CL Rx good for 1 year or a 1-year's supply?

**Andrew Weiss** · 08-27-2007, 11:19 AM

This question came up in our office today:

Our doctor says that his contact lens Rxs are good for a one-year supply of lenses, not for one calendar year.

Any thoughts?

**1968** · 08-27-2007, 11:39 AM

Originally Posted by Andrew Weiss

This question came up in our office today:

Our doctor says that his contact lens Rxs are good for a one-year supply of lenses, not for one calendar year.

Any thoughts?

In my State, the contact lens prescription must specify an expiration date. I do not see that the law requires me or prevents me from specifying the quantity of lenses a patient may obtain. I currently do not specify quantity as I do not think it really prevents anyone from obtaining more than a 12 month supply.

**HarryChiling** · 08-27-2007, 11:48 AM

Originally Posted by Andrew Weiss

This question came up in our office today:

Our doctor says that his contact lens Rxs are good for a one-year supply of lenses, not for one calendar year.

Any thoughts?

We have a few patients that wear 2 week disposables weekly and throw them out. They say it feels more comfortable that way, if they were to see your doctor your saying that they would need to be examined every 6 months? That would blow.

**Johns** · 08-27-2007, 02:00 PM

According to my state laws...If someone walk into my office with an Rx that expires in 1 day, I can sell him 400 boxes, if that's what they ask for, so long as there is no amount specified.

I've never seen a specified amount.

**Andrew Weiss** · 08-27-2007, 02:02 PM

Originally Posted by HarryChiling

We have a few patients that wear 2 week disposables weekly and throw them out. They say it feels more comfortable that way, if they were to see your doctor your saying that they would need to be examined every 6 months? That would blow.

I kinda doubt that; he'd probably look at how they're wearing the lenses and say that what's normally a 1-year supply is, for them, a 6-month supply. At least I hope that's how he'd think about it; I don't think he's unreasonably rigid as a rule.

**obxeyeguy** · 08-27-2007, 02:21 PM

The Fairness to contact lens consumers act says a cl script is good for minimum 1 year.( if state law is longer, its ok) It also says you can limit the quantity, but not to artificially shorten the length of the Rx. The quantity must be enough to last thru the expiration.

You can stop them from buying a years supply 1 month before expiration, but I don't think its required.

**Andrew Weiss** · 08-27-2007, 02:26 PM

I'll expand a bit here:

This patient had ordered a 1 year supply of contacts from us and ran out of them about 1 month before his annual eye exam. He wanted a copy of his Rx so he could (and he said this specifically) order another 1 year supply from 1800 CONTACTS. Our doctor said he wouldn't give him a valid Rx but would gladly give him trial lenses to tide him over until his next exam.

In this context our doctor's position does not seem unreasonable to me, but I've never encountered a doctor who drew the line so firmly on this issue. His rationale is that the Rx is good for a one-year supply of lenses, not for one calendar year. Whether or not that rationale is valid, I think his intention -- to deter the patient from purchasing a year's supply of lenses a few weeks before his upcoming exam -- is good clinically (and makes more sense for the patient economically too -- what is this guy thinking??).

**chip anderson** · 08-27-2007, 02:55 PM

If the Rx is valid you may sell him as many as he will buy. Nothing against selling 10 years worth if the Rx is in force. The only reason for the 1 year expiration is so the doctor can sell him a years worth at the time of exam and he will have no recourse except to see the doctor for another exam and another years worth, hense being unable to buy from another supplier..

**1968** · 08-27-2007, 03:53 PM

Originally Posted by chip anderson

If the Rx is valid you may sell him as many as he will buy. Nothing against selling 10 years worth if the Rx is in force. The only reason for the 1 year expiration is so the doctor can sell him a years worth at the time of exam and he will have no recourse except to see the doctor for another exam and another years worth, hense being unable to buy from another supplier..

In other words, an eye doctor is NOT acting in the best interest of a patient when he or she indicates an expiration date (as required by law), but following your advice of selling that patient 10 years worth of contact lenses (or as many as he will buy) IS acting in his best interest. I see.

**Andrew Weiss** · 08-27-2007, 04:13 PM

Chip, 1968, I did not want to create another thread to rehash yet again whether the Rx expiration laws are a good idea or not. The reality is that the law exists, and what I want to know is how to interpret it.

Thanks, all.

**chip anderson** · 08-27-2007, 05:06 PM

1968, and Andrew:

I didn't say this was good idea or that one should sell more than a year's worth. I seldom sell more than a 6 pk per eye unless the patient request more. But as far as the law you can sell as many as you want. Just as you can make the patient as many pairs of spectacles as he wants with a valid Rx (I haven't seen one yet that says: "Good for one pair only.")
If the patient chooses to wear his spectacles or his contacts "beyond the validity of his Rx." it ain't your problem baby.
I am sure somewhere some time some enterprising board of optometry will attempt or possibly limit the number of products that can be sold on each Rx, except in his own store. But so far the law has not addressed this.
Now me if a patient asks for a inordinate amount of lenses or solutions or whatever, I'm gonna mention the expiration date, then let him get what he wants.

Chip:idea:

**1968** · 08-27-2007, 05:39 PM

Originally Posted by chip anderson

Now me if a patient asks for a inordinate amount of lenses or solutions or whatever, I'm gonna mention the expiration date, then let him get what he wants.

So, if he wants a 10 year supply of contact lenses, you would get it for him? You should take a look in the mirror before taking pot shots at the "hypothetical" board of optometry.

**HarryChiling** · 08-27-2007, 08:02 PM

Originally Posted by 1968

So, if he wants a 10 year supply of contact lenses, you would get it for him?

You would need a shopping bag to dispense his lenses, that'll be 80 boxes of Acuvue Advance, would you like me to load it into your trunk. :D

**Johns** · 08-27-2007, 08:18 PM

Originally Posted by 1968

So, if he wants a 10 year supply of contact lenses, you would get it for him? You should take a look in the mirror before taking pot shots at the "hypothetical" board of optometry.

By law, he's walking out of your office with his contact Rx in hand. How do you know he doesn't stop at 5 different stores, then go home and order more on line?

What's the difference if he does it day one, or the one day before it expires? And now the prescriber is going to say he won't release it if he's going to go online with it?

What kind of control does the prescriber think they have?:hammer:

The pts. can, and do, use the law to their favor. If we don't like it, we should change the law.

**1968** · 08-27-2007, 08:41 PM

Originally Posted by Johns

By law, he's walking out of your office with his contact Rx in hand. How do you know he doesn't stop at 5 different stores, then go home and order more on line?

I don't.

Originally Posted by Johns

What's the difference if he does it day one, or the one day before it expires?

There isn't.

Originally Posted by Johns

And now the prescriber is going to say he won't release it if he's going to go online with it?

Is that a question for me?

Originally Posted by Johns

What kind of control does the prescriber think they have?:hammer:

The pts. can, and do, use the law to their favor. If we don't like it, we should change the law.

The law is fine, as far as I'm concerned. Other than what I write on the Rx pad, I don't presume to have any control over what others do. And that was my point about Chip. He stated he would give the patient whatever he wants, apparently regardless of what is in his best interest. If the filler of an Rx is not going exercise his or her control and put any thought into what is in the patient's best interest, perhaps he should not be filling the Rx.

**MarcE** · 08-27-2007, 10:02 PM

Originally Posted by Johns

According to my state laws...If someone walk into my office with an Rx that expires in 1 day, I can sell him 400 boxes, if that's what they ask for, so long as there is no amount specified.

I've never seen a specified amount.

It happens every day. We always specify an amount on the Rx. If it's one 1 month until the Rx expires, we will write an Rx for 1 box, even if they never bought a box yet (i.e. still wearing the diagnostic lenses). I hope lots of O.D.s and OMD are reading this and start specifying amounts. Of all the things that are done to care for our patients; it's hard to believe that we could allow someone to buy several year's supply of CL the day before the Rx exprires. Scary.

**1968** · 08-27-2007, 11:42 PM

Originally Posted by MarcE

It happens every day. We always specify an amount on the Rx. If it's one 1 month until the Rx expires, we will write an Rx for 1 box, even if they never bought a box yet (i.e. still wearing the diagnostic lenses). I hope lots of O.D.s and OMD are reading this and start specifying amounts. Of all the things that are done to care for our patients; it's hard to believe that we could allow someone to buy several year's supply of CL the day before the Rx exprires. Scary.

This all sounds good to me, however, my experience has been that specifying a quantity on the Rx (or on contact lens verification faxes) does not prevent patients from getting more than the quantity I specify.

**Johns** · 08-28-2007, 09:43 AM

Originally Posted by 1968

If the filler of an Rx is not going exercise his or her control and put any thought into what is in the patient's best interest, perhaps he should not be filling the Rx.

My point is that the "filler" of the Rx is nothing more than a retailer, regardless of the fact that the person that wrote the Rx isn't.

Like you and MarcE said- unless the limit is specifically listed, which it usually isn't, you can't control it.

I have a question for those that write amounts:

If you write "1 box" on the Rx, is the "filler" supposed to take the Rx from the pt. and keep it?

And again, this isn't possible for internet sales. Is the writing of the amount designed mainly to cover the prescriber?

I really am curious, as I'd like to start doing this at our offices, but don't really see how it can have any positive affect,other than to cover the person writing it.

**chip anderson** · 08-28-2007, 09:55 AM

As you can see, I have inadvertnetly started the see in the O.D.'s mind that the amount of product can be limited on the Rx. And I know this is common on medications (should be, as patient needs re-evaluation for effects of medication and condition).. I predict that soon, very soon someone will attempt to introduce something into a legislature somewhere.

What should one do (and I have had this happen) when the patient tells me that she is going to Bangladesh for two years on a missionary trip and needs two years worth of soft lenses and an some back-up spares. Tell them "I'm sorry you will have to come back to U.S. for re-exam or see someone in Bangladesh for new Rx?

I suppose this all boils down to if you give someone a little power they always want more, ususally under the guise of "bono si publico."

Chip

**DragonLensmanWV** · 08-28-2007, 11:14 AM

Originally Posted by Andrew Weiss

I'll expand a bit here:

This patient had ordered a 1 year supply of contacts from us and ran out of them about 1 month before his annual eye exam. He wanted a copy of his Rx so he could (and he said this specifically) order another 1 year supply from 1800 CONTACTS. Our doctor said he wouldn't give him a valid Rx but would gladly give him trial lenses to tide him over until his next exam.

In this context our doctor's position does not seem unreasonable to me, but I've never encountered a doctor who drew the line so firmly on this issue. His rationale is that the Rx is good for a one-year supply of lenses, not for one calendar year. Whether or not that rationale is valid, I think his intention -- to deter the patient from purchasing a year's supply of lenses a few weeks before his upcoming exam -- is good clinically (and makes more sense for the patient economically too -- what is this guy thinking??).

He's thinking he won't need that exam if he has contacts for another year. And you can bet that if he DOES keep his exam and his contacts change, he's going to want to return his unused ones for the new ones at even exchange.

**Andrew Weiss** · 08-28-2007, 11:58 AM

Originally Posted by DragonLensmanWV

He's thinking he won't need that exam if he has contacts for another year. And you can bet that if he DOES keep his exam and his contacts change, he's going to want to return his unused ones for the new ones at even exchange.

Good luck doing that with 1800 CONTACTS!

**Andrew Weiss** · 08-28-2007, 12:01 PM

Originally Posted by chip anderson

What should one do (and I have had this happen) when the patient tells me that she is going to Bangladesh for two years on a missionary trip and needs two years worth of soft lenses and an some back-up spares. Tell them "I'm sorry you will have to come back to U.S. for re-exam or see someone in Bangladesh for new Rx?Chip

Chip, if that happened in my office I would contact the prescribing OD/MD, explain the situation, and get an extension on the Rx (which I figure should be gladly given). If the Dr doesn't extend the Rx, well, I might be tempted to conveniently overlook something (like the quantity limit) . . .

**renee1111** · 08-28-2007, 02:31 PM

Canadians don't have this problem, because prescriptions from Optometrists do not expire...oh they can add an expiry date if they want, but it is at the discretion of the patient if they chose to have there RX filled, since it is their property.

**1968** · 08-28-2007, 08:08 PM

Originally Posted by Johns

My point is that the "filler" of the Rx is nothing more than a retailer, regardless of the fact that the person that wrote the Rx isn't.

I disagree. That is like saying that a pharmacist is just a retailer.

Originally Posted by Johns

Like you and MarcE said- unless the limit is specifically listed, which it usually isn't, you can't control it.

What I said is that you can't control it even if the amount is specified.

**1968** · 08-28-2007, 08:09 PM

Originally Posted by chip anderson

What should one do (and I have had this happen) when the patient tells me that she is going to Bangladesh for two years on a missionary trip and needs two years worth of soft lenses and an some back-up spares. Tell them "I'm sorry you will have to come back to U.S. for re-exam or see someone in Bangladesh for new Rx?

You should tell her to talk to her eye doctor.