Hardbody said:Agreed, I was the jack a$$. I became a little too emotional when I was responding on this thread. Sorry for the "jack a$$" crack, it was uncalled for.
I do thank you for your apology! No hard feelings....
Hardbody said:Agreed, I was the jack a$$. I became a little too emotional when I was responding on this thread. Sorry for the "jack a$$" crack, it was uncalled for.
KidDr said:hey sdn1977,
Thanks for your input on this topic, it's interesting and helpful.
A couple questions for you--in the example you're referring to (originally posted by Twiki), the resident who was prescribing did have a full license, but the insurance company still did not pay for it. But you seem to be saying here that as long as a resident has a personal DEA# (and not an institutional DEA), the insurance companies should cover it. What am I missing here? Did the pharmacist just maybe not have access to the resident's personal DEA? (or maybe the resident had a license, but not a DEA# yet??). Along these lines, I'm also curious about this--when we call in prescriptions, and you look our names up in your system, does it say whether we have a personal DEA# (and can you access the number?). Thanks so much for your help!
KentW said:More info., for anyone interested.
http://www.cnn.com/HEALTH/bioethics/9811/self.prescription/template.html
http://www.aafp.org/fpm/20050300/41shou.html
http://www.nh.gov/medicine/bnews_guidelines_self.html
http://ask.metafilter.com/mefi/27780
http://www.webmm.ahrq.gov/case.aspx?caseID=71
Self-prescribing by Physicians. Vatcher et al. JAMA.1999; 281: 1488-1490.
The AMA position on self-prescribing, as shown in one of the above links:
KentW said:The AMA position on self-prescribing, as shown in one of the above links:
LADoc00 said:OMG, code of ethics?? Show me the code of ethics which says you are disallowed from treating yourself?! OMFG, you are in outer space! Im banging my head against the computer screen, Im in a profession filled with idiots. If you think other MDs should sit around in a waiting room to get Rx's for albuterol and flonase refills (I have had asthma/allergies since childhood) to do nothing more than line the pockets of self serving PMDs, you are quite frankly high or greedy.
Seriously, SHOW ME THE CODE OF ETHICS YOU SPEAK OF! Link it. Or STFU.
Im not claiming you should be treating complex diseases or serious issues, but the original poster Im sure would do just a good of a job managing his/her own asthma condition as any of us.
Let me make this as crystal clear as possible: IT IS RIGHT to give yourself an albuterol refill.........for the love of all living things, it is right and ethical.
driedcaribou said:Excellent post.
I don't see why everyone is so uppity about something that is established in guidelines.
Panda Bear said:Preach it, brother! You have just become one of my favorite posters.
Doc Oc said:(I get sick alot. 'Nuff said.)
I'm not going to waste my precious, rare SPARE TIME on making an appt, requesting time off (if conflicts occur), sitting in a waiting room, then sitting in the little room, lamenting my decision to leave the STAR magazine in the waiting room, only to have some meathead who isn't my PCP interrogate me about my asthma to determine whether or not I really need to refill my inhaler and/or my pulmicort, and suggest I get worked up for GERD, get a CXR (maybe the coughing is an infection and not the asthma even though this is how it worses EVERY WINTER for my whole freakin' life), etc.
Same goes for my 47th UTI, which I do call about, but get told that "I need to be seen", because as a medical student, I could have made the wrong diagnosis.
Or the "Here's my $15, go buy yourself a steak" appointments so that my PCP can write lab orders to check my TSH for my hypothyroidism (and don't even get me started on how I have to have an appt to get the results!)
Or the third bout with mastitis that started in an airport when about to board a plane with my ten week old son in order to move to another state, where I of course, could not possibly have a PCP yet. (After three days, it finally went away on its own.)
It just seems lame to have to go in or suffer (as in the last example) when one is a physician and knows what to do and is able to do it. I think that I can and should check my own TSH, order my own asthma meds, and treat my own UTIs and mastitis (initially).
LADoc00 said:I think some of the people here are screwed on so tight they may need medicinal MJ, in large amounts.
I agree.Doc Oc said:Or the "Here's my $15, go buy yourself a steak" appointments so that my PCP can write lab orders to check my TSH for my hypothyroidism (and don't even get me started on how I have to have an appt to get the results!)
irrka said:awesome. after reading this thread in the time i could've but didn't find a pmd on my handy dandy new insurance plan which i don't even know how to work out yet, i just called cvs and called in a maintenance med prescription for myself. "when would you like to pick it up m'am?" was the only question that threw me
How do they know I'm a doc and not just some schmoe trying to get their flonase fix?
Hurricane said:Hi, newly minted intern here. So what exactly does one have to do to call in a prescription? How do they know I'm a doc and not just some schmoe trying to get their flonase fix?
Hurricane said:Hi, newly minted intern here. So what exactly does one have to do to call in a prescription? How do they know I'm a doc and not just some schmoe trying to get their flonase fix?
sdn1977 said:I'm in CA & I actually had to call today to verify the validity of someone in FL - we share info all the time - not just numbers, but we can see if you have an active license, what state your license came from....& in this case...the Fl pharmacist thought the MD I was asking about was dead (he wasn't - just an inactive license, which still meant he couldn't prescribe in my state).
group_theory said:If a doc in State A writes a rx for a patient in his office (in State A), but the patient then travels to State B and goes to the pharmacy in State B, is that prescription valid and will the pharmacy fill it?
This is assuming that the doc has a valid license in State A, but does not have a license in State B.
suckstobeme said:Hey Guys-
Quick question (I'm sure someone addressed it at some point, but I can't find anything right now). Anyway, I just graduated med school 2 months ago and am now doing a residency. Can I prescribe stuff to myself? Does this look totally shady? Dont worry- I dont want to cover myself in fentanyl patches or anything. My albuterol is running out and I was wondering if I could get myself some more w/o having to talk to my PMD. I haven't been told I have a DEA# or anything, though.
Thanks.
Hurricane said:Hi, newly minted intern here. So what exactly does one have to do to call in a prescription? How do they know I'm a doc and not just some schmoe trying to get their flonase fix?
mcindoe said:If you're worried about getting into trouble for whatever reason, call it in and don't leave a paper trail by providing a written Rx.
KentW said:There's still a "paper trail," it's just an electronic one. The pharmacist has to record who he dispensed the medication to, who the prescriber was, etc. in his computer system. If somebody wants that information, it's there.
sdn1977 said:If I dispense a Z-pk to you - I AM DOING YOU A FAVOR! I am breaking the law.
What the hell?traintosave2000 said:and also make sure to refresh on basic health care ethics ; they teach this in pre-med
KidDr said:I'm sorry, dumb question here again--what law are you breaking? (one that says a provider can't be both the prescriber and the patient?) Does it only apply to those with institutional (not full) licenses? Thanks
sdn1977 said:Actually, there was a thread awhile ago where I listed all the applicable CA business & professions codes which apply. That was CA only - there are 49 other versions! My internet connection is transient because my power is on a rolling blackout, so I can't cite them exactly.
But...here it is in a nutshell - in CA...you have you to have a "good faith relatioship" with the pt in addition to other stipulations. This is a particularly ambigious statement to be sure. But...the original intent (decades ago) was to prevent just anyone from prescribing - what one poster said - just calling me up impersonating a prescriber. Currently...what this is doing is limiting the "internet" prescribers. That thread went back & forth on all the different possibilities of interpretation, but it comes down to what the pharmacist feels comfortable doing. If they've been harrassed by their state board inspector, they will do nothing outside the boundaries.
The other major limitation is prescribers are limited to their "scope of practice". So...a dentist should not be prescribing lisinopril, for example.
However, I do use this example because I was just presented with this very situation on Sunday. A local dentist - I know him from other rxs I've filled had his Canadian mother visiting. She lost her lisinopril which she packed (DON'T PACK YOUR MEDICATION). She had a bottle in her purse with 1 tablet remaining so I could see the label, see the pharmacy (Montreal Canada) see the drug & strength, verify the one tablet was indeed what it was supposed to be - BUT we cannot fill rxs from prescribers from out of the country nor can we transfer them. She was 79, in my area for 3 days & with a son who was a dentist. So...I could send her to the local ER (which is waaaaay backed up because we've had hotter than normal temps for more than 10 days - very unusual) - or - I could let him prescribe 5 days worth of medication until she got home or to her next stop when the luggage might catch up. Did I break the law - yep. Lisinopril is definitely out of the scope of practice of a dentist & he did not have a proper medical relationship with her - dental maybe, but not medical.
But...I used my judgement to give the lady what she needed so she didn't end up being a pt here, she could finish her visit & go on the the next set of grandchildren or home, whatever....I didn't charge her - professional courtesey.
A few points to remember:
Each state is governed by separate pharmacy laws - what is allowable in NY may not be allowable in CA. So - if you did your first PGY-1 year in NY then you move to CA & we are different, its because we have different laws.
As a licensed MD/DO/DDS - you can prescribe - you don't need your institutional #. However, your degree alone does not allow prescribing - you must be in good standing with your license - whichever state licenses you. A license to practice medicine or dentistry is good enough (you have to pay your money & get the license#!) Not all states allow prescribers from other states to prescribe in their state - we do in CA. So...MD's who do academic research only & do not have a license do not get to prescribe.
Insurance reimbursement requires an indentifying prescriber. Currently - it is a DEA - it will change by May of next near to an NPI which is far better. So...if the pharmacist calls & says the insurance denies your prescription (which they might because they do sometimes deny institutional DEA's) - its not because you are not allowed to prescribe - its because the insurance cannot recognize you. In this situation, use your attending's name & #, if its ok with him/her.
To prescribe controlled substances, you need a DEA # - your DEA can be 2, 2N, 3, 4 or 5. If you don't have the appropriate classification on your DEA #, I won't dispense what you write. So...if you don't have a 2N - I won't dispense Percocet, but I will dispense Vicodin if you have a 3. These are federal laws, however, if state law is more restrictive, state law prevails (TX for example).
Pharmacy is one of the most regulated professions around with more exceptions to the rules sometimes than rules themselves. There are 50 versions of each set of rules too - so its hard to give you a flat answer on a forum such as this. I only know CA laws since that is the only place I'm licensed.
Go talk to your pharmacist....be nice....explain what you'd like to have. Really - most of us want to work with you. We have no vested interest in pissing you off & sometimes its external forces (like a state board inspector) who might cause us to be extra tight.
I hope that answered your question - gotta send this before my power goes out again!
It is not the pharmacist who is "demanding" that a DEA# accompany all Rxs. If a cash customer has a non-controlled substance RX, we can process it without a DEA#. Very few insurance companies will process an online claim these days without a valid DEA#. Some of them actually have databases that cross reference the DEA# with the type of prescriptive authority and will reject certain claims based on this. For example, the processor for the Group Health Options Plan identifies and excludes Rx's written by dentists, since their formulary excludes dental Rx's. The DEA#s were not intended to be used this way, which is why there was the push to go to another identification code system. If you are upset about being asked for a DEA# for insurance purposes, you belong on the backs of the insurance processors. It's their system. Like the patient and prescriber, we just operate within it.LADoc00 said:Contrary to popular belief, DEA numbers are not needed for non-controlled substances, even if it a pharmacy demands it, it is ILLEGAL for them to require you have one for routine drugs. Tell them this or speak to a supervisor. DEA numbers are also not needed for insurance billing. That is myth.
There is no federal law. It's a state-by-state thing. In OR it's legal to self prescribe any drug. In WA a prescriber may not self-prescribe controlled substances. Some states may have laws outlawing any self-prescribing. It is each prescriber's responsibility to know and follow their own state law.KidDr said:I'm sorry, dumb question here again--what law are you breaking? (one that says a provider can't be both the prescriber and the patient?) Does it only apply to those with institutional (not full) licenses? Thanks
sdn1977 said:As a pharmacist....I bend lots of "rules" - really, there are more exceptions to the rules than rules themselves...so....yeah, I fill lots of stuff, but no controlled drugs.
As for insurance - the issue is the DEA#, which I spoke of before. No...you don't need a DEA# to prescribe noncontrolled substances, but the only way (right now anyway) for insurance companies to identify a prescriber...which they must do to process the rx, is the DEA#. The DEA#'s that won't fly are those that are issued to "institutions" - ie each teaching hospital has a DEA# which residents who don't have their own personal # can use to prescribe controlled substances. But...the insurance companies know these are institutional #'s (the embedded info...)& won't allow them, on occasion. I can argue myself deaf, dumb & blind - but...if the processor won't allow it....they just won't do it. For myself, in these situations, I ask who the attending is & I can find that DEA# in my files & I use that. There is usually a way around it.
This new NPI # should alleviate all this insurance nonsense!
And about the audits.....I just spent 30 minutes tonight looking thru our hardcopy rx files to make copies of rxs to send to an insurance company along with our dispensing record & signature record. I do this about 6-8 times per year.
As pharmacists, we're usually pretty good about stuff like this. Sometimes, we'll ask you to give us a name of one of your buddies we can use so we can fill an rx. So....please.....try not to call us names
bananaface said:The DEA#s were not intended to be used this way, which is why there was the push to go to another identification code system.
neurodoc said:There is nothing wrong, per Se , with a licensed physician prescribing for himself or his family, and there are no State Laws which categorically forbid that. There are laws that address the self-prescription of controlled substances, like narcotics and sedative-hypnotics. I have prescribed non-controlled medications to myself and family members (MDIs, ABx, etc.), based on my examination (and yes, I keep notes on file). I see nothing wrong with this. I'm sure that many will disagree, and I suspect that most of them are not licensed physicians. Many of them may well change their opinions after they graduate from med school and get licensed and have been practicing for some time.
sdn1977 said:You and I are coming from different perspectives, you as a prescriber & me as the dispenser, but we practice in the same state, so we are on the same page here. I take exception to your statement there are no laws which address this - there are - they are just not in your field.
Your medical laws may not expressly state that you cannot prescribe for yourself - I don't presume to know those laws. However...there are pharmacy state laws in CA, which I must follow, which expressly state that I cannot filll an rx from someone:
1. outside of the scope of their practice
2. for someone the prescriber does not have a professional relationship with
3. for the prescriber him/herself
and - I know those laws very, very well since I've been a pharmacist in CA for nearly 30 years. I've had lots of experience & uniformly those physicians who have been in practice a long time have others write their rxs. Again....that is not to say I won't do it - especially if you are prescribing Imitrex for your wife (are you a neurologist?) However...if you want to prescribe Lamisil for your dad or amoxicillin for yourself - we are now out of your scope of practice & that becomes a favor & my decision on how much risk I take. I'm sure you've done it & it was filled, but perhaps you didn't realize the pharmacist was breaking one of his/her laws that you weren't even aware of.
All we ask is you are respective of the laws we must function under even though you don't know them & they don't make rational sense to you.
Watch your state laws. Think about the political climate. By calling and writing your own scripts, you leave a paper trail. If it's an emergency - but otherwise, get your intern/resident to call it in - that's so easy.
It's just not worth the risk to call in your own stuff.
It's just one of those things that is not a good idea to get started with.
You never know who is watching - and if the state law says, then follow.
yes, go ahead and prescribe. Get stoned
Get stoned on what? Amoxacillin for bronchitis? Atenolol for essential hypertension or migraine prophylaxis? Let's get real here. Or maybe you are just "projecting" (that's a term from psychiatry).
Nick
You shouldn't be treating bronchitis with anything other than comfort care as it is almost always viral. Nor would amoxicillin be your druf of choice for a pulm infection. You did say you were a neurodoc however. So, I'll cut you some slack
I was referring to bacterial bronchitis, which can appropriately be treated with amoxacillin, doxycycline, TMP-SMX, or a po cephalosporin, or in more severe cases with Augmentin, Biaxin, Zithromax, or even fluoroquinolones....but thanks for cutting me some slack...
Nick
Can I prescribe stuff to myself? Does this look totally shady?
To go back to the original question:
1. Yes, you can prescribe meds for yourself. As evidenced here by the testimony of many physicians. There are no laws against it, only guidelines.
2. Does it look shady? Perhaps. But this is an ethical call for you and your conscience to battle out.
3. No DEA number? May be problematic for the filling pharmacy.
I have run into the no DEA number for some of my non-controlled substances. I still and adamantly refuse to provide a DEA number for unscheduled Rx. Why?
Because our state monitors the use of Schedule II-IV medications by patient/prescriber and in the "pay-for-performance" scheme of things, I get dinged if I am one of multiple prescribers. There are certain pharmacies that want a DEA number for any meds. In the past, I have relented since my patients were the ones caught in the crossfire.
This has caused me a bunch of trouble as certain pharmacies will pick the closest sounding physician's name or match out of the computer and I find myself receiving reports from the state for prescribing amphetamines to children all the time from a particular pharmacy.
The problem with this is that I don't do behavioral medicine, and certainly not in pediatric cases. I'm an oncologist. This is so far outside my scope of practice as to be just plain weird. So, each time I get one of these reports, I have to a) call the pharmacy, b) be put on hold c) fill out paperwork and d) fax it off to the pharmacy and request they verify the script and the author and e) report the discrepancy to the state.
Ergo, pharmacists out there, if the Rx is not for a schedule substance the only way you'll get my DEA number is bamboo splints under the fingernails. Once burned, twice shy.
I too am waiting for someone to cite laws against self prescribing. I have been asked by people in our office for Rx for relatives, too and routinely tell them I have to see their relative, but I have given Bactrim for UTIs in people I know well.
Oh, and as an oncologist, I do treat pretty much everything cancer related, so while I would not prescribe digoxin for a cardiac arrythmia, without at least calling the patients treating cardiologist, if the tumor is in the mediastinum. I might prescribe gabapentin for TG-neuralgia referred for facial pain if it hadn't been tried, before we move on to radiation ablation of the nerve. I am not a neurologist, and this is well within my scope of practice.
How does the pharmacist determine what is and is not within my scope having not seen my practice? Do they know who practices what and why? I don't recall ever writing an "indication" for a drug on an Rx pad and I don't think PRN pain qualifies.
Sorry! If you have read this whole thread you'd realize the ONLY way for an insurance company to identify you as a prescriber right now on Sept 12, 2006 is to use your DEA #.
Sorry! If you have read this whole thread you'd realize the ONLY way for an insurance company to identify you as a prescriber right now on Sept 12, 2006 is to use your DEA #.
sdn1977 said:That is the only way they know who you are!!!!And - no - we do not choose the closest sounding physician's name!
Where did this come from? You have never seen my scripts or you would know that my name is Printed on the Form by the printer. And I believe that CA still requires a secure paper preprinted forms for Scheduled substances.sdn1977 said:If I can't read your name on the rx - I don't fill it - easy! Its just not done! If you choose to not have your name clearly printed on the rx - too bad - you're asking for your own trouble.
sdn1977 said:It doesn't matter if you're writing for amoxicillin or phenergan with codeine - the insurance won't pay if you can't be identified. Also...you're DEA # is online - who are you hiding it from - not me for sure!!! I can find it & get it if I know your name & where you're licensed!
What we have here is a failure to communicate. I told you that my concern is the law and could care less about your insurance audits. They already cost me too much money in paperwork manufacture. As I stated before, my state has something very similar to CURES. I got a whole lot more "Not My RX," "Not My Patient" events when I gave out the DEA number on all Rx. I've changed my practice and the events have gone way way down.sdn1977 said:Yes....I am audited by insurance companies. They do come look at the actual prescription. They look at the original copy - either the one you wrote or the one I wrote from the verbal rx given to me. You are identified to them by your DEA # - how can you not have gotten this from this thread??????
No. They want it. Unless they cite the law that entitles them too it, they can go look it up on their own or do without.sdn1977 said:BUT...until that changes....the way you - as a prescriber is identified by the insurance company,..snip.... t - they need your DEA #!
Ahh yes. But did you also know that I am double boarded? My license says on it, Physician and Surgeon. I, and hospital credentialling boards, not you determine my scope of practice. And just how do you know who is, and who is not my relative? HIPPAA won't allow me to share their complete social history with you without their permission. Some of my relatives and friends come to me for care because they know me and trust me to give them the best possible treatment.sdn1977 said:Now...as for the scope of practice...give me a break! I know exactly what your scope of practice is!!!! If I know you're are an oncologist & you are prescribing Benzaclin for your daughter - forget it - unless she is off to college in the next week - then I'll fill it. I know you're an oncologist because I've received rxs from you before for other patients. We know who are local prescribers are & I am in a huge urban area. I know you prescribe many medications outside of antineoplastics, analgesic & antiemetics....I'm not comletely stupid. But..please...I know when you are prescribing something for your relative & Nuva Ring is totally outside your scope of practice - I'll give you slack once...but not twice.
sdn1977 said:I can cite my actual laws - it will take me days & days to find them exactly.
I have read the whole thread.
This is not true and you know it or should know it. My office phone number and address are on the scripts. It is not like we scribble an Rx on a sheet of legal pad and hand it to the patient. You lose credibility when you make this type of statement. And if this is true, then why do the forms I get from the state have a column on the form saying, "Not My Rx," and "Not My Patient."
Maybe your pharmacy doesn't, but I can assure you that others do.
Where did this come from? You have never seen my scripts or you would know that my name is Printed on the Form by the printer. And I believe that CA still requires a secure paper preprinted forms for Scheduled substances.
Then you can go look it up, and don't waste my time. I will not write it, nor will I ask for or write a patient's soc number on an Rx as one pharmacist insisted. Their ssn is not used in my medical records and I will not ask for it. I will be pleased to amend this policy if you will cite the code that requires it for non-scheduled medications.
What we have here is a failure to communicate. I told you that my concern is the law and could care less about your insurance audits. They already cost me too much money in paperwork manufacture. As I stated before, my state has something very similar to CURES. I got a whole lot more "Not My RX," "Not My Patient" events when I gave out the DEA number on all Rx. I've changed my practice and the events have gone way way down.
No. They want it. Unless they cite the law that entitles them too it, they can go look it up on their own or do without.
Ahh yes. But did you also know that I am double boarded? My license says on it, Physician and Surgeon. I, and hospital credentialling boards, not you determine my scope of practice. And just how do you know who is, and who is not my relative? HIPPAA won't allow me to share their complete social history with you without their permission. Some of my relatives and friends come to me for care because they know me and trust me to give them the best possible treatment.
I don't think you know as much as you think you do.
Took me exactly 3 minutes. Another 5 or so to read and comprehend. Wonderful thing, the internet. Time to go make make some burritos. And there are lots of pharmacists in the town I practice in that don't bug me or my patients about such things. Life's a regulatory witch for us all.