Who can write an Rx

I'm wondering if any Dr can write a Rx based of a sleep lab recommendation. Especially when it comes to cpap.com

My wife is a dentist and can refer a paitent to a sleep lab (i.e. if she is doing a snoring/apnea appliance).

Seems the local Sleep Dr's and the DME's around here have the same back scratching scheme going as you have all heard before. They dont want to give me my Rx - they will only fax it to a local DME. I asked them to also send a copy to my Dentist (they don't know its my wife) and they said ok but never did.

I could fight them and I just might do that but it got me thinking. Can a dentist or a freindly GP write a Rx based on a Dr's letter of recommendation?

To the best of my (limited) knowledge, a GP can write a script for a CPAP without any sleep studies at all. Of course, in this situation, an APAP would make more sense.

Treehorn wrote:I'm wondering if any Dr can write a Rx based of a sleep lab recommendation. Especially when it comes to cpap.com

My wife is a dentist and can refer a paitent to a sleep lab (i.e. if she is doing a snoring/apnea appliance).

Seems the local Sleep Dr's and the DME's around here have the same back scratching scheme going as you have all heard before. They dont want to give me my Rx - they will only fax it to a local DME. I asked them to also send a copy to my Dentist (they don't know its my wife) and they said ok but never did.

I could fight them and I just might do that but it got me thinking. Can a dentist or a freindly GP write a Rx based on a Dr's letter of recommendation?

Don't see why not. The Dr at the sleep lab refused to do anything except send the report to my PCP. My PCP wrote mine. I have no problems getting him to write a script but he has other things to do besides write scripts 3 or 4 times a year because my DME wants a new one every time I need supplies. I have a friend that had a friendly ENT write his.

Jerry

I would definitely question this one - a dentist can prescribe certain dosages of certain meds, like antibiotics, or treatments related to oral tissues, etc., but I have to say I wouldn't want a dentist prescribing respiratory treatment - not their area of expertise by a mile, whether or not they're "allowed" to do it. They are NOT M.D.'s (medical doctors).

GP's write prescriptions for CPAP all the time. That fits with their objective of managing or treating overall health.

And dentists can write prescriptions in the course of practicing their dentistry:
http://en.wikipedia.org/wiki/Medical_pr ... scriptions

But apparently dentists may not write prescriptions having no legitimate dental purpose in at least one state:
http://www.2theadvocate.com/news/45193172.html

Julie wrote:I would definitely question this one - a dentist can prescribe certain dosages of certain meds, like antibiotics, or treatments related to oral tissues, etc., but I have to say I wouldn't want a dentist prescribing respiratory treatment - not their area of expertise by a mile, whether or not they're "allowed" to do it. They are NOT M.D.'s (medical doctors).

Don't know for sure.......but.......
Dentists can also prescribe pain killers and they make dental devices which supposedly in come cases can work to keep a person's jaw in the proper place when sleeping.

The Thornton Adjustable Positioner® (TAP®) comes to mind.

http://www.cosmetic-dentistry-center.co ... iance.html

http://www.amisleep.com/

http://www.dentalartslab.com/tap-3-thor ... positioner


Den

Treehorn wrote:I'm wondering if any Dr can write a Rx based of a sleep lab recommendation. Especially when it comes to cpap.com

My wife is a dentist and can refer a paitent to a sleep lab (i.e. if she is doing a snoring/apnea appliance).

Seems the local Sleep Dr's and the DME's around here have the same back scratching scheme going as you have all heard before. They dont want to give me my Rx - they will only fax it to a local DME. I asked them to also send a copy to my Dentist (they don't know its my wife) and they said ok but never did.

I could fight them and I just might do that but it got me thinking. Can a dentist or a freindly GP write a Rx based on a Dr's letter of recommendation?

If your wife's a dentist, why not ask her if she can write the script? Seems she should know.

Could the need for a new prescription for every mask be an insurance requirement instead of a legal one?

My NP wrote me a prescription for an APAP machine, which I purchased from cpap.com, with no sleep study and no note from a doctor. I wrote her a letter describing my symptoms. She talked it over with a ... pulmonologist, I think she said.

Seems like a dentist would have a hard time justifying it as part of dental necessity. But who knows...

Cassandra

If you are in the USA, that script is a part of your medical records and as such you have a legal right to a copy under HIPAA. You might need to remind them that you are very much aware of this.

You do NOT have to use the local DME supplier they FAX'd your script to unless 1] they are the only local DME supplier your insurance is contracted with, 2] you aren't willing or able to buy your equipment online.

As much as I like a global conspiracy plot, I don't think it is as insidious as that. Now, before you write me off as a kook I am just as convinced that (some not all) sleep labs, doctors, DME providers, vendors and lawyers (yes lawyers) have a special interest in a horizontal monopoly of all things CPAP. They are working the system.

The FDA has three classes of medical devices in order of increasing risk. They are Class I, II and III. CPAPs are Class II. Now tongue depressors are a Class I. Tongue depressors you say? How are tongue depressors a risk? The best reason I could think of was because a proctologist might get confused one day and say, "Open wide."

The FDA regulations, known as Title 21 of the CFR, Parts 800 to 1299, also states that anything used with a CPAP also has the same class. Clearly the FDA people and more importantly, the vendors requesting a 510(k) clearance wanted to do as little as possible.

Bottom line, government goonies protect their turf and are only interested in getting to retirement. OK, OK, so there are some well-meaning folks but as I learned a long time ago about government gravity...stuff travels downhill not up.

Now for the greedy horizontalists. I did some digging around yesterday and today. My impetus was caused by what started out as a simple snafu; I called my DME provider and asked for a new mask cushion. She said, "You just got the machine." I reminded her that I got the first machine on May 13th along with the mask and she owed me 2 cushions (I would settle for one.) he said, "You'll get a whole new mask on August 13th." I said I don't need a new mask only a cushion. She said, "We don't carry parts, just whole mask systems."

I hung up and sent off an email to my Senator explaining how they and the doctors were "gaming the system. Doctor X determines I need a CPAP sends the prescription for fulfillment to someone I didn't choose who delivers a machine, hopefully set to the values on the prescription, and of make and model of the DME's choice, which may or may not be a new machine (my ResMed VPAPIII ST was a used machine) and then refuses to fulfill a request for a part for the system they delivered (the mask cushion).

My thinking was that with all the attention being paid to medical costs these days by our servants in Washington, how could I go wrong. I even named names. I got a call from the DME 2 hours later telling me they would be delivering a cushion. It came, the guy left and left me with the wrong cushion. Stupid me, I should have insisted he install it. I called this morning very cheerful (a smile goes further than a growl) and explained the difference between ResMed part 16606 and 61293. Tomorrow they are sending a whole new mask. More waste.

Now how do lawyers fit in all of this? Lawyers own the DME. The DME sells medical equipment and then lawyers have clients who are involved in medical screw ups, accidents, etc. (money pits in waiting) and the lawyers split the pot after expenses are paid.

Now you understand horizontilization.

rogelah wrote:As much as I like a global conspiracy plot, I don't think it is as insidious as that. Now, before you write me off as a kook I am just as convinced that (some not all) sleep labs, doctors, DME providers, vendors and lawyers (yes lawyers) have a special interest in a horizontal monopoly of all things CPAP. They are working the system.

The FDA has three classes of medical devices in order of increasing risk. They are Class I, II and III. CPAPs are Class II. Now tongue depressors are a Class I. Tongue depressors you say? How are tongue depressors a risk? The best reason I could think of was because a proctologist might get confused one day and say, "Open wide."

The FDA regulations, known as Title 21 of the CFR, Parts 800 to 1299, also states that anything used with a CPAP also has the same class. Clearly the FDA people and more importantly, the vendors requesting a 510(k) clearance wanted to do as little as possible.

Bottom line, government goonies protect their turf and are only interested in getting to retirement. OK, OK, so there are some well-meaning folks but as I learned a long time ago about government gravity...stuff travels downhill not up.

Now for the greedy horizontalists. I did some digging around yesterday and today. My impetus was caused by what started out as a simple snafu; I called my DME provider and asked for a new mask cushion. She said, "You just got the machine." I reminded her that I got the first machine on May 13th along with the mask and she owed me 2 cushions (I would settle for one.) he said, "You'll get a whole new mask on August 13th." I said I don't need a new mask only a cushion. She said, "We don't carry parts, just whole mask systems."

I hung up and sent off an email to my Senator explaining how they and the doctors were "gaming the system. Doctor X determines I need a CPAP sends the prescription for fulfillment to someone I didn't choose who delivers a machine, hopefully set to the values on the prescription, and of make and model of the DME's choice, which may or may not be a new machine (my ResMed VPAPIII ST was a used machine) and then refuses to fulfill a request for a part for the system they delivered (the mask cushion).

My thinking was that with all the attention being paid to medical costs these days by our servants in Washington, how could I go wrong. I even named names. I got a call from the DME 2 hours later telling me they would be delivering a cushion. It came, the guy left and left me with the wrong cushion. Stupid me, I should have insisted he install it. I called this morning very cheerful (a smile goes further than a growl) and explained the difference between ResMed part 16606 and 61293. Tomorrow they are sending a whole new mask. More waste.

Now how do lawyers fit in all of this? Lawyers own the DME. The DME sells medical equipment and then lawyers have clients who are involved in medical screw ups, accidents, etc. (money pits in waiting) and the lawyers split the pot after expenses are paid.

Now you understand horizontilization.

Brilliant Rogelah! Absolutely Brilliant!

Any doc with a license can write a prescription, but it may not be legal to fill.
The guiding principal is that any practiotioner in the course of his/her practice may write for a bona fide patient.
This gets a bit fuzzy.
If a dentist treats a patient for apnea, then he may writa a legal RX.

I was in a pharmacy in coastal Jax with lots of vacationing people.
One time I had a dentist come by and told me he was a dentist from Ga on vacation and his child was sick and he wanted a RX for Amoxicillin for her ears, iirc.
I told him I could not and suggested he cal a practitioner in Ga to call it in.
An out of state doc cannot write a RX in another state unless s/he is licensed there.
He may write it in HIS state and get it filled out-of state.
A vacatioing doc may not wirte a RX for someone he is visiting.
A patient must have an established professinoal realtionwith the doc and records may be required.
This from the top of my head and some may be outdated.

These are extreme examples and common sense is required in these cases.

tomjax wrote:Any doc with a license can write a prescription, but it may not be legal to fill.

Technically, any literate person with a pen can WRITE a prescription if you stipulate it may not be legal to fill it.

Also, PAs (Physician's Assistants) routinely write 'scripts. I have two in my wallet right now. The licensed physician in the office had nothing to do with either one. Both have been filled several times.

Heck, when I switched to a data capable machine, the DME was balking because the language wasn't specific enough, so I dictated the 'script over the phone to a secretary at the Drs office (and upgraded myself to an Auto for my trouble!!). It was faxed, and promptly filled by the DME. Later I noted that NO ONE had signed it. (Shhhhh!)

DcKalop wrote:If your wife's a dentist, why not ask her if she can write the script? Seems she should know.

Lol, that makes sense. She was asleep when I posted this.

I asked her today and she laughed at me. Definitely not something that she personally thinks she should do.

She has occasionally written me Rx for some not dental related things before in a pinch (i.e. antibiotics for stomach bug, etc) but even though she is currently treating my apnea with a intraoral device she feels this is crossing a line.

Non issue anyway because the receptionist at the sleep lab faxed me the Rx (with a little friendly persuasion).

Thanks guys. I am one step closer to getting my machine.