Changes in Florida’s Prescribing Medication Laws

In their ultimate wisdom, the Florida Legislature has decided that all medication prescribing shall be done electronically by computer beginning in January 2020.  As of November 1st, the Florida Medical Association has not informed its members of this but it was discussed briefly at a hospital staff meeting.

We were told that most pharmacies will no longer honor paper written prescriptions.  My office electronic health record system, which slows down seeing patients remarkably, has had electronic prescribing software which we have used for several years now.  The big change is that we will now be required to order controlled substances online electronically when in the past it was not permitted.

Since the opioid crisis struck Florida, physicians have been required to create an account with the State’s narcotics hotline named E-Forsce and check out the recipient prior to prescribing controlled substances for pain.  We then issued a written prescription.

It never made sense to me why if one is trying to track narcotic prescribing it wasn’t being done on computers from the beginning?  Nonetheless, this is a change which will require prescribers to download additional software and use two methods of identification as the legitimate prescriber before you can actually prescribe for your patients.

It will give you the freedom to prescribe from your phone or tablet when out of your office which is a convenience not available in the last few years. It will however mean more time in front of the computer screen, more user names and passwords to remember and less time actually listening, talking and communicating with patients.

Prescription Refills For My Patients

My office staff is instructed to automatically fulfill any refill request for active patients seen within the last six months requesting non-narcotic prescriptions. If your medication bottle says that you no longer have any refills, we ask that you call the office and request a refill rather than calling the pharmacy.

If you have been calling your pharmacy first when you are out of refills, we have most likely not received a message from them.  Pharmacies typically communicate with us electronically and if the transmission does not go through they just keep resending it without recognizing that the message is not going through.

In this scenario, patients have been told by the pharmacy that we have not responded to their request for a refill. We can not respond if we don’t know about it. Please, if you are out of refills please call us first and we will call the pharmacy and renew the medication.  If your prescription bottle shows that you have remaining refills then it is quicker to call the pharmacy directly and give the prescription number.

Why Narcotics Are Not Kept At My Practice

From time to time I’ll have a patient that needs to be treated with narcotics.  It’s not uncommon for the patient to be surprised when they learn that we do not keep narcotics, injectable or oral, in our office.

Florida law makes it extremely difficult to keep, maintain and administer narcotics for pain.  If a practice keeps narcotics in their office under lock and key as required by law, the paper work is long and tedious, the threat of theft is large and the reward monetarily is quite small.

Furthermore, there is a certain level of risk associated with keeping narcotics.  During my 30 year medical career, I have been robbed at knifepoint by someone seeking narcotics and my family has been stalked by a crazed drug seeking patient which only stopped when the police became involved.

When a patient has pain requiring injections we will provide a prescription for the patient to obtain the medication at a local pharmacy. We will gladly administer the medication for the patient in the office or at home and train them and their caregivers how to administer the medicine yourself.   On occasion, we have referred patients to the hospital Emergency Department when necessary and met them there for the purposes of providing injectable narcotics for pain relief or control.

Unfortunately, keeping narcotics at our office has become far too dangerous and complicated in today’s world.  We appreciate your understanding of this matter and we will do everything possible to effectively treat our pain patients and make the treatment as convenient as possible.

Prescription Medications and Insurance Company Oversight Plans

From the perspective of a practicing physician, patient and consumer; the free pass Congress has given the pharmaceutical and insurance industries in health care reform drives me crazy. Yes I heard about the voluntary relinquishing of 80 million dollars by the industry. That makes about as big a dent in their bottom line as me urinating in the Atlantic Ocean and trying to raise the tide.

It is unclear why prescription medications are so much cheaper in Canada and Mexico and overseas?  What is even more unclear is where all of our prescription medications are being manufactured and how do our domestic standards actually compare to products sold across the border?   You never see Consumer Reports do a review article on the quality and safety of prescription drugs produced outside the Continental USA and the locally produced products?   You never see a cost analysis of producing these meds here and abroad.  Yes, you see plenty of articles on vitamins, minerals and herbal products but absolutely no credible studies on their efficacy and safety either.

If I have a major beef as a physician and consumer it’s with the firms health insurance companies hire to oversee their prescription drug plans. The insurance companies know well that most of their patients get their health and insurance and drug plans through their place of employment. They additionally know that most years the plan changes as does the patients general medical doctor.  You see a new patient who is  obese, hypertensive individual with high cholesterol and prescribe them a cholesterol lowering medication only to receive a fax from the prescription drug plan over-site company asking you if the patient has failed on the generic lovastatin and or pravastatin?   They will not prescribe the drug you prescribed, even if it is on the formulary, without first checking that data. Of course you don’t have that data. You know the patient has had five different PCPs in five different years. You may know that the patient had some muscle aches on simvastatin.  The insurance companies don’t care. They know that each time they throw an obstacle in the prescription process; the patient will reach into their pocket book 70% of the time, or more frequently, and pay for the drug themselves rather than wait for the review process.

Even quantities prescribed are an issue. The plans only dole out one months supply. Last month a patient of mine went on a midweek vacation about a two hours drive from home. Her life had been dramatically improved by the addition of Effexor XR for obsessive compulsive problems years before.  The drug helped greatly but if you miss a pill or two it produces a nasty withdrawal syndrome.   The patient, by mistake left her pill bottle at home. She called her pharmacist and asked if he could prescribe some of the medication for her at the local pharmaceutical chain outlet which was close to her hotel. He called me for permission and I approved. The problem was that the drug plan over-site firm had already prescribed a thirty day supply and would not approve the prescription.   How ridiculous. The patient paid for five additional pills at full price just to avoid the hassle.

It’s time for State Legislatures and State Insurance Commissions to put their foot down and start tightly regulating the insurers and the drug review companies. It’s clear our elected Congressional officials don’t have the backbone to do what is right for their constituents in the face of attractive campaign pledges. Thus, it’s time for consumers to act instead.