Beaches Behavioral/ Beaches TMS and Brain Health Policy for the prescription of Schedule 2 Control Medications: Stimulants for ADHD.

All patients need to be aware that there is a national shortage of stimulants for ADHD

The Federal regulations for ADHD medications are complex. It is our office policy that any changes of prescriptions or pharmacy of schedule 2 control medications will require a face to face medical visit with your provider. We understand that our policies are not going to be a good fit for every person in need of ADHD medication.

What YOU can DO:

1. Be prepared for having pharmacy issues. The shortage of one medication can create shortages in other ones!
2. Do not wait until you run out of medications to get your next prescription filled or request an appointment.
3. Make appointments in a timely manner and be sure to have your prescriptions at the pharmacy at least 3-5 days before you need it so they have time to order it.
4. If it is really important for you to have the medication for school or work: consider taking less on the weekends or on your days off if that is possible. It will allow you to keep a small supply for times of pharmacy shortage or vacations. We are aware that this is not suitable for all patients.
5. At each appointment, please clarify which pharmacy you need the prescription electronically sent to or if you would prefer a printed prescription. If we have different pharmacies in your profile, that can make us prone to send prescriptions to the wrong pharmacy.
6. Become knowledgeable about the Federal and State laws and regulations related to prescribing medications for ADHD so you avoid frustrations with the pharmacy or the office staff. 
7. Visit the following website or download the FDA Drug Shortages mobile app to keep track and monitor Drug Shortages: https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
8. Please keep track of your medications. Keep accurate dates of the last time that you filled the prescription and the next time you should fill it. Keep track of how many prescriptions you have at the pharmacy or at home. Please call the pharmacy regarding any prescription issues before calling the office.
9. Once you are stable you will usually have 3 prescriptions at the pharmacy for the next 3 months unless you have 90 day supply. If the pharmacy give you a partial fill: you will need an appointment to get a new prescription issued for the rest of the prescription
10. Be flexible: if the pharmacy will not have the medication for a few days: consider taking less until your medication arrived. 
11. If you frequently need to change pharmacies or use several pharmacies to find the best price, please ask the provider for a hard/paper copy prescription at your appointment or be sure to tell the provider during the visit each pharmacy that apply to each prescription: our system only keeps one pharmacy as the main one for your profile.
12. Do not make request to staff that they cannot comply with.

What the Office Can Do:

1. After initiation of treatment with stimulants for ADHD, most patients will have follow ups every 1-3 months prior to the writing of subsequent prescriptions. More frequent visits may be required when medication formulation or dosage is being adjusted.
2. Stimulants are prescribed for 30 days and up to 90 days, in separate prescriptions or as 90 day supply.
3. In order to qualify for 90 day supply by our office for a stimulant medication: you will need to meet clinical criteria establish by your provider.
4. Any request for prescriptions will require an appointment to determine the appropriateness of medication: dose change, dose formulation, amount of medication or extra prescriptions.
5. Currently the wait time for an appointment in our office is a few weeks but you can ask to be added to the cancellation list: most patients will get appointments the same week if they are willing to be flexible about the day and time.
6. Early refill requests will not routinely be issued to accommodate out of town travel. Prescriptions will not be sent outside the State of Florida. 
7.  Prescriptions will be sent to your local pharmacy electronically or we can issue a paper prescription at the time of your appointment. If the pharmacy doesn’t have the medication: your options are
   1. Wait until they order it and get the medication.
   2. Make a new appointment to issued a new prescription to another pharmacy or get a paper prescription.
   3. There is a $25 fee for each prescription change outside appointments. 
   4. Please allow 24-48 hours to prescriptions to be issued
8. The pharmacy usually will not tell you or us if another pharmacy will have the medication. This is the general policy of most pharmacies and our office will not call to check pharmacy supply.
9. If the pharmacy has made suggestions of other doses, type of medication or formulation that they have available as a substitution be aware that is our office policy that the prescription will not be change from your profile without an office visit so your provider can evaluate if it is a good option for you.
10. If your ADHD medication change to a different formulation because of the shortage: be aware that you may need several appointments to asses side effects and dose as your provider has no way to know if the new medication is going to be a good fit for you.
11. In the event of electronic transmission failure or a pharmacy that do not accept electronic submission you will need to pick up a hard copy prescription from the office.
12. Please Note, some pharmacies are not accepting new patients. You may need to call the pharmacy before a prescription is elelctronically sent or request a paper prescription. 
13. Medical Marijuana has been legalized in the State of Florida for some medical purposes; however, the current clinical evidence does not support the use of THC products for patients with ADHD and several other mental health disorders. As a general rule our office will not prescribe medications for ADHD while on Medical Marijuana or while consuming other THC products.
14. Services from our office will be terminated
    1. Evidence of suspicious behavior including frequent, early refill requests or multiple “lost” prescriptions
    2. Abusive behavior (including abusive language) toward office staff or provider.
    3. Constant requests to the staff that are against federal law or office policy
15. Patient is required to release Beaches Behavioral from any liability related to their misuse of the controlled substance prescribed.
    
    

We are all are working and living with the challenges of our healthcare system. We want to ensure you are educated about your options and our policies so that we can create a more organized process and reduce confusion and frustration. We appreciate your understanding and are looking forward to collaborate in the reduction of interruptions in your treatment.

About Our Services:

Beaches Behavioral: General and substance abuse psychiatry- outpatient services

Beaches TMS & Brain Health: We offer second opinion evaluations and treatments for patients with treatment resistant depression, depression with anxiety, OCD and others. Patients will be presented with options that are medically appropriate for their diagnosis and circumstances with therapeutic modalities like TMS or Spravato (Esketamine). All of our programs are supervised and overseen by Alina M. Galliano-Pardo, MD (Board certified in Psychiatry and Addiction medicine).

To learn more about our services please visit www.beachestms.com or call 904-853-5900.