RE: to adderall, or not at all, that is the question

[Guest guest]

I for one, think this is excellent. I have no need to see

perfectly stable patients with ADHD or pain more often than stable patients

with htn or dm. Just because the medication is “controlled”

doesn’t mean their condition isn’t or that it requires closer

doctor supervision. If we are trying to prove that Primary Care and being

a Medical Home reduces costs, this is one of the ways; by not seeing patients

that don’t need to be seen. Of course, it’s not good for our

bank balances; so I for one am always at crossed purposes with myself.

Personally, allowing refills decreases the chance of abuse vs.

multiple serial prescriptions. With refills, the patient must return to

the same pharmacy and use is easier to track. With individual

prescriptions, the patient can fill it anywhere, yes, they are dated but still,

it’s easier to hide patterns of abuse that way.

Interestingly, I have a family that has been getting 90 day

supplies of Adderall through Caremark for a couple of years now. Apparently

this is still not legal so I am wondering why Caremark is doing this.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

[Guest guest]

Many patients get their prescriptions for ADD Meds by mail

order, 90 days at a time. My understanding is that the DEA does not

require one to physically see a patient every month, they only require that

there be no refills to a prescription. At least that is the way it

was explained to me by the State of Washington Board of Medical Quality Assurance,

when I inquired about this. I generally see my stable patients with

ADD every 90 days, and give them the option of getting a 90 day prescription,

or a 30 day prescription, that they will have to pick up every 30 days between

their required 90 day visit. The reason that they cannot get 90

days except by mail order is that insurance companies want them to pay a co-pay

every month for non-mail order pharmacies, and do not allow these pharmacies to

fill several months in advance because of the fear that a patient will drop

coverage after they have filled 90 days of an expensive drug.

The above board has expressed an opinion that a patient

should be evaluated by a physician every 90 days, to meet minimum

standards of care for controlled substances, but they have not specified

exactly what that evaluation consists of for ADD.

I suspect that what is acceptable or standard of care varies

from state to state.

dts

From:

[mailto: ] On Behalf Of Kathy

Saradarian

Sent: Thursday, January 03, 2008 5:40 AM

To:

Subject: RE: to adderall, or not at all, that is

the question

I for one, think this is

excellent. I have no need to see perfectly stable patients with ADHD or

pain more often than stable patients with htn or dm. Just because the

medication is “controlled” doesn’t mean their condition isn’t

or that it requires closer doctor supervision. If we are trying to prove

that Primary Care and being a Medical Home reduces costs, this is one of the

ways; by not seeing patients that don’t need to be seen. Of course,

it’s not good for our bank balances; so I for one am always at crossed

purposes with myself.

Personally, allowing refills decreases

the chance of abuse vs. multiple serial prescriptions. With refills, the

patient must return to the same pharmacy and use is easier to track. With

individual prescriptions, the patient can fill it anywhere, yes, they are dated

but still, it’s easier to hide patterns of abuse that way.

Interestingly, I have a family that has

been getting 90 day supplies of Adderall through Caremark for a couple of years

now. Apparently this is still not legal so I am wondering why Caremark is

doing this.

Kathy

Saradarian, MD

Branchville,

NJ

www.qualityfamilypractice.com

Solo 4/03,

Practicing since 9/90

Practice

Partner 5/03

Low staffing