Stopping CL Rx abuse

[Ryan_eyeball]

So you've finished your CL examination on a patient, written out an Rx per patient request, and mark that the Rx expires in one year. The patient is upset to even be seen since, "My prescription hasn't changed for years." The patient takes the Rx to Sam's clus (or insert any place you want really) and buys a year supply of contact lenses. The place photocopies the prescription and gives it right back to the patient.

Nine months later, the patient doesn't want to see the doctor for that annual exam because he "sees fine". So he takes his prescription to say a different optical Sam's club (different from the first club, there are a lot of optical chains) and buys another year supply of contacts. I know not every optical place would sell a year's supply, but I've seen it happen. And then the person takes it to another place Target Optical and buys more CL's. Some technicians consider a CL Rx just a PRN prescription.

This patient may be stuck with more CL's than he might need if his Rx ever does change, but I'm afraid this patient might try to stretch out the CL's into years down the road. The real sad part is that this patient doesn't get eye care for 1 to 3 years from the previous examination.

What can we do to prevent prescription abuse. I've possibly thought of having a Rx pad that has a box of 8 that each salesperson would initial each time that a box of CL's would be sold. Or maybe a note to call doctor's office before filling. I know maybe some people would say this is overkill, but I believe we should try to prevent abuse.

My personal quote. "You see an dentist every six months for your teeth. I might see you hopefully once a year. What would you rather lose to care....a tooth or your vision." It usually works to put things into perspective.

Who knows...my 2 cents

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[3eb4me]

What do you think about 1800contacts.com???
Their website for verification is offline and the only way to verify a patient's CL Rx is to fax them. :-/ And if you don't fax them within 8 business hours then the Rx is automatically filled (even if it's expired)?!?

 

[Ben Chudner]

I have started writing "Dispense only 8 boxes" on all CL Rx's (or whatever a one year supply would be). I believe in Washington State, CL Rx's expire in 2 years unless the doctor has good reason to change it to 1 year. In the past, I have felt that "because I say so" is a good enough reason, but I now like this better. I don't know that this works any better, but it's worth a shot. There will always be patients as well as CL retailers that will abuse the system. I have found that education, such as the dental example you use, is the best way to help prevent that abuse.

 

[KHE]

So you've finished your CL examination on a patient, written out an Rx per patient request, and mark that the Rx expires in one year. The patient is upset to even be seen since, "My prescription hasn't changed for years." The patient takes the Rx to Sam's clus (or insert any place you want really) and buys a year supply of contact lenses. The place photocopies the prescription and gives it right back to the patient.

Nine months later, the patient doesn't want to see the doctor for that annual exam because he "sees fine". So he takes his prescription to say a different optical Sam's club (different from the first club, there are a lot of optical chains) and buys another year supply of contacts. I know not every optical place would sell a year's supply, but I've seen it happen. And then the person takes it to another place Target Optical and buys more CL's. Some technicians consider a CL Rx just a PRN prescription.

This patient may be stuck with more CL's than he might need if his Rx ever does change, but I'm afraid this patient might try to stretch out the CL's into years down the road. The real sad part is that this patient doesn't get eye care for 1 to 3 years from the previous examination.

What can we do to prevent prescription abuse. I've possibly thought of having a Rx pad that has a box of 8 that each salesperson would initial each time that a box of CL's would be sold. Or maybe a note to call doctor's office before filling. I know maybe some people would say this is overkill, but I believe we should try to prevent abuse.

My personal quote. "You see an dentist every six months for your teeth. I might see you hopefully once a year. What would you rather lose to care....a tooth or your vision." It usually works to put things into perspective.

Who knows...my 2 cents

I don't think allowing CL patients to go more than a year between exams is out of line. We've all seen our share of ulcers and CL abusers. But my experience was that I saw just as many ulcers in patients who got yearly exams as I did in people who abused their lenses and rarely sought care. In fact, I probably saw more in the "check yearly" crowd. Usually, they were people who were dilligent about their lens care, and who don't normally sleep in their lenses, but fell asleep in them by accident and woke up with a problem.

Is there really any scientific evidence that seeing a patient in the 12 month prevents an ulcer in the 13 month? Because I saw a LOT more people who abused the crap out of their lenses than I did ulcer and keratitis patients.

 

[ewsmith]

Ryan,

FYI, you see your dentist q6 months to eval for oral cancer (approx same number as melanoma/yr and 6th leading cancer death). They do this, you just are not aware it is occuring. kinda like all the stuff you look for when a pt thinks you are just figuring out their RX.

Trust me, my residency program primarily treats head and neck cancer and you would be much better off w/o an eye then having oral cancer requiring a bilateral neck dissection with free fibula graft or pectoralis flap.

A medicine RX is a legal document and should not be returned to a patient or photocopied by anyone. I do not know, but since your vision RXs are not filled by a licensed pharmd then maybe these rules do not apply and just about anyone may fill them. If you guys are worried about it, and your pts, take some action with your state board and try to get more regulation. This way, someone filling the RX could be sanctioned if they fall outside the rules. Or better yet, just buy your lenses from Costco and dispense them yourself; pts would rather get their stuff right away. The only downside might be profit margin, but if you are truly worried about vision then this will not be a big issue and you'll find a way to make it work.

 

[JennyJet]

What do you think about 1800contacts.com???
Their website for verification is offline and the only way to verify a patient's CL Rx is to fax them. :-/ And if you don't fax them within 8 business hours then the Rx is automatically filled (even if it's expired)?!?

I didn't know they filled them automatically w/o doctor's verification. I'm appalled! I hate the annoying phone verification that won't stop calling back until you listen to the whole thing. I work in a very busy office and we do not have the time to listen to the 5 minute automated message that I can't understand half the time. I've spoken with 1800contacts about how inconvenient this system is and why can't they fax verifications over. They're answer was they can't due to HIPAA. We receive faxed spectacle Rx before from other offices and also faxed Rx to pt. So I don't think it's due to HIPAA. (Then again I don't know HIPAA inside and out so I may be wrong.)

I think it's a conspiracy!