A Method of Renewing Prescriptions from your Doctors

Since you guys are so nice, I would like to share with you a mechanism of renewing prescriptions from your doctor that has been very well liked. It's also relatively painless for all parties. It was developed primarily because of a large number of medications that needed to be managed and I needed something easier and more convenient than "calling their prescription line". Only a few prescriptions are shown to illustrate the technique.

It can be used as a "list of medications that your currently taking" which other medical providers routinely ask for. I use a more comprehensive document which contains other "medical history" information for that. The .PDF version of a sample document is also shown because it can be opened within a browser.

Basically what I do is print two copies of the list. One copy doesn't contain the last page that contain the so called "address labels".

The formatting is designed so the last page is odd and it printed on a separate piece of paper since I print duplex. In order to get the file size down, some formatting was lost. If you print duplex use the Insert/Break/Section Break/Odd page before the last page.
The last page has essentially mailing labels. There are two in bold and two in italic. The bold characters are the address and the italics characters are the return address. This helps avoid placement errors. The addresses are cut out to make makeshift labels. The makeshift labels are then taped to the envelopes. The italic labels are return addresses.

I pace one copy in the envelope that goes to the doctor's office and keep one for myself. I also put the SASE in the envelope and mail. Within a few days I have my prescriptions. If I don't use the SASE, the prescriptions would still be mailed to me, but the trip would be longer. The letter would have to travel from his office through interoffice mail to the hospital where he is affiliated, the would add the proper postage and then off to outgoing mail.

Controlled substances usually have to either be picked up by 7 days or postmarked by 7 days. They also require the doctor's DEA number, thus I don't want the SASE mailed by the doctor's office on a Friday.

The list is arranged by “Controlled substances” and “Normal Prescriptions” and within each category by brand name with the generic name in parenthesis. It's gone through quite a bit of development. With the event of 30 day / 90 day supply pharmacy, some drugs are written as 90 day supply without a specific quantity.

The way the pharmacies do things like Insulin is quite nuts. There may be five 300 ml pens in a package and you get 3 packages but only a 75 day supply. They may not say 15 ml, qty #3, or they could say 45 ml. It get's confusing, so you can write notes to that effect. I had one pharmacy which could only type in whole numbers. The mail order pharmacy and your local pharmacy may use different systems. This is why 90 day supply is best. The notes can tell you how many boxes or bottles you get. Pen needles, for instance, usually come in a 100 count package yet it's counted as 90 days. All the nuances of the particular drug companies will eventually become apparent. Some manufacturers are changing the quantities to 90 in a box. One particular thing comes in packages of 102's, but it's still counted as 90 even if you get multiple boxes, the effective number in the box is 102.

I like to make prescription ordering a one-shop deal. Your PCP should be aware of any drugs specialists prescribe and they MAY be willing to prescribe the routine meds. You can place the original doctor's name as a note as well. If you are getting any controlled substances always get a script from the same doctor. Don't keep switching. Make sure that the specialist knows the PCP is prescribing the medications.

It's probably not worth the effort if your taking a few medications, but the SASE technique is fast, avoids errors and saves a trip to the doctor's office to pick up a prescription especially if that prescription needs to be mailed.

Attached Images

Prescription Renewal Template.pdf (20.3 KB, 704 views)

Attached Files

Prescription Renewal Template.doc (6.1 KB, 872 views)

Thanks for the help KISS!! I'm sure this will come in quite handy for people!!

There is only one problem with this. If it is a controlled substance the doctor usually insists on an office visit or he won't dispense this period. He could very well lose his license to practice medicine over this!

And heaven forbid he would even consider dispensing a controlled narcotic prescription in the mail!

Sounds good in theory but I can definitely see other drawbacks/problems with this type of communication.

If a patient is in need of controlled substances an office visit will be in order. My doctor would never dream of dispensing anything like that through the mail - EVER!!

Twinkie:

There are those that take controlled substances long term and are expected for them to be on them forever. My mom takes Vicodin for chronic pain. NSAID's are out of the question. Surgery is not possible. She sees the doc regularly.

I take controlled substances continually on an as needed basis. I've done so for 30 years. The "as needed" is determined by me.

Abuse is still monitored because the doc writes the scripts.

As for other offices, controlled substance scripts may require seeing the doctor which makes sense. Sometimes, scripts can be picked up from the office. The SASE is not really different from being picked up from the receptionist at the office.

The SASE is required in my case because if I don't use it it gets picked up as bulk hospital mail and postage metered and it gets delayed too much.

Controlled substance prescriptions do not have to be picked up at a pharmacy. They can be mailed to a mail-order pharmacy.
So, in the mail, is perfectly acceptable.

Remember, it's a doc individual preference based on trust, hiw long you have been on the medication and even how long you have been a patient.

The doctor's office prefers the method because they can do it on their own time.

What state are you in KISS that allows you to just have the narcotics RX's mailed to you?

My late mother had 10 RX's to fill each month. I never ever did it any way other than call them in to the doctor's office and then go and pick them up at the pharmacy. Any pain med RX's were refilled with a phone call from the original RX written out at the office visit.

You can have pain meds refilled over the phone. My neurologist would have my pain meds refilled over the phone ONCE and then when that ran out I had to make an office visit to get more. And I took the same pain meds for 11 years. The way you are stating things makes a person think all they have to do is send in a letter with a self addressed envelope and get brand new RX's!!

I doubt there is any law about mailing scripts. How you physically obtain them shouldn't matter. It's the doctor's discretion. The doc has a "prescription line" that can be used to renew medications. That doesn't make sense for 20+ of them now does it? The point is, the physical prescription is required to fill the controlled substance script. Electronic prescription transmittal is on the horizon, though.

ID may be required at pickup of the script, drop off the script, and pickup of the medication. Mailed controlled substance scripts may require a delivery signature as well.

Rx's generally fall into 40ur catecories
1. Expires within a year (e.g. Neurontin)
2. Expires in 6 months (e.g. Fiorinal)
3. Expires immediately (e.g. Oxycontin)
4. State imposed rules: E.g. Vicodin must be written for 1 months supply and expires in 6 months.

Insurance companies are requiring that meds be prescribed for a 90 day supply except antibiotics and pain meds.

Hence, getting a 90 day supply is the norm within the limit of the laws (1-4).

Works for me. I was initially prescribed Oxycontin PRN (my suggestion) by my neurologist. He said to me that "YOU" can just call and pick up the prescription. Others have to come in for an appointment just as you said. This was a med that the neurologist prescribed until he left the practice and I trasitioned the med to the PCP. The neurologist always kept the PCP informed via progress notes.

If an allergist prescribes an Albuterol inhaler, does it matter who writes the prescription? Nope. If an eye doctor prescribes a "nasty eye drop" which I can use PRN, does it matter who prescribes it? Yes. PCP's shouldn't be treating eye issues.. If the eye drop is a lubercating drop, does it matter who prescribes it (allergist vs PCP)? Nope. Would a psychiatrist prescribe it? Nope. You only transition log-term therapies to the PCP. In many cases this is what happens. In my mom's case, the neurologist said, I can't do anything more for you, let the PCP treat you from now on. Info is transferred and everyone is happy. The specialist does the acute care and the PCP can sometimes do the long-term maintenance.

The method is useful when managing a lot of prescriptions. The doc polices, the pharmacy polices and the state polices.
It's important to know what may cause red flags. Scripts for the same narcotic written by different doctors will set off a red flag.

It's used with the doctor's involved consent. i.e. Is it OK to have x script used in long-term therapy prescribed by my PCP?

or

Is an SASE an acceptable form of renewal instructions?
For controlled substance x; for normal scripts?

The method minimizes errors and allows the doc to write the scripts on his own time. True, he could charge to do so.

Wow Im surprised this is a sticky as it may be illegal to do in the U.S. and I dotn see a country specific to it. Its also unethical. I can't imagine a doctor writing a perscription to a someone without at least a follow-up. In the case of recurring perscriptions I know doctors can set a number of "refills" so this process can be eliminated. Also it may fall outside of hippa guidelines as you have no idea who is sending the letter. This looks like a bad idea overall.

Doctors can also write 1/yr for renewals without specifying the actual number.

If I send prescriptions to a mail order pharmacy, then by your reasoning, how do they know it's from me?

If a mail order pharmacy ships Ativan and Fiorinal to me, how do they know I received it?

There are additional signature controls on Vicodin. An adult must sign. I don't know about Oxycontin or Percoset since I get them locally.

Followups occur at regular intervals. Every 3-4 months.

I also have no trouble dropping off, picking up or paying for mom's Vicodin. I have to use my ID.

Try renewing 20 scripts over the phone on a doc's prescription line.

They can't know who you are and that is why all persciptions should be signed for. Otherwise your creating an illegal situation. Like despensing drugs to a minor. There are also clauses of Title 21 CFR, Part 1300-1399 that they may be guilty of if they don't. All perscriptions are for controlled substance of one kind or another. It just varies by class.

Tick:

I recently wrote a specialist about a new medical device approved by the FDA and I enclosed some webpages on it and asked for a prescription vi SASE if he though it might be worthwhile. He enclosed a post-it note that said we were on the same page and it can't hurt. I saw him last about a month ago.

And...
I saw my PCP on a Tuesday and did not have the list of medications that I needed a new prescription for ready. I dropped that list which contained about 5 controlled substances and 10 normal prescriptions.

In stead of the SASE, I asked his office to call me when I could pick it up.

I was called on a Monday morning and started dropping off the scripts Monday afternoon. So far, ~$3100 for medications. Reimbursement should happen eventually. The ball is rolling to get retroactive drug coverage.

This method ELIMINATES the mail, so you should be happy.

KISS, It's certainly convenient for you that you have established a relationship with and your doctor knows you well enough that the rules concerning controlled substances will be bent for you. Vicodin happens to be one of the few that can be telephoned into the pharmacy still. Oxy or Percs cannot. A 90 day supply on any of them can only be written as separate scripts, with "do not fill before" dates on each one. It would never have crossed my mind to consider asking my PCP to fill write anything I get from my pain management physician.

But, the reason for this reply was to mention "pill box apps" for smart phones. If someone has so many prescriptions that they would need to consider refill measures such as you have suggested, then obviously there's a large amount of medications being used daily and a significant amount of tracking to do. I've been treated for RSD for about 4 years now.

I use one on my Ipod that was free, it has different color/size/shape pills to choose from to represent each pill from the list of anti-seizure, anti-depressant (both off label prescribed for neuropathy), control release opiate, break through pain releivers, otc pain relievers, allergy medications, etc. At the end of each month, I can email the list from the iPod to my home computer (or to my doctor if I wanted to) and print out a word doc showing the times everything was taken, and more importantly, for anyone who takes an "as needed" medication, it gives a very clear indication of how often "as needed" really was. This information is then used by your doctor to adjust the daily use medications to better control and reduce the "as needed" moments and over the course of a few months, you will dramatically improve your life.