Will you neutralize & dupe? What about expired Rxes?

[tdj]

Will you neutralize a pair of spex and duplicate them?

Will you fill an expired Rx? What if you call the OD and they say "oh... well if they want it"

I will not neutralize and fill. Haven't run into a situation yet in which I would. I can think of a few, but they would involve the pt being glassesless, injured and bedridden and unable to come in, and not knowing their doc's name. I've had almost that situation arise, but have always been able to get a situational OK from their doc.

Expired I will only do with an OK from the prescribing OD/MD. I figure, their Rx, their expiration date, their call. Not mine.

I won't even touch expired ctl prescriptions. Too much liability there IMO

[cocoisland58]

Will you neutralize a pair of spex and duplicate them?

Not as a matter of course but I have and no doubt will again. If the paper Rx say's "expired" than I won't fill it.

[tdj]

Not as a matter of course but I have and no doubt will again. If the paper Rx say's "expired" than I won't fill it.

I don't think I've ever had anyone dumb enough to bring in one of those HIPAA-released-but-stamped-expired Rxes... do you mean those or the ones where the expiration date has passed?

[CNG]

Duplication is legal, common, and totally part of opticianry.
cng

[tdj]

Duplication is legal, common, and totally part of opticianry.
cng

Just because it's legal and common doesn't make it ethical or justifiable if all the patient is doing is being cheap IMO

if I had a dollar for every pt who came in claiming perfect acuity in their 5 year old gls with no problems in ocular health and came out of the chair with a glaucoma referral, full diopter+ change or both, I could retire yesterday

[braheem24]

That's the best thing about opinions.

[CNG]

Duplication is totally ethical. You probably have been brain washed by a prescriber who wants to get another exam fee. There are many reasons why opticians should duplicate lenses such as high Rx and prescriber is closed or unreachable. Patient broke frame and requires a pair ASAP and no prescriber available. Further more not offering a duplication is borderline for malpractice if your refusal has detrimental effect to the patient such as accident or job loss; now having said that you can turn the cards around and ask what about the brain tumor. The answer is mainly on the standard of care and your scope of practice. You could have prevented the accident by providing the service...but you could not have prevented the brain tumor because it is out of your scope of practice. Now if you want to prove to yourself that the patient can see well enough to your standards, construct a temporary pair (trial frame) and have them read a snellen chart. Your state may or may not permit you to that. Such screenings are legal in most places. Also you can do a pinhole test and if patient sees better well...duplicate the lenses and have the patient see your MD on Monday morning ASAP.

CNG

[tdj]

Duplication is totally ethical. You probably have been brain washed by a prescriber who wants to get another exam fee. There are many reasons why opticians should duplicate lenses such as high Rx and prescriber is closed or unreachable. Patient broke frame and requires a pair ASAP and no prescriber available. Further more not offering a duplication is borderline for malpractice if your refusal has detrimental effect to the patient such as accident or job loss; now having said that you can turn the cards around and ask what about the brain tumor. The answer is mainly on the standard of care and your scope of practice. You could have prevented the accident by providing the service...but you could not have prevented the brain tumor because it is out of your scope of practice. Now if you want to prove to yourself that the patient can see well enough to your standards, construct a temporary pair (trial frame) and have them read a snellen chart. Your state may or may not permit you to that. Such screenings are legal in most places. Also you can do a pinhole test and if patient sees better well...duplicate the lenses and have the patient see your MD on Monday morning ASAP.

CNG

Legally I am sure I could trial frame and test acuity... however... I would be fired on the spot for doing so. If I wouldn't be, I would find that an okay solution to emergency situations.

However . . . I'm thinking I would not be considered liable for job loss or an accident for refusing to fill an Rx . . . because I do not have an on-site or next day lab. The quickest I can get jobs in is 3 days, usual is 7-10. If they are that desperate, can't wait 5 days (I can promise a non AR/non glass SV, non digital PAL, FT28/35 or 7x28 job in 4-5 days) I send them to LC (which is in walking distance). . . they won't neutralize, ever, for anything, but that is the only same day service within 50 miles. Unfortunately same day service is the only way to prevent them from walking around without correction for several days and thus possibly getting in an accident or losing a job.

Also my shop makes nothing from exams. Our OD is very very part time, pays a rental fee for his office. The cash is his and because we are not his primary employer he couldn't care less if I push exams.

[EyeFitWell]

We do not knock on the patient's door and confiscate glasses on the day the Rx becomes expired. The patient is able to keep and use them as long as they like, provided they do not break. It's pretty hard to justify refusal to duplicate considering the pt was wearing them yesterday, they broke today, now they need a new Rx? I mean, I agree that they SHOULD get a new Rx, just as we SHOULD all get routine dental cleanings, but not everyone does. Being in the eyecare field, I am especially passionate about why everyone should get an eye exam every 12-24 months, but I do not think that refusal to make new glasses is the way to encourage such visits. What about the guy who has 20/20 vision? Isn't it also important he get an eye exam every year? If we use the refusal of new lenses as the only means to encourage our patients to see the doc, we are emphasizing in the patient's mind that an eye exam only gives them a new eyeglass prescription. It also reinforces resentment towards the OD's and OMD's and (IMHO) supports the (FALSE) notion that the industry is only trying to squeeze more money out of them.
I think it is best practice to encourage your patient to see the eye doctor for a new exam every 12-24 months and to educate the patient on the importance of such visits to monitor eye health and catch diseases while treatable. But, in the case where the glasses broke, I don't see the logical sense in refusing to replace the broken specs with a pair of optical equivalence.

PS This is entirely different for contact lenses which increase the risk of eye infection and injury. I do not think patients should be able to get more than a year's supply of contacts with a new script. No contacts should be given for an expired Rx without an eye exam.

[tdj]

We do not knock on the patient's door and confiscate glasses on the day the Rx becomes expired. The patient is able to keep and use them as long as they like, provided they do not break. It's pretty hard to justify refusal to duplicate considering the pt was wearing them yesterday, they broke today, now they need a new Rx? I mean, I agree that they SHOULD get a new Rx, just as we SHOULD all get routine dental cleanings, but not everyone does. Being in the eyecare field, I am especially passionate about why everyone should get an eye exam every 12-24 months, but I do not think that refusal to make new glasses is the way to encourage such visits. What about the guy who has 20/20 vision? Isn't it also important he get an eye exam every year? If we use the refusal of new lenses as the only means to encourage our patients to see the doc, we are emphasizing in the patient's mind that an eye exam only gives them a new eyeglass prescription. It also reinforces resentment towards the OD's and OMD's and (IMHO) supports the (FALSE) notion that the industry is only trying to squeeze more money out of them.
I think it is best practice to encourage your patient to see the eye doctor for a new exam every 12-24 months and to educate the patient on the importance of such visits to monitor eye health and catch diseases while treatable. But, in the case where the glasses broke, I don't see the logical sense in refusing to replace the broken specs with a pair of optical equivalence.

PS This is entirely different for contact lenses which increase the risk of eye infection and injury. I do not think patients should be able to get more than a year's supply of contacts with a new script. No contacts should be given for an expired Rx without an eye exam.

I guess I kind of see this the way I see, say, scripts for penicillin.

Say a guy comes into a pharmacy with a script from penicillin from 5 years ago, or better yet, the old bottle.

He (thinks he) has strep throat.

He's been taking the leftover penicillin every time he has a scratchy throat or the sniffles, and it works just great, from what he tells us.

The penicillin *might* knock out the strep just fine, and he could be fine. Or he could have something completely different, or it could be a resistant strain, or or or . . .

Just because the pt would be *happy* with that refill from the label on the old bottle, is it ok?

Sure, the laws and regulations forbid pharmacists from doing that! But just because the laws and regulations differ between the professions, are the ethical best practices bypassable as well? Why do we allow pts to self prescribe in our field . . . no other fields do!!

[optiman37]

There are very few exceptions to duplicating a rx that is expired. One is if they have nothing to drive with and are from out of town and lost there glasses. I agree that if a patient is just trying to get a rx filled and doesnt want to pay for an exam I understand. The doctor gets that call but a licensed optician you have every right to refuse to fill. We are protecting the public and sometimes in the best interest of the patients we have to refuse. I would refuse also depending on last exam if over 3 years or more i would refuse

[Crazy-bout-Optics]

We get every so often people visiting from out of the country who has lost/damaged their sun or eyeglasses and if they have another pair I will neut and make them up. Basically emergency situations. Oh, and I do work at LC and we *can* neutralize.

[cocoisland58]

I don't think I've ever had anyone dumb enough to bring in one of those HIPAA-released-but-stamped-expired Rxes... do you mean those or the ones where the expiration date has passed?

The ones where the written expiration date has passed. Usually they have had it in their wallet for so long they never even realized it was too late to use. Perfect time to squeeze them in for an exam.

[scriptfiller]

Don't have a problem with neutralizing to make new specs. We do attempt to schedule a new exam, typically it's the cheapies who want neutralization. An overwhelming majority of folks will get an exam though. Let the pat. make an informed decision.

[DC Optix]

I agree with scriptfiller...the patient should be the one making the informed decision. I think we all agree that it is *BEST* practice for the patient to have a new exam every 1-2 years, but that duplicating an Rx is not, in and of itself, wrong. Why not suggest strongly to the patient that he/she get a new exam and if they decline, then discuss duplication?

[Uilleann]

I'm just curious - when did it become legal to fill an expired Rx of ANY type, when we're not the prescribing physician (nor indeed physicians of any type) in the US? I have always been told very very differently. Thanks.

[Judy Canty]

Here in the Old Dominion, spectacle rxs do not expire unless there is a medical reason for it. CL rxs do, however, expire.

[pseudonym]

When you say Old Dominion, do you mean VA? I know someone who was told that the Rx cannot be filled if it is over 5 years old in VA.

[Judy Canty]

They were mis-informed. Spectacle rxs do not expire unless there is a medical reason for an expiration date. CL rxs expire. It does pay to belong to your state assocation. It's just amazing what can be learned.

[pezfaerie]

I'm just curious - when did it become legal to fill an expired Rx of ANY type, when we're not the prescribing physician (nor indeed physicians of any type) in the US? I have always been told very very differently. Thanks.

+1

[Uilleann]

They were mis-informed. Spectacle rxs do not expire unless there is a medical reason for an expiration date. CL rxs expire. It does pay to belong to your state assocation. It's just amazing what can be learned.

Really. So what you're stating then is that all the docs out there who write a very specific expiration date on their SRx's are breaking the law? How does that compare to federal law I wonder, or interstate Rx fulfillment...

Just thinking out loud.

[Judy Canty]

State law...Feds have no standing on this issue. Yup, they do it all day long and no one calls them on it.

[Johns]

Just because it's legal and common doesn't make it ethical or justifiable if all the patient is doing is being cheap IMO

So...if they're not being cheap, and want to drop a chunk of change it's more ethical?

I neut & dupe anything a customer brings in, and make them a pair of glasses from it. In my state, it's all legal, and VERY common practice.

[Uilleann]

State law...Feds have no standing on this issue. Yup, they do it all day long and no one calls them on it.

Hmmm, and again, what are the interstate implications of this? What does the FTC have to say - they're federal, and they regulate optical Rx release in many cases correct?

[Johns]

Hmmm, and again, what are the interstate implications of this?

We can do it, but the customers can't wear them across state lines? (just a guess)