Legislative Changes

Governor Rick Scott signed bills passed in the 2011 Legislative session that change medical practices. These laws went into effect July 1, 2011 and because of these new LAWS, the policies and procedures for how you may have received prescriptions or refills of certain medication has changed. This is the law and must be followed.

  • counterfeit-proof prescription paper must be used to prescribe any CONTROLLED SUBSTANCE. [see the list of controlled substances here]
  • new “standards of practice” for a controlled substance prescribing practitioner are expressly defined and require
    • a complete medical history and physical exam
    • a written individualized treatment plan
    • a written controlled substance agreement
    • regular, follow appointments at least every 3 months

While Primary Care Physicians is not, nor have we ever identified ourselves as pain management providers, our patients do occasionally have pain. We also prescribe other medications classified in the same category as opioid and pain medications, such as sleep aids, anxiety medications, medications of Attention Deficit Disorders and muscle relaxers. There is no denying that, as family physicians and primary care providers, that we use these medications in the care of our patients and their medical problems but the state legislature has left the language in these laws vague and broad. Primary Care Physicians has NEVER dispensed any controlled substances from the premises. We do not stock any injectible narcotics. We do not write these schedule and controlled substances for the majority of our patients. And while we treat pain that is associated with medical problems, as family physicians, our goal is to address the CAUSE and ORIGIN of pain and treat that.  If no identifiable cause can be found, then our patients will be referred to the pain management specialists. More of our patients will be referred to the specialist because of these laws. The state is restricting the scope of the practice of medicine with regards to controlled substances and we will comply with the state laws. The treatment of pain and the chronic use of opioids and controlled substances will become a separate and distinct specialty of medicine and must be provided by the pain management specialist. We aren’t surgeons and could remove your tonsils or gallbladder. Likewise, we are not pain specialists and cannot manage your pain.

Florida has one of the highest rates of prescription drug abuse in the country, if not the world. In Broward County, there are more pain clinics than Burger Kings.

We must all do our part at limiting the flow of controlled substances onto the streets. And because of these new laws these are our new rules:

  • Before you can receive your next prescription, you must sign a controlled substance agreement. Refusal to sign this agreement will result in our INABILITY to write your prescription.
  • Any refills for controlled substances at your  pharmacy will cancelled.
  • If you have not been seen since July 1, 2011, call and make an appointment for your headaches, arthritis, ADD, insomnia, anxiety or whatever condition you may take these controlled substances.
  • Random drug testing can be ordered.
  • You are required by the STATE to be seen in the office AT LEAST every three months.

If you want more information regarding these laws, read them here: www.doh.state.fl.us/mqa/osteopath/

 

 

 

Mandatory 90 Day prescriptions

 

On April 5th, CVS Caremark mailed letters to state of Florida employees on Blue Cross Blue Shield giving them notification that any chronic medications would now be filled ONLY through the CVS Caremark mail order process. This is MANDATORY. It is very likely that state of Florida employees received (by mail) prior warning that their medications must convert to 90-day quantities after the initial three month grace period,  but we think it is likely that people discarded those envelopes unopened.

This creates dilemma on multiple levels.

1.      You may be out of medication.

2.      You could fill a bridge prescription at your local pharmacy but it will be at full cash cost. Your insurance co-pay will NOT apply to the filling of the local, 30-day prescription.

3.      Your physician may not want to give 90 days of a medication. Maybe the dose is being adjusted. Maybe the medication has proven ineffective. Maybe the medication is a controlled substance.

Patients who take medications that are absolutely necessary to maintain their chronic disease states should NOT abruptly stop ANY medications. This includes blood pressure meds, asthma medication, antidepressants, diabetes medications, anti-coagulation drugs like Plavix or Coumadin. Stopping medications can increase your risk for adverse events. Abruptly stopping can also cause severe discontinuation syndromes. If you are uncertain if your medications fall into the ABSOLUTELY NECESSARY categories, please call the office @ 352.377.2022. Leave your message on the voice mail for your physicians medical assistant.

There are chronic medications that could be held temporarily without risk. This will save you the cost of paying CASH to fill a bridge 30-day prescription. You can hold lipid lowering drugs, hormone replacement therapies, osteoporosis treatments, reflux medications, anti-inflammatory drugs used for arthritis, sleep aids and most topical medications.

We at Primary Care Physicians understand that the changes to your insurance benefits are beyond your control. It is purely associated with the state of Florida diligently trying to maintain high quality medical insurance coverage for their employees while managing the ever escalating cost of that insurance. These changes to your prescription drug coverage is the state’s attempt to manage (and maybe lower) cost. We are proud to be Blue Cross Blue Shield providers and are very grateful that the state has continued to provide health insurance through a company with whom we are providers.

It is our mission as your primary care providers to collaborate with you and operate within your insurance coverage as much as possible, to be mindful of your out of pocket expenses and to also be mindful of the overall cost of delivering you the highest quality medical care.  But please be aware…there are recommendations we will make….recommendations that are truly the best standard of care….that your insurance company may NOT consider necessary.

A patient has rights. And a patient has responsibilities. Know your rights. Know your responsibilities. Get online and verify the new benefit structure for your insurance plan. Services once covered may no longer be covered.

Prescription Drug Plans

One of the most expensive parts of medical care is the cost of medications. For primary care providers, these are the drugs used to treat diabetes, hypertension, cholesterol disorders, depression, infections and gastrointestinal complaints. The Publix pharmacies will now dispense for FREE some antibiotics. These are the most common antibiotics used for community acquired infections. Publix also will fill some diabetes medications, such as metformin at no charge. If you have a Publix brand glucometer, they will also fill the test strips at no charge. One recent change in diabetic care guidelines is that patients with Type 2 diabetes, or insulin resistant diabetes, may not need to check their blood sugar using a finger stick any longer. The glycohemoglobin that is ordered by your doctor is usually all that is needed to assess how well your blood sugar is controlled.

A few years ago, Prilosec was released to be sold over-the-counter(OTC). The Prilosec OTC is the exact same medication as the drug once available only by prescription. Now, a few other proton pump inhibitors used to treat reflux esophagitis will be sold over-the-counter. Prevacid is now available OTC. Soon, Zegerid will be available, too. Most insurance companies will refuse to cover the prescriptions forms of these OTC drugs. Additionally, they will require proof of use and failure of TWO of these OTC brands before they will paid for any of the remaining proton pump inhibitors. Prilosec is sold as a store brand and will be labeled Omeprazole. It is the most inexpensive option and has the exact same efficacy as once prescription only Prilosec.

Remember, reflux is often easiest to treat by avoiding the common triggers: large meals, late meals, lying down within two hours of a meal, carbonation, caffeine, alcohol, nicotine and peppermint. Also, being overweight can contribute to reflux.

Lastly, the drugs used to lower cholesterol or triglycerides now have generic choices. Depending on how much of a reduction is the goal for your cholesterol, the choice of drugs may vary. It is best to make an appointment to see your provider to discuss other drug choices. Please note, there is no generic for Lipitor or Crestor.

There is a drug coupon website that may also be helpful.  www.internetdrugcoupons.com