Controlled Medication Policy

The purpose of this policy is to ascertain that long-term controlled medications are prescribed in the safest, most effective manner in compliance with state and federal law. Utilization of controlled substances may be medically useful but, if used inappropriately, carries risks. In order to receive controlled medications from our office, please review the following policies.

All patients receiving prescriptions for controlled medications from our clinic are REQUIRED to:

1. Have a yearly physical exam and bloodwork with their Primary Care Provider every year and provide the report to the office.
2. Have a urine drug screen (UDS) at least once per year. Our providers may request UDS monitoring more often and/or at random depending on your history.
   • Drug screens can be conducted at our office for $25 or at a laboratory of your choice.
   • You may request an in-person appointment and complete your drug test prior to your appointment.
3. Our purpose is to help you improve your health: the use of illegal drugs, certain prescription drugs, and other addictive substances/behaviors may need interventions and help. Certain controlled medications will be tapered or discontinued, if you have other problems that need treatment or stabilization. You may be refrred to other professionals if necessary. 
4. Medical Marijuana has been legalized in the State of Florida; however, we do not recommend the use of marijuana along with controlled substance medications for patients that are being treated for mental health disorders. Use of medical/recreational marijuana, while under contract, will be considered a violation of our controlled substance policy.

Additional policies and information:

• After initiation of treatment, the patient will follow up every 1-3 months prior to the writing of medication refills. More frequent visits may be required when medication dosage is being adjusted.
• Any request for refills or changes in prescribed medication will require an appointment to determine the appropriateness of medication changes and to issue any new prescriptions
• Refills of a controlled substance medication Will NOT be made if I “run out early." I am responsible for taking the medication as prescribed and for keeping track of the amount remaining.
• Early refill requests will not routinely be issued to accommodate out-of-town travel.
• If your pharmacy is out of stock, you are out of town, or are traveling, THE FIRST STEP IS TO CALL YOUR PHARMACY AND REQUEST YOUR MEDICATION BE TRANSFERRED TO ANOTHER PHARAMCY. The only medications that cannot be transferred are stimulants for ADHD.
• Prescriptions will be sent to your pharmacy electronically only at the time of your appointment. You have the right to request paper prescriptions, so you can try to get your medications at different pharmacies if there is a shortage. There is a fee of $25 for any requests to change pharmacies, alter dosages, or formulation : example generic vs brand one etc. outside of appointments.
• In the event of electronic transmission failure, I understand that I may need to pick up a hard copy prescription from the office.
• If you frequently need to change pharmacies or use several pharmacies to find the best price, please ask the provider for a hard copy prescription, no prescriptions will be mailed. Additionally, you can request that your pharmacy transfer your prescription to a new pharmacy.
• I give permission to my primary care physician, prescribing physician and/or his colleagues to communicate with any other physician or health care provider and any pharmacists egarding my use of controlled substances.
• Patient is required to release Beaches Behavioral/ Beaches TMS & Brain Health from any liability related to their misuse of the controlled substance prescribed.
• I understand that allowances will not be made for lost, stolen or misplaced prescription or drugs. Any stolen prescription must be reported to the police and my provider immediately. A police report must be presented. Lost prescriptions must be reported to my provider within 24 hours

 

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. 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.
8. 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
9. Be flexible: if the pharmacy will not have the medication for a few days: consider taking less until your medication arrived. 
10. 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 applies to each prescription: our system only keeps one pharmacy as the main one for your profile.
11. 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. Not all patients are candidates for 90 day supply, you are welcome to discuss with your provider.
3. In order to qualify for 90 day supply by our office for a stimulant medication: you will need to meet clinical criteria established 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 or you can see one of our other providers temporarily if they have appointments available earlier.
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 changed 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 changes to a different formulation because of the shortage: be aware that you may need several appointments to assess side effects and dose as your provider has no way of knowing 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.

We are all 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 collaborating in the reduction of interruptions in your treatment.