Expired Rx, again.

[pinto]

I know that there has been several threads on this and I have searched previous threads and am still confused about the legal right to an expired RX. I was under the the impression that the expiration was not legally binding and it was not illegal to fill a a spectacle prescription that was past the expiration date. Is the expiration date a recommended time frame, or does the prescriber have the right to withhold a prescription that is over one year old?
Is it the same for contact lenses? I looked at 16 CFR part 13 and did not find a definitive answer. Please set me straight on this. Thanks

[m0002a]

It depends on the state. In most states, an Rx expires after 1 year, or the expiration date written on the Rx, whichever is earlier. There are sometimes differences for contacts. AFAIK, expiration dates are legally binding in all states (even if the time periods differ).

Check out your state regulatory agency for the details in your state.

[Audiyoda]

State of Michigan (I'm in West Michigan) expires a eyeglass Rx after 24 months from the date of exam unless the prescribing doctor signs a waiver indicating the Rx is alright to use and then the Rx is 'good' for another 24 months.

Contact lens Rx expires after 12 months, not way around it. The doctor cannot waiver a CL script - there must be annual fitting check on file for the patient.

Either exam can be withheld once expired. I personally have released a expired Rx - but I write in BIG RED letters across the entire Rx EXPIRED.

[chip anderson]

Depends as stated earlier on what state on is in. Law in each state depends on how great an influence the board of optometry has on the legislature.

[HarryChiling]

A way around it is some states will allow opticians to duplicate a Rx, if you quetion the Rx you could always dup it. ;) Check your state laws first.

Also, if you just need the Rx and the office is refusing to give it out, you can always have the patient sign a records release and they do have to send over the record as the information on it belongs to the patient.

[cocoisland58]

If it's an outside Rx and the expiration is clearly written we won't fill it but will duplicate from lenses if patient insists and it is duly noted. Generally we take this opportunity to do an eye exam since it always makes more sense if they are going to spend the money for new glasses that they put an updated Rx into them.

[optical24/7]

On the CL law, I believe there is a 3 month emergency extention.

[Shwing]

Can't get more definative than this: Circa 2007 no less...

http://www.eyesite.ca/english/program-and-services/policy-statements-guidelines/CPG-periodic-eye-exam_e.pdf

[motelska]

I was always under the impression that Cls Rx's expire 1 year after the prescribing date. Now correct me if i'm wrong, but it's my understanding that Contact lenses are considered a medical device (close your eyes and they're INSIDE the body) and the length of time that the prescription is good for is regulated by the FDA.

The Dr has the option of extending it a few months, but it's still a good idea to have the patient get an eye exam every year. We generally will give them a pair of trials and set up an appt in cases where the pt's Rx is expired.

In cases of Eyeglass Rx's i've seen 24 and 12 month expiration dates... here in cali.. 24 months is the longest you can have a eyeglass Rx, unless the Dr signing the Rx chooses to make it 12. That's their discretion. Our office will not fill an expired outside Rx. Our own patients... usually not, but there have been a few extreme exceptions.

[CME4SPECS]

motelska, Your statement is not accurate regarding expiration date on CA prescriptions.

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.

[orangezero]

First off, I should point out the possible trouble that could arise from using anything from Canada as a guide on legal applications in the US. No offense meant, but the legal system down here is just a bit different.

Also, while it is ultimately up to the patient to decide what is best and to seek care, I think its a poor policy to try to bend these rules/laws. It comes off as seeming a bit too eager to simply make a sale. I also think its a weak argument to claim these types of things are done simply as a way to help a patient out in a crisis or emergency. There is little reason to assume a crisis in eye care delivery that would realistically necessitate most of these types of eyeglass sales as allowed for in some of these laws. Patients can get in to most eye care providers offices the same day and almost all within the same week.

If its just about being cheap and saving the cost of an exam, please remember (at least in the US) these "cheap" patients are also the ones much more likely to sue everyone involved should something go wrong. An optician's name could certainly be pulled in to a malpractice suit when a patient was sold glasses from an expired prescription or made from lensometer readings and the patient ends up getting in an accident or looses and eye from undetected disease. This isn't good for anyone.

I would think it a better policy to recommend the patient first spend the few minutes to get an eye exam, and then return to your store for glasses. I've found most of these "emergency" patients in fact have not had an eye exam in years or even decades. AND, most importantly, despite what some think, patients generally are very poor at diagnosing vision problems and understanding their eye health and visual system.

Ideally, we shouldn't be looking for ways to get around or slight the intent of the laws. The laws are not set forth simply to ensure eye doctors stay in business, but rather to protect the eye health and overall safety of the community. I freely admit politics may play a role and there should be room for professional judgement. But I hope the vast majority of eye care professionals are just as concerned with patients vision and health as they are about making a sale (not implying you all are not, I'm just saying...)

Since this is an open forum the public and newer members of our professions look to for guidance, I think these points are important to bring up. Based on previous experiences, its more than evident there are some who will disagree with some or all of this. Its not my intention to get in a new round of arguments, but rather to look at this from another light.

I think in the end the patients will be better served and your business will be better for it.

[motelska]

motelska, Your statement is not accurate regarding expiration date on CA prescriptions.

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.

What about contact lenses?

[CME4SPECS]

Contact Lens Expiration

2541.2. (a) (1) The expiration date of a contact lens prescription
shall not be less than one to two 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 one
year, or the presence or probability of visual abnormalities related
to ocular or systemic disease indicate the need for reexamination of
the patient earlier than one year. If the expiration date of a
prescription is less than one year, the health-related reasons for
the limitation shall be documented in the patient's medical record.
In no circumstances shall the prescription expiration date be less
than the period of time recommended by the prescriber for
reexamination of the patient.

[HarryChiling]

Ideally, we shouldn't be looking for ways to get around or slight the intent of the laws. The laws are not set forth simply to ensure eye doctors stay in business, but rather to protect the eye health and overall safety of the community. I freely admit politics may play a role and there should be room for professional judgement. But I hope the vast majority of eye care professionals are just as concerned with patients vision and health as they are about making a sale (not implying you all are not, I'm just saying...)

In some states the laws are too stringent so their are cases where slighting the law is advatagious. I do understand the importance of a routine eye exam, but these very same patients are going to get them no matter who provides them. Their have been cases where a patient is going out of town and needs them right away, although rare this is the most commonly used excuse (I won't assume my patient is a liar, so I take their word for it). Fabricateing an Rx from a pair of glasses can be prone to error, however in some states it is acceptable and no matter where the Rx comes from the optician who fabricates it is usually responsible for the glasses in eighter case. Let's just say I disagree, but I do see the importance of an eye exam.

[Barry Santini]

When a client comes in with an eyewear Rx containing

an expiration date, I pause a moment, and open my dispensing drawer. I take out a little pocket calendar and begin writing in it, while saying the following:

Optician (me): "Oh, I see that your prescriber has included an expiration date on your eyewear Rx. I'm going to mark that June, 2008 date in my pocket calendar."
Client: "Why?"
Me: "If your Doctor feels that it would possibly comprimise your eye-health for me to *duplicate* this Rx after this date, then I do not want to to let these eyeglasses endanger your health through your continuing to wear them after this important date. I'll even make a house call to you to ensure you don't wear them even one more day than your Doctor feels is appropriate."
Client: "This is preposterous!"
Me: "Absolutely not! In fact, while I'm at your door, I even pick up any older *spare* pairs that you might have left around. When eyewear is akin to medicine, there's nothing healthy to be gained using a *medication* passed its expiration date!"

Whew!!!.....what utter nonsense!

Barry