PRESCRIPTION REFILL POLICY
All refill requests should be made during your appointment
Refill arrangements are usually easy to make, but sometimes, especially with some of the ADHD meds, patients can run into complications filling/refilling prescriptions, as described below.
The refill arrangements depend on the type of medication, pharmacy, your medical insurance pharmacy benefit coverage, and your insurance formulary. The insurance companies seem to change the rules randomly and this can be very confusing and stressful for parents. A new obstacle is that many of the most frequently prescribed and useful medications are sometimes out of stock. This can be incredibly frustrating for patients/families and I will work hard to help you navigate any challenges that present along the way!
Medications cannot be filled outside of the three-month appointment window.
Federal law does not allow clinicians to prescribe “controlled” substances (including most medications for ADHD) unless patients have been seen within three months. For this reason, it is imperative that you plan accordingly, well in advance, for any foreseeable appointment scheduling changes.
If you have not had an appointment within three months, I will be unable to fill your prescription.
Please remember: Because my schedule can become quite full, it is important to always plan ahead and ensure you have an appointment scheduled well ahead of time so that your medication can be refilled.
Refill requests require 2 business Days’ notice
This means if you request a refill on a Saturday, it will be processed and sent to your pharmacy by the following Wednesday. Excepting true emergencies, REFILLS WILL NOT BE PROCESSED ON WEEKENDS OR AFTER BUSINESS HOURS.
Refill requests can be made my calling the office at 802-491-3220 and leaving a confidential voice message or by messaging me via the secure SimplePractice Patient Portal.
Call your Pharmacy after 2 Business DAYS to confirm your Refill is Ready for Pickup
Be sure to contact your pharmacy to be sure your prescription has been processed. Once I submit the script electronically I do not receive updates with regard to when the prescription has been processed and is ready for pick-up. Please note that some pharmacies seem to no longer reliably contact patients to tell them whether the prescription is ready or not. This sometimes even happens when patients sign up for pharmacy notifications. So, I always recommend that patients call the pharmacy to confirm their prescription is ready for pick-up prior to making the trip to the pharmacy.
Please note that although a rare occurrence, electronic prescribing snafus can occur where the prescription seems to disappear into some sort of electronic Bermuda Triangle ether. And, while I can see on my side of the electronic system that I have indeed ordered a prescription, I cannot control what happens on the other side when a pharmacy does not receive or fill the medicine I have already ordered. I am very meticulous about sending prescriptions for compliant patients within the 2 business day notice window, so please call me at my office at 802-491-3220 if your pharmacy says they do not have your prescription after the 2 business days have passed so I can resubmit the prescription that was seemingly erased from the pharmacy electronic system.
$25 processing fee per prescription requested outside of appointment times
The $25 prescription processing fee will be automatically billed to your credit card after the electronic refill is submitted. It covers the time required for me to process, submit, and document an electronic refill that has not been arranged for during a regularly scheduled appointment.
Any new prescription requests not addressed during appointment times are granted on a case-by-case basis. This includes requests for frequent pharmacy changes, backorder/stock problems, camp med changes, lost prescriptions, or to cover extra medicine from missed appointments outside of the policy window of three months. If you are a patient in active treatment, you should rarely (hopefully never) need a prescription outside of appointment times and thus not incur any prescription processing fees.
** The refill Fee does NOT apply to treatment dosage adjustments or any planned refills already arranged during an appointment less than 3 months ago
If I decide to adjust your dose for titration between appointments or change your medication altogether, this is part of your treatment plan and, of course, would not incur any prescription fees. If there are back-order issues out of your control for camp medications discussed during your appointment, or insurance mail order problems, no worries either.
Be super clear and confirm the details of your preferred pharmacy during each appointment
During your appointment, please confirm the pharmacy you use for prescriptions or mail order insurance pharmacy if indicated. You will need to provide the full name, address, and zip code of the pharmacy in order to allow me to manually enter and route your prescription.
If your regular pharmacy is out of stock and cannot fill your medicine
FIRST, be sure you tell your pharmacy to cancel the first prescription that they could not fill (strange, but necessary). The prescription can only be canceled by the patient, so please call them to be sure. It is only then that I will be able to start over and resubmit your prescription to a different pharmacy. Please then resubmit a refill request to me via your secure SimplePractice Patient Portal, clearly stating that you are changing pharmacies and give all the new pharmacy information (name, address, and zip code). Since time is of the essence, I ask that you also call me on my office number (802-491-3220) and leave a confidential voicemail detailing the prescription and new pharmacy information.
Switching pharmacies sometimes is ODDLY complicated
Switching pharmacies can EASILY be done DURING your appointment time or with plenty of notice before the next prescription is next due. There can be only ONE pharmacy address under your name in the system. Sometimes certain pharmacies run out of certain medications, and we MUST switch pharmacies: no worries, we can do this, but it can be tricky, so please read below.
Since there can only be one pharmacy in the system per patient, changing pharmacies can result in confusion for filling future prescriptions, can cause glitches in the electronic system, and can have bigger issues when transfers to out-of-state pharmacies are involved. Thus, I ask that you always remind me of your current pharmacy during your appointment to be sure any previous changes have not caused prescriptions to go rogue to default pharmacies.
If you are scheduled to be away/out of town when your medication refill is due
You can get a vacation override for an early refill as long as you plan ahead. Call my office phone at 802-491-3220 and I will order your medication with a “vacation override” request. Usually, the pharmacy calls the insurance company to facilitate this after I place the override order, but sometimes the insurance company creates roadblocks. In this case, YOU will need to call the insurance company to explain (assert) why you need the medicine early.
If you need an extended refill (e.g., for a trip to study abroad), YOU will need to first call your insurance company to figure out their policy about this and then let me know how your insurance company would like us to handle such a situation. This can be highly time-consuming (like calling an airline to make changes), so please plan ahead. If you get a representative who seems unsure as to how to assist you, request to speak to someone else. After you have received clearance from your insurance company and they have provided you with instructions regarding how we are to proceed, please relay them to me so that I can assist you.
PRIOR AUTHORIZATION (PA) INSURANCE REQUESTS FOR MEDICATION
If your insurance company or pharmacy informs you that your child’s medication needs a “PA”, please note that it sometimes takes at least a week to get it authorized. Please also note that after the PA request is made, the insurance company may choose to not authorize the medication, especially if they demand “step” care within their formulary. In effect, sometimes the insurance company insists on managing the medication treatment plan.
Although insurers can be difficult to deal with, I will advocate for you in attempt to resolve the PA problem. Many insurance companies are simply not covering certain ADHD medications on their formularies, and I must jump through hoops to appeal and push for you to get your needs met. Please note that in the event that a medication is not on the formulary at all, this PA appeal process often ends with the insurance company refusing coverage.
In summary, if your pharmacy informs you that your prescribing clinician needs to do a PA, please reach out to me via my office phone 802-491-3220 or via the SimplePractice Patient Portal to inform me of the issue and of all necessary insurance contact information and I will work, within 2 business days, to attempt to resolve this issue. Please note that this process can be extremely time consuming, that it is ultimately up to the insurance company regarding how long they make us wait for their response, and that medication requests are often denied.
Should efforts to appeal to your insurance company for a medication PA require more than 15 minutes of my time, you will be billed at the standard medication management session rate, depending on the time required.
Very rarely, insurance companies demand extended telephone calls with prescribing clinicians called “peer to peer” appointments. This demand would require me to schedule an appointment time with the insurance company physician so that I may explain my reasoning for wanting to start a certain medication for your child. This will be billed at the standard medication management session rate, depending on the time required.
Final notes about prescriptions
I am meticulous about refills and will strive to give you enough medication to last you until your next visit. My goal is to reduce your stress and worries and make refills as seamless as possible. If you are about to run out and require a refill, I will work with you to understand why this happened, and hopefully prevent it from happening to you in the future.