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> Also ridiculous but only tangentially related: Psychiatrists (or similar functions) cannot send prescriptions for ADHD drugs (Adderall / Amphetamines etc) to

> Also ridiculous but only tangentially related: Psychiatrists (or similar functions) cannot send prescriptions for ADHD drugs (Adderall / Amphetamines etc) to pharmacies (by any method). You need to pick up the physical prescription from the health care provider, then take it to any pharmacy. The pharmacy may not even have the medication, and certainly will need some time to fill it on the spot. This is not true, at least in California. I take a certain ADHD medicine that’s a Schedule 2 drug. So I’m limited to 30 day prescriptions with no refills (so my doctor sends in 3 at a time), but my doctor can most definitely send them direct to my pharmacy.

meej 6y ago
This is exactly what my doctor in Oregon does. I've never had to deal with a handwritten prescription.
verst 6y ago
My psychiatric nurse practitioner certainly wanted to reduce her own possible COVID-19 exposure here in the Seattle area but stressed that she could not call or send in the prescriptions for Adderall because of government regulations. Unclear who that regulating body is however.
- colejohnson66 6y ago
  IANAL So I looked it up because that is very perculiar, and my quick skimming of the laws seem to imply that Schedule II through V drugs can be sent electronically:[0] > (1) Information concerning a prescription for a controlled substance included in Schedules II through V, or information concerning a refill authorization for a controlled substance included in Schedules III through V, may be electronically communicated to a pharmacy of the patient's choice pursuant to the provisions of this chapter if the electronically communicated prescription information complies with the following: > ... [0]: https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.312 https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.312
  - verst 6y ago
    Thanks for checking! :) I'll bring it up with her. I think all of us agree that the paper prescriptions are ridiculous, especially at this time.
    - RyJones 6y ago
      I wonder if we have the same practitioner. I'm having the same issue with mine; she's part of a couple, they practice in Redmond.
      - verst 6y ago
        I doubt this is an issue specific to the NP. Regardless, we have different providers.
- BurningFrog 6y ago
  Maybe it's a lowly nurse practitioner vs deeply trusted MD issue?
  - verst 6y ago
    Doubtful and she works with a MD. I have many friends in the medical field. This MD vs NP hatred needs to stop. NPs can be specialized and have great knowledge and experience in their particular field. And my NP visit is cheaper - absolutely worth it to me.
    - DangitBobby 6y ago
      I think you misunderstood the parent comment. The commenter is not saying NPs are a problem, they are pointing out that NPs aren't treated with due respect. The sarcastic use of "lowly NP" gives it away.
      - BurningFrog 6y ago
        Can confirm! Sarcasm comes across poorly in online communication, so I should probably use it less :)
  - FireBeyond 6y ago
    My understanding is that an NP is considered as autonomous as a physician. I know several of my friends who are PAs and they're lobbying to be treated the same as NPs, as they feel that some of their restrictions are unnecessary and bureaucratic, logistical issues only, rather than based on patient care.
    - verst 6y ago
      Exactly. Lots of MDs are of course frustrated because they spent more time and money on education. The focus should absolutely be on patient care.
- pnw_hazor 6y ago
  My GP doc in WA sends electronic prescriptions of Adderall. When I was using a solo psychiatrist, he would give 3 mos of (1 per month) printed hardcopy prescriptions. Note, getting the scrip from my GP requires an annual HIPAA privacy waiver and random piss tests. Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek.
  - verst 6y ago
    Super valuable info. Thanks for that.
  - raverbashing 6y ago
    > requires an annual HIPAA privacy waiver... Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek. So, how good is a regulation if you need to waive it for something as basic as getting your medication? Makes me respect GDPR even more.
    - pnw_hazor 6y ago
      Yes, it totally sucks, and it almost caused me harm trying to avoid it. I am sure I was not the only one. I imagine some poor souls got into some real trouble even suicide. The American Medical Association, et al., sold out their patients in exchange for not being held accountable for the US opioid crisis. (my opinion of course.) My doc didn't think it was any big deal, she said I was her first patient to question it. She thought the waiver had some limitations, I showed her that it did not have any limitations except that access had to be for official use (which is not much of a limitation.) The records are stored in an electronic registry that various local or federal government agencies can access without warrants or notice. As a lawyer I cannot imagine voluntarily entering into such an agreement against the interest of my clients. I still find it shocking.
      - texasbigdata 6y ago
stallmanite 6y ago
It varies state-to-state. In Michigan it is as op described. You have to go in person to get a physical prescription. A few years ago it changed briefly but it changed back. Since COVID the rules have been relaxed at least in MI.
- to11mtm 6y ago
  Yep. For a long time in Michigan it was physical prescription only, but they could write you two additional 30 day scripts at the time, or you could get a longer script if you were going to be out traveling. But you still have to take it to the pharmacy yourself every 30 days in most cases. (again, much of this has been relaxed.) My gut says that a lot of this is because of all of the regulations around handling and amount-on-hand rules in MI. There is one not-terrible side effect to the resulting process however; Since typically you'd just wait to get it filled (or pick it up ASAP,) It limits the risk of an electronic fill sitting around and getting 'lost'.
omgwtfbyobbq 6y ago
That's odd that you can't get a 90-day supply. I'm also on a Schedule 2 drug for ADHD in California and have gotten a 90-day supply with Kaiser. Granted, when I was seeing an individual psychiatrist prior to having Kaiser, she said I could only get a 30-day supply as well and would just send 3 at a time too. I feel like there is a way to do a 90-day supply that many providers either don't want to do or don't know about. Edit - It might be something that's possible with electronic scripts and not possible with paper.
- scottmcf 6y ago
  It can also be related to your insurance and employer's choices when setting up the benefits.
- texasbigdata 6y ago
  I don't think insurance will allow you to triple fill something and don't prescriptions for controlled substances expire?
  - lnanek2 6y ago
    You don't triple fill all at once. The doctor calls in one prescription for, say January, then one prescription for February, then one for March. You have to go to the pharmacy each month, but the doctor only 4 times a year. Basically the doctor can prescribe a prescription that doesn't start until a certain time. So the start time on the three prescriptions differs.
    - WarOnPrivacy 6y ago
      That's how it's done in FL for non-opioid schedule II. None of our Dr's can call or transmit Schedule II Rx, they have to be hand carried paper scripts. Opioids are limited to a 3 day supply tho (with some tight exceptions, for those patients that can afford a PM Dr).
- giantrobot 6y ago
  With Kaiser at least, if a doctor sends an Rx to the pharmacy the pharmacy can likely see the history. If the doctor sends a 90 day Rx and the last fill date was around 90 days prior, it's plain from that data the abuse is unlikely. They can also easily ping the doctor to verify the Rx and after so many Rx'es would flat the Rx as ok for 90 day supplies. But that's just me spitballing. Some random pharmacy can't see the fulfillment history from other pharmacies. They only way they could see abuse would be after the fact. They don't want to set themselves up for a lawsuit or criminal investigation so they just limit their Rx amounts.
2OEH8eoCRo0 6y ago
If they imposed this in California you'd see mass exodus of Adderall addicted techies leaving.
paulmd 6y ago
For healthcare purposes, a fax is usually considered a "paper copy" (unlike, say, an email) so it is quite likely that this is in fact legal.
AuryGlenz 6y ago
I’m in Minnesota and take both a stimulant and testosterone. You can pick up the prescription from the doctor and deliver it to the pharmacy, or they can mail it in. They can’t use their online system, which I would think would actually be the most secure out of those three options. 30 days only for the stims, 90 days for testosterone.

meej 6y ago

This is exactly what my doctor in Oregon does. I've never had to deal with a handwritten prescription.

verst 6y ago

My psychiatric nurse practitioner certainly wanted to reduce her own possible COVID-19 exposure here in the Seattle area but stressed that she could not call or send in the prescriptions for Adderall because of government regulations. Unclear who that regulating body is however.

colejohnson66 6y ago
IANAL So I looked it up because that is very perculiar, and my quick skimming of the laws seem to imply that Schedule II through V drugs can be sent electronically:[0] > (1) Information concerning a prescription for a controlled substance included in Schedules II through V, or information concerning a refill authorization for a controlled substance included in Schedules III through V, may be electronically communicated to a pharmacy of the patient's choice pursuant to the provisions of this chapter if the electronically communicated prescription information complies with the following: > ... [0]: https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.312 https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.312
- verst 6y ago
  Thanks for checking! :) I'll bring it up with her. I think all of us agree that the paper prescriptions are ridiculous, especially at this time.
  - RyJones 6y ago
    I wonder if we have the same practitioner. I'm having the same issue with mine; she's part of a couple, they practice in Redmond.
    - verst 6y ago
      I doubt this is an issue specific to the NP. Regardless, we have different providers.
BurningFrog 6y ago
Maybe it's a lowly nurse practitioner vs deeply trusted MD issue?
- verst 6y ago
  Doubtful and she works with a MD. I have many friends in the medical field. This MD vs NP hatred needs to stop. NPs can be specialized and have great knowledge and experience in their particular field. And my NP visit is cheaper - absolutely worth it to me.
  - DangitBobby 6y ago
    I think you misunderstood the parent comment. The commenter is not saying NPs are a problem, they are pointing out that NPs aren't treated with due respect. The sarcastic use of "lowly NP" gives it away.
    - BurningFrog 6y ago
      Can confirm! Sarcasm comes across poorly in online communication, so I should probably use it less :)
- FireBeyond 6y ago
  My understanding is that an NP is considered as autonomous as a physician. I know several of my friends who are PAs and they're lobbying to be treated the same as NPs, as they feel that some of their restrictions are unnecessary and bureaucratic, logistical issues only, rather than based on patient care.
  - verst 6y ago
    Exactly. Lots of MDs are of course frustrated because they spent more time and money on education. The focus should absolutely be on patient care.
pnw_hazor 6y ago
My GP doc in WA sends electronic prescriptions of Adderall. When I was using a solo psychiatrist, he would give 3 mos of (1 per month) printed hardcopy prescriptions. Note, getting the scrip from my GP requires an annual HIPAA privacy waiver and random piss tests. Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek.
- verst 6y ago
  Super valuable info. Thanks for that.
- raverbashing 6y ago
  > requires an annual HIPAA privacy waiver... Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek. So, how good is a regulation if you need to waive it for something as basic as getting your medication? Makes me respect GDPR even more.
  - pnw_hazor 6y ago
    Yes, it totally sucks, and it almost caused me harm trying to avoid it. I am sure I was not the only one. I imagine some poor souls got into some real trouble even suicide. The American Medical Association, et al., sold out their patients in exchange for not being held accountable for the US opioid crisis. (my opinion of course.) My doc didn't think it was any big deal, she said I was her first patient to question it. She thought the waiver had some limitations, I showed her that it did not have any limitations except that access had to be for official use (which is not much of a limitation.) The records are stored in an electronic registry that various local or federal government agencies can access without warrants or notice. As a lawyer I cannot imagine voluntarily entering into such an agreement against the interest of my clients. I still find it shocking.
    - texasbigdata 6y ago

stallmanite 6y ago

It varies state-to-state. In Michigan it is as op described. You have to go in person to get a physical prescription. A few years ago it changed briefly but it changed back. Since COVID the rules have been relaxed at least in MI.

to11mtm 6y ago
Yep. For a long time in Michigan it was physical prescription only, but they could write you two additional 30 day scripts at the time, or you could get a longer script if you were going to be out traveling. But you still have to take it to the pharmacy yourself every 30 days in most cases. (again, much of this has been relaxed.) My gut says that a lot of this is because of all of the regulations around handling and amount-on-hand rules in MI. There is one not-terrible side effect to the resulting process however; Since typically you'd just wait to get it filled (or pick it up ASAP,) It limits the risk of an electronic fill sitting around and getting 'lost'.

omgwtfbyobbq 6y ago

That's odd that you can't get a 90-day supply. I'm also on a Schedule 2 drug for ADHD in California and have gotten a 90-day supply with Kaiser. Granted, when I was seeing an individual psychiatrist prior to having Kaiser, she said I could only get a 30-day supply as well and would just send 3 at a time too. I feel like there is a way to do a 90-day supply that many providers either don't want to do or don't know about. Edit - It might be something that's possible with electronic scripts and not possible with paper.

scottmcf 6y ago
It can also be related to your insurance and employer's choices when setting up the benefits.
texasbigdata 6y ago
I don't think insurance will allow you to triple fill something and don't prescriptions for controlled substances expire?
- lnanek2 6y ago
  You don't triple fill all at once. The doctor calls in one prescription for, say January, then one prescription for February, then one for March. You have to go to the pharmacy each month, but the doctor only 4 times a year. Basically the doctor can prescribe a prescription that doesn't start until a certain time. So the start time on the three prescriptions differs.
  - WarOnPrivacy 6y ago
    That's how it's done in FL for non-opioid schedule II. None of our Dr's can call or transmit Schedule II Rx, they have to be hand carried paper scripts. Opioids are limited to a 3 day supply tho (with some tight exceptions, for those patients that can afford a PM Dr).
giantrobot 6y ago
With Kaiser at least, if a doctor sends an Rx to the pharmacy the pharmacy can likely see the history. If the doctor sends a 90 day Rx and the last fill date was around 90 days prior, it's plain from that data the abuse is unlikely. They can also easily ping the doctor to verify the Rx and after so many Rx'es would flat the Rx as ok for 90 day supplies. But that's just me spitballing. Some random pharmacy can't see the fulfillment history from other pharmacies. They only way they could see abuse would be after the fact. They don't want to set themselves up for a lawsuit or criminal investigation so they just limit their Rx amounts.

2OEH8eoCRo0 6y ago

If they imposed this in California you'd see mass exodus of Adderall addicted techies leaving.

paulmd 6y ago

For healthcare purposes, a fax is usually considered a "paper copy" (unlike, say, an email) so it is quite likely that this is in fact legal.

AuryGlenz 6y ago

I’m in Minnesota and take both a stimulant and testosterone. You can pick up the prescription from the doctor and deliver it to the pharmacy, or they can mail it in. They can’t use their online system, which I would think would actually be the most secure out of those three options. 30 days only for the stims, 90 days for testosterone.