Why a Prescription for XPap Machine?

[OwlCreekObserver]

This ground may have already been covered on this, but I don't recall seeing it here over the past three years or so:

Does anyone know why a prescription is required when purchasing a machine? Obviously the law requires it, but I'm trying to figure out why the law requires it.

It isn't like you're buying blood pressure medicine or insulin where you might over-medicate yourself, nor is it like buying pain pills or antidepressants to experiment with.

So what's the logic?

OCO

[jdm2857]

Other than the medical industry wanting to be in the loop and collect money for PSGs, I'm not quite sure either.

From what I've read, it's pretty difficult to harm onesself with an xPAP unless one has some pretty severe conditions, like end-stage COPD. And compared to the harm from not treating OSA (hypertension, motor vehicle accidents, etc.) the potential benefits far exceed the potential risks.

If one suspects OSA, it's much cheaper to buy an APAP online than to have the two PSGs desired by most sleep docs and then most probably have to get an xPAP anyways.

[rogelah]

It's classified as a medical device used for treatment of a medical condition which could have dire consequences if used improperly or if not used at all. As a device used for treatment it must be approved by the FDA. It needs a prescription because, like a drug, it's use should be approved by a doctor with the proper settings and instructions.

And like some prescribed drugs that say take as needed for pain you determine when to take them. It might say take one and sometimes, when the pain is excruciating, you take two.

You don't call the doctor to tell him you took two, you just take them. After you get your xPAP machine you can treat it like the pain meds...learn what works for you and do it.

[Silver Pelt]

Follow the money. Prescriptions are a tool the government uses to enforce a monopoly on medical care. Prescriptions provide the following benefits to the protected class:

1) Prescriptions ensure additional income for doctors, vendors, sleep labs, and all the people and vendors supporting them.
2) Prescriptions allow the government to track who is doing what with their body. Prescription data is not confidential, it is commonly bought and sold. CPAP.com has an unusually strong privacy policy, but if the Obama administration has its way, CPAP.com will probably be compelled to submit all their records to the government in the name of "universal health care."
3) Prescriptions help to shut down free-market competition. If you go to Craigslist, a top of the line brand new APAP costs $300-500. If you go to CPAP.com, it costs $450-$1100. If you go with the traditional insurance/durable medical equipment supplier, the same machine nets $85 per month plus $20 from you forever. In 4 months your payments have bought the machine. In 5 years you buy it 15 times over. That represents 14x profits, split somehow or other between the DME supplier, doctor, and insurance.
4) Prescriptions keep you dependent on, and coming back to, the doctor. He/she has power over you, your body, and your life. No Rx, no machine. At a minimum an office visit is required to renew/confirm your need. Many docs give a cut to a sleep lab, who get more $ to perform questionable measurements in highly suspect circumstances with outdated equipment.

I could go on, but I trust my point is clear. Free market prices for this technology would be 1/2 to 1/5 of present-day prices, perhaps less. Prescriptions transfer a lot of money from a lot of pockets to a few people whose sole qualification is their participation in the scam. xPAP is quite safe, many if not most customers take off the mask and stop using it. If the same forces that brought us iTunes and Craigslist were allowed to go to work, in no time at all people who only thought they had OSA would be buying the (cheap) equipment and seeing if it improved their lives. Mask makers and machine vendors would be locked in a furious competition to see who could satisfy more consumers, much as Dell and their ilk offer ever-cheaper machines to millions of people.

Instead we have 3-5 vendors serving a captive market of people whose OSA is so severe we are willing to put up with this BS.

Follow the money.

[GumbyCT]

This ground may have already been covered on this, but I don't recall seeing it here over the past three years or so:

Does anyone know why a prescription is required when purchasing a machine? Obviously the law requires it, but I'm trying to figure out why the law requires it.

It isn't like you're buying blood pressure medicine or insulin where you might over-medicate yourself, nor is it like buying pain pills or antidepressants to experiment with.

So what's the logic?

OCO

While I agree with the follow the money logic - I encourage you to ask this very question when we get those almighty DME techs here telling us what we are doing worng. pun intended

[timbalionguy]

This problem is lesser or dosen't exist in much of the world. However, health care is still expensive everywhere because you 'can't live without it'.

Take prescription drugs. I take allopurinol for gout, and because it is a genetic problem in our family, I will be taking it for the rest of my life. its a pretty benign drug as drugs go. I can buy allopurinol, or hundreds of other drugs over the counter in Mexico, whenever I need them. Here, I need a prescription, which entails a doctor's visit every six months to a year. Rarely is anything really done, as allopurinol is a long-term maintenance drug that either works or it doesn't.

But what a crime it is if I purchase allopurinol in Mexico (luckily, it is quite inexpensive as drugs go), and try to bring it here. I would be in the same class as someone bringing in crack.

The main thing we need to fix our health care system here is to thoroughly purge it of greed. Not create another, nationalized insurance monster that will drive costs even higher, and make services harder to obtain.

[Gerald]

Following Silver Pelt's lead..........

"Freedom" is defined as "that societal condition wherein each person has 100% control over his own property". It's clear that this certainly ain't the "land of the free".

Anytime a person wants to determine whether a system is moral or not, the way to do it is simple. Ask if the system is based on voluntarism...or not. Can people make a choice....or not.

Ultimately, the market will correct itself......but the Socialism we live under now will have to run its course. Things will finally get so bad that people will abandon the systems we have now.....and migrate toward lower costs....and a medical service industry that offers more value.

A monopoly can only exist so long as it has government force to back it up.......and that's what we have now in the medical industry. Over time, the Internet and other forms of information exchange will do an end run around a medical system that limits people's freedom to choose.

This forum is a perfect example of how the market corrects injustice over time. Those of us who exchange views here are enjoying the fact that many of us actually know much more than the "doctors" who "treat" us.

For an eloquent explanation of "what's happenin' now", I suggest the classic novel, ATLAS SHRUGGED by Ayn Rand.

Gerald

[Goofproof]

A XPAP machine dispenses a dangerous drug that is addictive, AIR. If you don't believe me stop breathing for five minutes. Really it to keep prices for treatment high.

If the noise wouldn't be so high we could use a real leaf blower from the hardware store for much cheaper, and we wouldn't have to worry about leaks due to the higher volume of the leaf blower. Jim

[ww]

It only requires a simple prescription written by any type of Doctor. The reason is that a machine is capable of causing harm to a very small group of people where the higher pressure can induce Central Apneas. Operating the machine at too low a pressure will prevent you from getting the required therapy. It is a complex machine, but when properly used by an informed patient, it can be a life saving machine. Afrin probably causes more medical problems when used incorrectly than CPAP machines do!

[billbolton]

It isn't like you're buying blood pressure medicine or insulin where you might over-medicate yourself

For some Sleep Disordered Breathing conditions, such as CSA, it IS like that.

Cheers,

Bill

[Michele1234]

I agree it's all about money, Luckily there are plenty of CPAP' available on craigslist and other places where you can usually buy them for significantly less.

[Pugsy]

Why the big national secret on even getting to your own data, much less modifying it? So, okay the government says we have to have a prescription (one of the reasons) because of a few of those people who might have get in trouble with centrals. Why is it they don't want us to know what our results are? Just so DME's can charge for card data? I see people reporting that their doctors don't put much stock in data. They want to go on how you "feel". Hmm. No wonder people say I feel no better and maybe worse, this isn't helping me and shove the supplies in the closet after a month or so.

The RT that did my titration study actually told me it was against the law for anyone to sell us the software and that watching data was just a waste of time. I asked him "so how am I supposed to gauge the level of effectiveness of my therapy?" His reply I swear was "by how you feel". Okay bozo, I ask " I assume we got a good titration study last night and good data so you saw what pressure I needed" "And I assume that I didn't have any major leak issues with the pillows or you would have switched me to FFmask" He say "yeah, that's right, you did really good."
So I asked him "Well, why if I did so well then why do I have my usual morning headache and feel like crap?" "How am I suppose to say I had good treatment when I see zero improvement with you tweaking all the knobs" Dead silence from him. I gave up on having any other informative discussion with him. Good thing I didn't get a survey regarding him when I was done.

I think at the very least patient education should include monitoring your own data at least with what is available showing on the LCD screen and an in depth translation as to how those numbers impact the way we feel. Those compliance data only machines are really almost criminal. Geezz, what about those folks that might throw some centrals that are part of the reason we can't get these machine without a prescription. Doesn't anyone care about them anymore? (and yes, I know about the DME saving an extra $50 between the 2 machines)

Geezz, this machine requires a prescription yet we only are supposed to gauge effectiveness by "how we feel" and when we say we don't feel so hot, they tell us to "give it time". Some degree of adjustment and giving it time is indeed needed but I think all too often it is simply a put off. I have worked in the medical field for many years. I know how the system works. While there are good caring health care workers out there, there are far more mediocre and poor providers.

My sleep study was done on May20. I have not seen the doctor since my very first consult in early April. I am not scheduled to go back until August 11 to discuss sleep study results and how I feel. If I hadn't been proactive with my own treatment I would still be feeling like total crap. No way would I have stuck with it till Aug 11.

It took the software and only 2 nights to see what I needed to do. It is not rocket science. It is more common sense and learning just a bit about what happens to our bodies when we have events. Education, education, education. Some people will give up because they could never get past the denial stage and confront this thing head on and will find every excuse to quit because they are looking for them. Some people will give up because the system let them down and it is those people that might be successful if they weren't told to "give it time" with no interaction with what is going on. I really think that if people could see what they are fighting in some way or another, they would stand a better chance at success.

Can we succeed with everyone, of course not. But I think we could sure have a better success rate and a better feeling patient with more education.

My stepsister has been on CPAP machine 3 years now. Nasal mask. Probably data compliant only machine. Says she feels much better but the mask always hurts. She is not 100% compliant and admits she notices the difference every time she doesn't use it. She had never heard of nasal pillows. There is never any interaction about how she feels or why the nasal mask that she has used for 3 years causes pain. Duh...... She is about to get a Brenda education next time she visits.

Insulin does not require a prescription. There is a quite detailed patient education system for diabetes. Why is it that a treatment with simply pressurized area requires a somewhat underground information system for the patients to get answers? Sad, sad way for this to be. So there is a high CPAP treatment failure rate among the general population??? Well the medical community has no one to blame but itself. This starts with doctors who have the god attitude and won't listen to patients and goes all the way down the line to the greedy DME's and their employees who either don't care or lack the skills and training to full help.

Okay, I am climbing down off soap box now.
Brenda

[tomjax]

This urban legend should be on snopes.
Why do you not simply read the package that PAPa come in or the accessories.
They do NOT require a prescription!!!

They require an ORDER.

There is a big difference in an ORDER and a Prescription.

DME'sw are licended to sell goods, pharmacies are licensed to dispense PRESCRIPTIONS.
No credible reference to any law has ever been provided to moi.
It is for an intermittent device, not a CONTINUOUS.

This has become so seared in our info base that we have acceted it as gospel.

I tried to recently explain this to my DME, but it fell on deaf ears.
An order is required by DME to set the pressure, not SELL the device.

But this posting, like many before will fall on closed minds.
Anyone know of a DME ever being prosecuted for selling a PAP w/o a RX?
And why do most online providers sell accessories withou a RX?
the law is the same.
Go figure

[fuzzy96]

oh but you was on such a roll brenda

yep follow the money.

all these specialist in the medical world. why? money . they can make 2-3 times the $$$$ of a gp. and less liability. they are the expert(god) so how dare you question them!

no different than a trade labor union with a contract. instead of teamsters or long shoremen etc. contracting with a company your dr's dme's etc contract with the government for it's trade protection. problem is how do you "break" this union without getting unqualified "scabs"???? (not that some aren't qualified now) ( or shouldn't be)

the solution is not a simple one if you want a free market AND quality at the same time.


the ama and a few other agencies (like lawyers with the bar association ) are left to police themselves.. now THERE"S an oxymoron.

perhaps if we all go on strike and refuse to see our doctors they will change thier ways and what few agenices govern these practices will move toward change.

i'm not holding my breath

[Silver Pelt]

Wow, what a pleasant surprise to find so many well-informed, thoughtful people in the forum in general, and commenting on this thread.

I'm new here, and I hesitated before posting my "follow the money" message, because some people don't take criticism of doctors or the status quo very well.
How delightful to find others who understand how the world realy works, the wonderful difference a free market can make in our lives, and the incredible burden
imposed on us by government.

Of course one can find certain people who might be harmed by xPAP under certain conditions. But compare xPAP to automobiles. Autos are far more dangerous, kill tens of thousands of people a year, injure hundreds of thousands. But you don't need a prescription or doctor's order (YET) to buy one. That's in part because a majority of people own cars, and they probably wouldn't put up with 1/10 of the nonsense people with OSA must endure. While there are lot of people with OSA, we are still a minority, and that makes for good pickings via a government-enforced monopoly.

One rarely hears about the injuries caused by the prescription monopoly. I presented to several doctors 35 years ago when suddenly I started falling asleep in the daytime. Back then, few knew about OSA and there was no internet. I was told I was depressed (I wasn't, but got that way as my life deteriorated) and basically had to suck it up. I learned to live with it. I mentioned it to another doc 15 years ago, because there was a sleep lab in the same building, but she wouldn't sign an order because she didn't believe in OSA or xPAP therapy. My present doc, who is pretty good as docs go, admitted that 10 years ago he felt the same way, but he let me pressure him into signing an order. The sleep lab almost refused to test me because of software problems with the hospital admission system, but I talked my way into staying for the test. As I count it, prescription/order medical/industrial complex monopoly has been harming me for at least 10 and more fairly 35 years. That's a lot of living lost! Even now, informed, determined, and aggressive when necessary, I find multiple obstacles in my path. The difference is now they slow me down but don't stop me.

The solution for risk is personal responsibility. Whether selecting a car or deciding on xPAP therapy, one needs to make prudent, well-informed decisions. In a free market, I would probably still have gone to a sleep lab (which would have cost 1/10 as much and been better equipped and much more pleasant) in order to get confirmation and quantification of OSA and an initial consulation with an expert. But I would have the report in hand by now (it's been a week, no word), have a machine, and be well down the road to learning to live with the rather significant life change. Instead, I'm waiting for the USPS to deliver the brand-new machine I bought from Craigslist, expecting a shipment of masks and related equipment from CPAP.com, and learning as fast as I can from this forum.

The free market is subverting the many obstacles put in my way. This forum is an important part of that marketplace. The prescription monopoly slowed me down and reduced my choices, but it's my life, my decision, and I will accept responsibility for what happens.