement from the insurance company that the Rx renewal comes from a psychiatrist specifically (I recognize these are two big ifs), I'd recommend giving this a try.

Also, be aware that an entirely new practice/provider might either need to request her records from the initial diagnosis or do the diagnosis themselves.
posted by rhiannonstone at 2:17 PM on January 17, 2022 [3 favorites]


Seconding that if this telemedicine provider is through your health insurance, you should complain to the insurer.
posted by snuffleupagus at 5:48 PM on January 17, 2022


Sorry for asking instead of assuming you've explored this avenue already, but are you certain she needs to speak with a psychiatrist to get a new/renewed prescription? Primary care doctors and NPs can prescribe ADHD and other psychiatric medications in the US, and mine was willing to do this for me when I was between psychiatrists.

This is going to depend on the state and the doctor. We were in this situation in December in North Carolina, and my wife's GP couldn't write the script because they weren't the originating doctor, even though they're all in the same system. It's worth a call to the PCP, but don't be surprised if it doesn't work, unfortunately. (What also didn't work: a walk-in to the behavioral health unit associated with our medical system. Same story. I eventually threatened to call the state psychiatric board and her meds got called in, but that only worked because she wasn't due a renewal appointment, the doc just kept not calling in the meds after swearing he had.)
posted by joycehealy at 6:04 PM on January 17, 2022 [1 favorite]


Response by poster: FWIW, my wife's "primary" is not helpful here. Her previous primary left the practice and the state; she was assigned a new one at random, but that person hasn't met her (pandemics, huzzah) and wanted to see her in person before prescribing anything; try to guess how soon that could happen.

Rock 'em Sock 'em's points about the challenges pretty well line up with ours so far.

(Waiting until March isn't the only issue here, it's that the multiple reschedules/cancellations have trashed our ability to trust this provider at all. This appointment itself was scheduled really far out, but she was ok with that because, well, COVID is the worst and it's the best anyone can do. At this point it's as much as about expectations as everything else.)
posted by Tomorrowful at 7:08 AM on January 18, 2022


A coworker's partner had luck with Cerebral when going without treatment trying to find a doctor.
posted by skunk pig at 11:35 AM on January 18, 2022


Best answer: PCPs can and absolutely do prescribe ADHD meds*, but many will be extremely hesitant (at best) to do so if they don't personally have a pre-existing patient relationship with you, even if you have a long-standing diagnosis. Others are fairly chill about it so long as you're known to the practice and a provider there has some history of managing your ADHD meds. Some practices are squeamish about this regardless of your state's guidelines.

If your wife got assigned to a random new provider within her practice, is it possible for her to be re-assigned to someone different within the practice who has in-person appointments available? If not, does her practice have some sort of blanket rules around what they will and won't accommodate through telemedicine, or is it provider-specific? If not, it's worth a having a chat with the office manager at her practice to see if she can push for getting a telemedicine appointment with one of their providers ASAP. Their answers to your questions will either give you a sooner-than-March solution to the refill issue or provide fodder for escalating this with your insurance.

I know you said that your wife's primary care practice hasn't been helpful, but this is one instance where it's worth it to put some pressure on them. Provided that your insurance doesn't care if a PCP prescribes ADHD meds, having your PCP involved in and on board with ADHD management can make these types of situations a lot easier when something goes wrong. Best of luck.

*Whether they can Rx stimulants in PA is another question, but it may or may not be relevant in your case.
posted by blerghamot at 11:37 AM on January 18, 2022


Response by poster: Update: The core of the issue seems to have been the specific provider she was assigned to by Donefirst, the telehealth provider; this person was also a new random assignee after a previous provider left, and did/said a few things that were not standard practice, which caused a lot of unnecessary confusion with the customer support folks who seemed almost... too confused by the problems to 'just' solve them, because they didn't understand why the problems existed in the first place. She got a new, new Donefirst provider who, seemingly, took one look at the situation and re-prescribed her for a single month.

I'm going to call this "done" but, for the record, insurance responded entirely by saying "oh well here's a list of psychs in the area who take this insurance" and did not help in any meaningful way.
posted by Tomorrowful at 12:40 PM on January 18, 2022 [3 favorites]


Response by poster: Bonus followup almost a year later: The 'solution' in the end was that she got a new PCP (for other reasons as well) who was willing and able to keep writing scripts as long as she wasn't looking for a changed dosage.
posted by Tomorrowful at 8:52 AM on December 2, 2022 [2 favorites]


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