Prescription rx expirations in California

[specs4you]

What is the rule/law for my state? I am in a general discussion about if a
rx. exp. dt. not stated by Dr., either O.D. or M.D. , what to do? Call the Dr?
I have googled till I am googly and can't get anything but that CL can't be made to expire "before 1 yr" and glasses rx. "before 2 yrs". What is the max? Anyone have a formal link so I can copy it and use it in the office?
Thanks geniuses.

[CME4SPECS]

2541.1. (a) A spectacle lens prescription shall include all of the
following:
(1) The dioptric power of the lens. When the prescription needed
by the patient has not changed since the previous examination, the
prescriber may write on the prescription form "copy lenses currently
worn" instead.
(2) The expiration date of the prescription.
(3) The date of the issuance of the prescription.
(4) The name, address, telephone number, prescriber's license
number, and signature of the prescribing optometrist or physician and
surgeon.
(5) The name of the person to whom the prescription is issued.
(b) The expiration date of a spectacle lens prescription shall not
be less than two to four years from the date of issuance unless the
patient's history or current circumstances establish a reasonable
probability of changes in the patient's vision of sufficient
magnitude to necessitate reexamination earlier than two years, or
presence or probability of visual abnormalities related to ocular or
systemic disease indicates, the need for reexamination of the patient
earlier than two years. In no circumstances shall the expiration
date be shorter than the period of time recommended by the prescriber
for reexamination of the patient. Establishing an expiration date
that is not consistent with this section shall be regarded as
unprofessional conduct by the board that issued the prescriber's
certificate to practice.
(c) The prescriber of a spectacle lens shall orally inform the
patient of the expiration date of a spectacle lens prescription at
the time the prescription is issued. The expiration date of a
prescription may be extended by the prescriber and transmitted by
telephone, electronic mail, or any other means of communication. An
oral prescription for a spectacle lens shall be reduced to writing
and a copy of that writing shall be sent to the prescriber prior to
the delivery of the lenses to the person to whom the prescription is
issued.
(d) A prescriber of a spectacle lens shall abide by the rules
pertaining to spectacle lens prescriptions and eye examinations
adopted by the Federal Trade Commission found in Part 456 of Title 16
of the Code of Federal Regulations.
(e) An expired prescription may be filled if all of the following
conditions exist:
(1) The patient's spectacles are lost, broken, or damaged to a
degree that renders them unusable.
(2) Upon dispensing a prescription pursuant to this subdivision,
the person dispensing shall recommend that the patient return to the
optometrist or physician and surgeon who issued the prescription for
an eye examination and provide the prescriber with a written
notification of the prescription that was filled.
http://www.leginfo.ca.gov/cgi-bin/ca...0-2559&hits=20

[jpways]

Here is the code section (as best as I can find).
Business and Professions Code Section 2541.1
Available at:
http://law.onecle.com/california/business/2541.1.html
The important section for your question is paragraph 5b. which states:

The expiration date of a spectacle lens prescription shall not
be less than two to four years from the date of issuance unless the
patient's history or current circumstances establish a reasonable
probability of changes in the patient's vision of sufficient
magnitude to necessitate reexamination earlier than two years

So as I read this, no maximum length for the prescription (though in our office we warn the patient about eyestrain and recommend they get a new exam it the prescription is older then 2 years, well sometimes 1 year too but the way this law is written I wouldn't try it for any less then 2 year, but this would be at your discretion as the optician as to how old of a prescription you are willing to take)

Of course in section 2 it say the prescription requires an expiration date for it to be valid, so you may need to contact the issuing doctor to have their office reissue the complete prescription as required by law.

[CME4SPECS]

Here is the code section (as best as I can find).
Business and Professions Code Section 2541.1
Available at:
http://law.onecle.com/california/business/2541.1.html
The important section for your question is paragraph 5b. which states:

The expiration date of a spectacle lens prescription shall not
be less than two to four years from the date of issuance unless the
patient's history or current circumstances establish a reasonable
probability of changes in the patient's vision of sufficient
magnitude to necessitate reexamination earlier than two years

So as I read this, no maximum length for the prescription (though in our office we warn the patient about eyestrain and recommend they get a new exam it the prescription is older then 2 years, well sometimes 1 year too but the way this law is written I wouldn't try it for any less then 2 year, but this would be at your discretion as the optician as to how old of a prescription you are willing to take)
Of course in section 2 it say the prescription requires an expiration date for it to be valid, so you may need to contact the issuing doctor to have their office reissue the complete prescription as required by law.

The CA law doesn't say anything about it's up to the discrection of the optician.

[Barry Santini]

IMHO, eyewear prescription expiration laws have become a thinly veiled effort to force people to return for complete eye exams (not even refractions), masquerading as personal health initiatives.

People can always wear their older (read "expired") spare and other pairs, so why this illogical pretense exists is beyond my thinking.

What other medical discipline essentially MANDATES the public get examined every one to two years, depending on the whim or discretion of the doctor?

My internist doesn't. My Dentist doesn't. Oh yeah, they "recommend" I get prophylatic exams periodically, but there are no laws that require it.

I say: "If the public's visual health is such a lofty concern, lawmakers, then why do you permit completely unregulated OTC and Rx on-line eyewear to be available for public consumption?."

"And why do you also, almost universally throughout our land, allow local state DMVs to permit acuity screenings (not even testings!) to be done at distances as little as 6 feet (this is the standard in NY. Just how does 6 feet correlate to ANY visual distance encountered while driving?), and only once every eight years?"

Hell, Wisconsin still has a law on their books letting people drive with 20/200 on a limited basis, i.e., "during the daytime hours"

?????? Do I smell legally blind?

I think it's because they feel there's no acknolwedged health risk, or at least a very minimal one (the FDA has essentially said as much). If this is the case, then why mandate these medically-couched eyeglass expirations of 1 to 2 years, when that same John Doe could easily obtain the SAME Rx so easily through so many back channels?

Logically, you can't have it both ways. It is, and you are (the lawmakers) either consistent with your concern of the public's visual/eye health, or you're not, and appear duplicitous.

Discussion?

(Shields on!)

Barry

[braheem24]

Try going to your internist and telling him you HBP meds are working fine you just need a refill.

Try going to your pharmacist and telling them the same story.

I would say Opticianary has it easy.

[CME4SPECS]

I think the expiration law is ridiculous! However I have to abide by the law. It's tough here in CA, we can't duplicate, we can't hire ODs. There's a couple of OD's around here that put a 1 year expiration on all of their rx's. They are allowed to do this if conditions warrant it.Ridiculous! I guess all of their patients are diabetic or something!

[Uncle Fester]

I think the expiration law is ridiculous! However I have to abide by the law. It's tough here in CA, we can't duplicate, we can't hire ODs. There's a couple of OD's around here that put a 1 year expiration on all of their rx's. They are allowed to do this if conditions warrant it.Ridiculous! I guess all of their patients are diabetic or something!

Does California allow you to duplicate an rx? If so could you "verify" the current glasses and make a new pair?

Also, this to me demonstrates the power to lobby with politically $avvy professional organizations.

[braheem24]

Fester, you're gettin' old...ER!

Read again

[obxeyeguy]

Fester, you're gettin' old...ER!

Read again

Does California allow you to duplicate an rx?

It's tough here in CA, we can't duplicate, we can't hire ODs.

I'll help out an "old" dude.




I even corrected his spelling.

[OHPNTZ]

I think the expiration law is ridiculous! However I have to abide by the law. It's tough here in CA, we can't duplicate, we can't hire ODs. There's a couple of OD's around here that put a 1 year expiration on all of their rx's. They are allowed to do this if conditions warrant it.Ridiculous! I guess all of their patients are diabetic or something!

Duplicating is ok within reason, but here in NY, I see way too many people that keep coming in year after year and duplicating their old rx. I have seen a handful who finally have an eye exam, of course only because their glasses are broken, who have had glaucoma, proliferative diabetic retinopathy, etc...

I don't see what the fuss is about the 1 year expiration...there are many people who have a script change. So what happens with the patient who had his/her exam 2-3 years ago, waits approximately that long to get their "new" pair of glasses, and can't see out of them? They come into your optical, and now what do you do?

[CME4SPECS]

Duplicating is ok within reason, but here in NY, I see way too many people that keep coming in year after year and duplicating their old rx. I have seen a handful who finally have an eye exam, of course only because their glasses are broken, who have had glaucoma, proliferative diabetic retinopathy, etc...

I don't see what the fuss is about the 1 year expiration...there are many people who have a script change. So what happens with the patient who had his/her exam 2-3 years ago, waits approximately that long to get their "new" pair of glasses, and can't see out of them? They come into your optical, and now what do you do?

I think I'm smart enough to address that issue prior to making glasses. There's is a big difference between laws and using common sense!

[Barry Santini]

I don't see what the fuss is about the 1 year expiration...there are many people who have a script change. So what happens with the patient who had his/her exam 2-3 years ago, waits approximately that long to get their "new" pair of glasses, and can't see out of them? They come into your optical, and now what do you do?

Redo them...just like I do withion a day or two of delivery now, when it is discovered that the refractive tech's Rx just is compeletly unsatisfactory.

No difference for me.

Barry

[obxeyeguy]

I don't see what the fuss is about the 1 year expiration...there are many people who have a script change.

My big beef with the 1 year thing, or any for that matter, is simple. I live in a tourist area, with 3 OD's, and 4 OMD's, 3 on a 1 or 2 day schedule, covering over 100 miles of beach. Many times in the summer we have lost eyewear, and when calling for the rx, we are told it is "expired" and they refuse to release it. We in many cases try to at least get a refraction on these people, but that is not always possible due to the limited availability of the Docs, and complete dilated exams are normally out of the question.

Has anyone really been harmed by wearing a 2 year old Rx, when they have to drive 500 miles maybe a quarter under corrected on their -3.50's, or driving without them? Some of you Doc's are just to hard headed to even have common sense. Sure, we explain that they need an exam, and to follow up at home with their regular Doc, but that's all we can do. Drive with something, or drive with nothing? Eye exams are a health related issue, and refractions are for seeing better, right? Even you doc's have separated those services in your billing, and don't always perform both at every visit. You can't force people to go to the Doctor to take care of their health, as they will do what they want, at least not yet.


I believe that the Nancy and Spex bill will in fact make this a felony in the house health care bill, to use a eyeglass Rx over 1 Year, period, unless there's a tax or fee.

[tigerlilly]

The problem is that it's a prescription. As braheem said, try getting your doctor to continue authorizing an RX for meds without seeing you. The doctor has prescribed something for the patient, and ethically s/he has a responsibility to make sure that the RX continues to be appropriate and correct. Since no one is forced to update new glasses or continue wearing contacts, what harm is there in requiring a new exam every two years, or even one year? That doens't seem unreasonable to me.

Obx, I understand how frustrating it must be for you. I definitely sympathize with the hassles you deal with, but I put the blame on the patient. I know I can't see without my glasses (-4.50 w/moderate cyl), so I'd never go on vacation without an adequate supply of contacts and my glasses. If I just wore glasses, I'd be damn sure to have a second pair with me. Some people even travel with a copy of their RX because they know that if they have a glasses accident, they can't drive home without new ones. Anyone who cannot function without correction should take responsibility for being prepared, and it's not the doctor's fault or yours when they break or lose their glasses and can't fill their expired RX.

[obxeyeguy]

Anyone who cannot function without correction should take responsibility for being prepared, and it's not the doctor's fault or yours when they break or lose their glasses and can't fill their expired RX.

Yes indeed they should. But I still don't see a health issue here, as the refraction is a separate part of the exam. I really don't believe that anyone has died from wearing 3 year eyeglass script. Health exam is one thing, refraction is another, they are not one in the same. If they are, my question stands, do the Docs do a dialated health exam at every CL visit, or a refraction at every IOP check?

I doubt I will get an answer yes here, as the Doc's can't dictate medical care, yet, but they can in fact influence it in this case thru an eyeglass script by limiting it's validity. Together when they want, separate when they bill you.

[optical24/7]

If I just wore glasses, I'd be damn sure to have a second pair with me. Some people even travel with a copy of their RX because they know that if they have a glasses accident, they can't drive home without new ones. Anyone who cannot function without correction should take responsibility for being prepared, and it's not the doctor's fault or yours when they break or lose their glasses and can't fill their expired RX.

At least 80% of my walk-ins don't have a copy of their Rx....They were never given one! Yes it's law to give one, but around here it is not the norm..Then all offices require a HIPAA release from the patient. I've read it, and from what I see, I'm continuing the care of the patient, thus, no patient release form is required....but, if it is........


Why the heck does 1-800 not need one? Only to fill as to the specifications the *customer* provides??...And if not "verified" within a set number of hours they can.... "Fill As Write"...by.......the *Customer"!


It's not the doctors fault? I tell ever patient how important it is to carry your Rx with you. If you need them to get around, you need quick access to replacement. I always make a copy to keep, but give the original back so they can carry it. Are area doc doing the same after the exam????

[tigerlilly]

We use triple carbonless copies for the RX. One copy stays in the chart with the doc, one gets shredded after we enter it into the computer, and the patient gets the top copy. The law says the patient gets a copy, and HIPAA hoops aren't necessary when the patient is getting a copy of their own RX. There's no excuse for practitioners to fail to provide a copy at checkout, and we only make ourselves look bad by dragging our feet and making it hard for patients to get their RX.

Does every patient need to carry a copy of their RX around with them all the time? No. Does a patient need to carry a copy when going far afield on vacation with only one pair of glasses and nothing to back them up? Yeah, they do. Getting access to your RX isn't always easy if it's an evening, weekend or a holiday, so it's important to have it with you if you're going to run around with one pair of glasses and you can't see without them. People with higher prescriptions know that they're screwed in an emergency without either some sort of backup or a copy of their RX and access to a one-hour place. I even tell people with really high RXs at pickup to keep their old pair in the glove box in case they have a problem while out and about so they can make it back home. We do have patients come in asking for another copy because they're going out of town and misplaced the original, so some patients do think ahead.

[obxeyeguy]

We use triple carbonless copies for the RX. One copy stays in the chart with the doc, one gets shredded after we enter it into the computer, and the patient gets the top copy. The law says the patient gets a copy, and HIPAA hoops aren't necessary when the patient is getting a copy of their own RX. There's no excuse for practitioners to fail to provide a copy at checkout, and we only make ourselves look bad by dragging our feet and making it hard for patients to get their RX.

Does every patient need to carry a copy of their RX around with them all the time? No. Does a patient need to carry a copy when going far afield on vacation with only one pair of glasses and nothing to back them up? Yeah, they do. Getting access to your RX isn't always easy if it's an evening, weekend or a holiday, so it's important to have it with you if you're going to run around with one pair of glasses and you can't see without them. People with higher prescriptions know that they're screwed in an emergency without either some sort of backup or a copy of their RX and access to a one-hour place. I even tell people with really high RXs at pickup to keep their old pair in the glove box in case they have a problem while out and about so they can make it back home. We do have patients come in asking for another copy because they're going out of town and misplaced the original, so some patients do think ahead.

Great response Tiger, just not a response to the origional question. We all know the general public will not follow the norm, and travel with an older Rx pair on hand, or a copy of that "expired" Rx, or follow what we think is common sense.

The question is if the given Rx should expire at a time frame determined by the Doc? And is the patient harmed by wearing an expired Rx?

PS. That system with the 3 part Rx is brilliant!! You might consider scanning the 1st copy in the computer, return it to the chart, eliminate number 2 and save a tree or 5.

[tigerlilly]

Sory, enver saw this. We can't do what you suggest - no scanner. Before the updated computer system, they kept the third copy in a separate paper patient retail file for reference (big box, independent doc owns charts, you're screwed if he leaves, etc.). I'm sure they could get away with double copies now, but nobody asks what I think.

I still don't have a problem with expirations on RXs. Will someone be harmed by wearing an old RX that's no longer accurate? Depends on their individual circumstances. I can certainly concede that it's not as urgent as having a current RX on a hypertension med or insulin dosage, but it's not the optimum level of care either. We all know there are physical or visual consequences to wearing an incorrect prescription. I'd imagine there might be liability issues, too. What if somone gets glasses on an old, expired and no longer correct RX and has an auto accident as a result of not having the right corection? If a patient chooses to drive without any glasses at all it's on their head, but if they drive with bad glasses, whose fault is that? I don't know the answer.

I wasn't aware that doctors had much say in it. I thought the law determines RX expiration. Is that incorrect?

[kcount]

First off, to the original post. I am happy I don't have an office in CA, I'd be in jail or fined to my eyeballs. In Illinois there is an old rule that says an OD has to neutralize an RX to be duplicated but there is no enforcement agency and most people haven't a clue its even out there.

As far as Rx expiration I go by a common sense concept. Eyeglass Rx's should be updated every two years but I'm not gonna drag you in to your doctors office if your 2 months over due. You want a back up pair for your trip Mrs. Zimmerman? No problem coming right up. I sell High end products to an affluent customer base and they do not appreciate being told they have to go and see their doctor all the time.

As for Cl's I'm a bit more strict, one year thats it your done get a new Rx. I have some stickler MD's around me that I just as soon not upset. Thats not to say I haven't given a trial to a patient to pull them through.

OBX, when I was working for other Doctors I would often get the call from offices such as yours. I never saw the fuss in giving out the Rx. The last thing a doctors office should want to do is get all High and Mighty in that moment. Do what you can to help the patient and get them home. If that means making an exception they should do it. The truth is the patients going to see you once their going to see the Dr. again and again. So I sympathize with your concern and understand where your coming from. If I were you, I'd probably get an Auto-refractor and a trial lens set; work out an Rx with a comment to follow up with their doctor for a proper exam when they get home. (I'm sure I'm going to catch all sorts of flack for that statement.)