Have to pay for doctor visit every 2 months for son's ADD and OCD meds?!

[creekmom]

My son is on Adderall and Zoloft, and the pediatrician will only give us 2 months of meds at a time.  I just went in and had to pay $100.00 for him to say, "So, how are you feeling?  Meds working OK?  Here's your new prescription." - Seriously, the appointment didn't last longer than 10 minutes. Is this normal??  Should I look for a new doctor?  

[Jean in Newcastle]

Are they new meds?  Is the check in just at first to make sure dosage is correct?  (This is normal, I think.)  I would expect that once things are stabilized and the dosage is set that visits would be spaced out further. 

[chiguirre]

I'd discuss it with him next time explicitly explaining how much each visit costs you out of pocket. If he won't budge without a very good explanation, I'd look for another doctor. Your regular family doctor or pediatrician may be okay with writing the prescription for an existing med your son has been using for a while.

[Janeway]

Once he is on the meds and stable, he should not have to go so often. Look for a new doctor.

 

We are finding a new doctor for my husband. He takes Synthroid and his doctor makes him come in every three months and have bloodwork or he will not refill it. That is ridiculous. My husband has been on this med for years.

[OneStepAtATime]

Agree with Jean are these new meds?

[kbutton]

We have full appointments three times per year for such things. In between, we get scripts for one month at a time, but it's a phone call/pickup kind of thing. 

[zoobie]

Added all requires a new prescription every month, but they don't usually require an office visit to get it. Maybe it's the Zoloft? How old is DS?

[marbel]

My kid who is on ADD meds has to be seen every 3 months. 

[nevergiveup]

You can ask your doctor for several month's worth of prescriptions. 

I think the rules have changed regarding controlled substances.  My doctor was willing to write out several months' worth at a time to save trips in.

[Loowit]

My kids had to be seen every three months after they were considered stable, every month before that.  That was through at office that specialized in mental health.  Eventually I got it transferred to their normal pediatrician, but she wouldn't do it until they were stable on medication for at least a year.  She wanted to see them every six months.  Right now only one child is still on those types of medication and she only gets seen once a year, which I am actually not happy about.  She is not as stable as I would like her to be, but the doctor did tell her to make an appointment if she was having problems or things were getting worse.  Medications like that really do need to be monitored, IMO, especially in growing children and if they are new meds it can take a while to adjust to get the right dose and sometimes even the right medication.

[goldberry]

I told my doc bluntly that I could not afford to come in that often for DD.  He worked with me.  Lay it out and if he doesn't work with you find another doctor.

[Storygirl]

The ADHD meds are a controlled substance, so there are laws about how doctors prescribe them. Our pediatrician said she can write three months at a time, and she can prescribe for six months between office visits. In other words, at the appointment, she can hand us three months' worth of written prescriptions. And when we are close to running out, she can write another three months' worth. We have to go to the office to pick them up; they cannot be sent to the pharmacy electronically. We do not get charged an office visit just to pick up the prescription.

 

Whenever meds are newly prescribed or being adjusted with a new dosage or a new type of med (and when we switched doctors, so that DS was a new patient for her, even though he'd been taking meds previously), she requests to see him in three months instead of six.

 

See if you can find out your state laws about this; they may vary from my state.

 

Your doctor may have policies that require more office visits than the law requires; if so, you could discuss how this presents a hardship for you, and see if they would waive or reduce office fees. If they will not work with you, consider switching to a different provider.

 

I agree with others that this frequent check-in may be temporary if the prescription is new.

 

[Paige]

I was talking to one of our doctors and he said that some prescriptions only allow a 15 day supply with a mandatory in person visit before he can give a refill! Depending on the laws of your state around the specific prescription, it's likely not your doctor's fault. You could ask if you could try a medicine that doesn't require as many visits. It's hard, though, if you think you've found the perfect fit. 

[creekmom]

Thank you for the advice. He has been on the meds for a while, but the dosage has been adjusted a little because he is growing (14 years old).  I will check my state's laws and see if he will at least let us go 3 months.  Crazy how expensive it gets!!

 

[Janeway]

Are you ok with these meds? Zoloft is contradicted in children now days, but many peds are still prescribing it. Adderall can cause anxiety. There are newer meds now with less side effects. If you are ok with it, then I am ok with it obviously, not my child so I have no clue what is going on or anything. But I have dealt with my own set of doctors who push meds. So I did not know if you were dealing with that at all.

Edited June 24, 2017 by Janeway

[Butter]

When Adrian was first put on Adderall, he was seen after 30 days and then after another 3 months.  If we tweak his dosage he needs to be seen after another month or two, but for now he's doing great on his current dosage so he only has to be seen every 6 months.  When we need a refill I can just go on the patient portal and ask for it and they call it in to the pharmacy (this is new - up until about 4 months ago we had to call and pick up the script).  Because they adjusted the dosage I can understand being seen more often, but hopefully that won't last long.

[Katy]

In our last state the doctor apologized and gave a schedule of required visits in advance, they were quite frequent by state law to control substance abuse issues.

[gardenmom5]

adderall is a controlled substance - that changes the way it can be dispensed - as in, how often the dr must see the patient to be able to write a rx. that can vary by state.  there's a huge issue of fake rx being written and it's sold illegally.

[dsmith]

We go every 6 months for Prozac, Abilify and Xanax. The Xanax I can only get 10 at a time for him, but he rarely uses it. We pay $395 a visit, but we are with the doctor for 30 - 60 minutes. He is worth every penny, too. We've gone more frequently when he was younger for dosage changes or new meds, but now that he is older and more stable it doesn't seem necessary. 

[Crimson Wife]

My kid who is on ADD meds has to be seen every 3 months. 

 

Same with mine, mostly to do a weight and blood pressure check. The stimulant she's on is an appetite suppressant and the non-stimulant is a high blood pressure medication so the doctor has to make sure that she is not experiencing any side effects from the medications.

[gardenmom5]

Once he is on the meds and stable, he should not have to go so often. Look for a new doctor.

 

We are finding a new doctor for my husband. He takes Synthroid and his doctor makes him come in every three months and have bloodwork or he will not refill it. That is ridiculous. My husband has been on this med for years.

 

synthroid is not a controlled substance - adderall is, and the state wants to make sure it is going to the person for whom it is being prescribed. 

 

if the dose is stable - the dr has no legit reason for requiring him to come in every three months for synthroid.  I had to change docs due to insurance changes- I only had one who required an in-person visit every three months and you had to ask AT teh appointment for a refill, or she wouldn't give it.  that and a few other things, i fired her.

and if all the dr is running is a tsh - well, that isn't even a thyroid hormone.  it's a pituitary hormone.

[AimeeM]

When our teen was on Adderall, she had to be seen for a "med check" every 3 months, as per state law. At that appointment, her doctor could write her three months worth of prescriptions, but it was advised that we only pick up one every month and let the office hold the rest -- because if they were lost, they were lost, no replacements (I think they could replace a lost script once, but no more than that). There were no exceptions due to the class of controlled substance Adderall is (and that it was prescribed to a minor may have played a part as well -- I don't recall).

 

If her dosage was adjusted, she had to be seen more frequently until it considered a stable dosage. 

Edited June 24, 2017 by AimeeM

[StephanieZ]

Adderall is serious shit. So is Zoloft, and it's treating a very serious condition (depression). 

 

So, if my kid were on those serious meds, I'd WANT a DR checking in on him regularly. 

 

Maybe you could ask if 90 days would work. 

 

IME, a 30 day follow up is typical for the first few months of psych medication in a young person. Maybe 60-90 days after the first few checkups if things are going well. Pysch meds routinely have to be tweaked on a regular basis. 

 

Depression is something you want someone monitoring closely, especially if this is a child (under 20 or so). IMHO. 

 

Depression can change quickly, and it can be fatal. It's not something I'd want to just medicate and then not have monitored closely. And, presumably, you're monitoring closely both to make sure the depression is being well controlled, but also on the watch for the time when the patient can get OFF the meds. 

 

So, yah, I think 60 days is responsible given the situation. 

 

FWIW, I've lost more than one beloved young man to suicide. So, to me, identifying (YAY!) and treating (YAY) depression is a critical situation, and I'd do anything possible to ensure close monitoring, adjusting of treatment/meds, etc. 

[Ravin]

Are you ok with these meds? Zoloft is contradicted in children now days, but many peds are still prescribing it. Adderall can cause anxiety. There are newer meds now with less side effects. If you are ok with it, then I am ok with it obviously, not my child so I have no clue what is going on or anything. But I have dealt with my own set of doctors who push meds. So I did not know if you were dealing with that at all.

Unless you are a doctor or nurse practitioner maybe you should throttle down second guessing what meds someone else's kid is on. The beef here is frequency of visits.

 

When we are adjusting things, a month or two at most between visits is expected. However, once they are stabilized we go to every 4 months. That seems reasonable to me with a growing kid. For an adult it would be a PITA.

 

We do have to pick up a paper scrip every month for meds and they won't write it unless/until the next appointment is scheduled.

 

DD also sees a counselor every two wreks, so the med prescriber isn't the only professional monitoring her.

Edited June 24, 2017 by Ravin

[chiguirre]

Just another idea, there is one med for ADHD that isn't a stimulant. It's Intuniv or generic guanfacine. That doesn't require a paper script of any of the controlled substance stuff. If it works for your child, it's much easier to deal with.

[Crimson Wife]

Just another idea, there is one med for ADHD that isn't a stimulant. It's Intuniv or generic guanfacine. That doesn't require a paper script of any of the controlled substance stuff. If it works for your child, it's much easier to deal with.

 

Guanfacine is a blood pressure medication so like my DD's Clonidine prescription, the doctor might still want the patient to come in every 3 months for a blood pressure check.

 

[melmichigan]

Thank you for the advice. He has been on the meds for a while, but the dosage has been adjusted a little because he is growing (14 years old).  I will check my state's laws and see if he will at least let us go 3 months.  Crazy how expensive it gets!!

Here it also depends if the doctor is getting therapy reports.  If the patient is seeing a therapist then they see the physician less often, unless there has been a med or dosage change.  If they aren't seeing a therapist, then they see the physician more often so that someone is keeping an eye on things.

[Hypatia.]

Just another idea, there is one med for ADHD that isn't a stimulant. It's Intuniv or generic guanfacine. That doesn't require a paper script of any of the controlled substance stuff. If it works for your child, it's much easier to deal with.

 

I have a child that's on a combo of Dexedrine and Intuniv. We can only get 100 days worth of Dexedrine at a time, but it's nice to be able to have refills on the Intuniv since it's not a controlled substance.

[heartlikealion]

Just curious, would it be any cheaper to see a psychiatrist for this? I just started meds and my visits are basically every 6 weeks right now. I pay a co-pay at my visits. I don't know what is typical for how often someone is seen, but I imagine in the beginning it's normal to be seen more often to check on dose and symptoms.

[gardenmom5]

Just another idea, there is one med for ADHD that isn't a stimulant. It's Intuniv or generic guanfacine. That doesn't require a paper script of any of the controlled substance stuff. If it works for your child, it's much easier to deal with.

 

amantadine has also started to be used for adhd (and asd).   it's not a stimulant, and is not a controlled substance. initial trials have shown about half of adhd patients respond to it.

[Laura Corin]

My son is on Adderall and Zoloft, and the pediatrician will only give us 2 months of meds at a time.  I just went in and had to pay $100.00 for him to say, "So, how are you feeling?  Meds working OK?  Here's your new prescription." - Seriously, the appointment didn't last longer than 10 minutes. Is this normal??  Should I look for a new doctor?  

 

Is there a nurse practitioner in the office who can prescribe?  Those visits should be cheaper.

[Pawz4me]

Is there a nurse practitioner in the office who can prescribe?  Those visits should be cheaper.

 

Not with our insurance. Our co-pay is the same whether we see a doctor, a nurse practitioner or a PA. I know it makes no sense, but such is the state of U.S. health insurance.

 

DS18 is on an anti-anxiety medication (not a controlled substance) and has been on a stable dosage for almost two years. He has to see his psychiatrist every three months. I have no issues at all with that, even though the appointment is rarely longer than ten minutes and even though he's soon going to be in college two hours away from her and it's going to be much more of a hassle to schedule appointments. But I'm glad she keeps such close watch on him. But it isn't a financial burden for us. I'd probably think differently if it was

Edited June 24, 2017 by Pawz4me

[Hilltopmom]

Yep, med checks every 3 months seem pretty routine for ADHD & depression meds.

 

I hate large co pays.

Edited June 24, 2017 by Hilltopmom

[Lady Florida.]

My son's doctor (his pedi and now his adult doctor) will go three months. However, adhd meds are a federally controlled substance and doctors can only go so long without seeing the patient, or they aren't allowed to continue prescribing the medication. It's frustrating and there's been a push to downgrade those meds from Schedule II. So far that's been unsuccessful so the unnecessary doctor visits are still required.

[Lady Florida.]

Just another idea, there is one med for ADHD that isn't a stimulant. It's Intuniv or generic guanfacine. That doesn't require a paper script of any of the controlled substance stuff. If it works for your child, it's much easier to deal with.

 

It's not yet approved for adults so I wonder if that means it doesn't work as well on adults. OP's ds is 17 and it's approved for ages 6-17, so he would have to try something else soon. A doctor probably wouldn't start someone on it at his age though.

 

amantadine has also started to be used for adhd (and asd).   it's not a stimulant, and is not a controlled substance. initial trials have shown about half of adhd patients respond to it.

 

It seems to have limited results mostly for those with mild adhd. Unfortunately ds has moderate adhd.

 

Ds did try Strattera when his doc was first trying different meds but it was ineffective. It seems to work best for those with inattentive type rather than impulsive type or combined type (which mine has). For those who do find it effective, the patent has finally run out and it's available in generic now as atomoxetine.

Edited June 24, 2017 by Lady Florida.

[GoodGrief]

My daughter on psych meds sees the psychiatrist every 1-2 months. I don't know the standard of care with Adderal and Zoloft, but think with a growing child you'd want to monitor the med situation relatively closely to catch any potential side effects early.