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Thread: doc recommendations vs. rx

  1. #1
    OptiBoard Apprentice
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    doc recommendations vs. rx

    How do you all handle it when a doc insists on writing a brand of progressive on an rx and then telling pt that its part of the RX so it must be filled.

    My understanding is that brands are RECOMMENDATIONS and you can not force the consumer to purchase. Some pts have ltd income, insurance allowances etc..,

    Also wouldn't this be some sort of violation the ftc would be interested in?

  2. #2
    Ophthalmic Optician
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    It is my understanding that if a specific drug and doseage is prescribed, and it is written, "No generic equivalant" that that drug must be used. I would assume that the same would hold true for an optical rx.

    I see no problem with an MD or an OD prescribing a particular brand. They must have gotten the desired results from it in the past and want the best for the patient. Of course, we all know the flip side to this profit building technique used at on-site dispensaries.

  3. #3
    Bad address email on file Susan Henault's Avatar
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    Excellent topic!

    I am very anxious to see some feedback on this issue. First of all, let me say that I have NOT specifically researched this, but over the years I was taught by industry professionals that prescription drugs are controlled substances -- spectacle lenses are not. I was also taught that contact lenses are controlled medical devices, yet again, spectacle lenses are not. I do not state these things as fact. On the contrary, I would like to hear some of the doctors share what they know about the law. I suppose it may vary by state, but I have not heard that to be the case either.

    If indeed "Johns" is correct, all I can say is that there are thousands of eye care professionals out there that do not adhere to such standards -- and I am not just referring to the chains.

  4. #4
    Master OptiBoarder Joann Raytar's Avatar
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    I've seen certain brands written on an Rx just to specify that it was written for a progressive. The brand replacing the generic term in the same way someone might ask for a Kleenex as opposed to a tissue.

    If the Doc actually said the brand was part of the Rx, there might have been non-adapt issues in the past or the Doc may feel this is the correct lens match. A few lifestyle questions might give you a hint.

  5. #5
    Bad address email on file optigoddess's Avatar
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    While I was in Idaho, I actually had a 3-way call with the corporate attorney and the state attorney generals office over this very issue. In Idaho, brands of spectacle lenses can not be prescribed.

    Now, in Oregon, we have some offices that "prescribe" the "brand" of a/r and progressives and mark off "No Substitutions". Our store management will not pursue finding out if this is actually legal in Oregon (although I have explained the situation and outcome in Idaho).

    Jo does have a point that it COULD be an adaptation issue but I suspect that the Dr's are writing this way because they know that we (chains) can not get these brands from the wholesalers and the Dr is expecting that the patient return for service.

    Karen (very jaded and untrusting, I know...)

  6. #6
    Master OptiBoarder Texas Ranger's Avatar
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    This certainly an issue...As an independent optical shop, I can get pretty much anything made. But the question is, is the doctors "suggestion" binding? sorta like saying anything on the written rx is, beyond the Rx numbers themselves and with some docs practices, that's even suspect,; like "add a +.25 for pal lenses", does anyone do that? or the pt, that you measure their monoc. p.d.s at 30 od, 34 os, and the rx says 60/57, and they had a 2.00 cyl at 45; the question is, when I do it the way it's written, is the prescriber going to pay the cost of remaking the lenses? not likely, and all those little "clerical errors" like "mistakenly" writing a sign wrong, or forgetting to put a 1 in front of the 80 on the axis, little things, just rarely happens with "non-dispensing" docs offices....hmmmm? I go the cussing out of my life several years ago, when we had a minor emergency clinic next door, the clinic's doctor brought his wife in for glasses, she demanded to have pal lenses, like some of her friends, the doc rx had ft-35, with a 225 add, we honored the pt request, when she picked them up, she hated them, immediately, took them right off, set them on the desk and walked out the door!! a hour later I got a call from the OD, heard some words I hadn't heard since I was a Navy Corpsman! the ladies doc husband paid me for the glasses, and took the frame and had the ft-35 lenses made at the od's shop! I still believe that it's the patient's business to decide what they want, what they should be paying for it, and stand behind what you let them buy...but I also know that there are serious differences in the function of some pal lenses over other designs. just be sure to take accurate monocular pd's, both horizontally and vertyically, don't overplus the add, and try your best to match base curves, and most designs will work fine on the average presbyope...

  7. #7
    Sawptician PAkev's Avatar
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    Beth,

    Although you didn't exactly indicate, it appears this is an RX coming from outside your office.

    This is actually a common practice in our office and a few other offices in our area. When folks ask for a price on PAL lenses we sell from premium lenses down so the expectations of the patient are are mostlikely to be met. Of course we dispense generic alternatives but usually when the patient has a price objection or does not recognize the value added benefits which premium PAL lenses offer. That being said, this equips the patient with a better tool for them to compare "apples with apples" among the retailers they may shop.

    We do not receive kickbacks from manufacturers but make an effort to create the best experience with PAL lenses for out patients and have greater success with some and not so good experience with others.


    Kevin

  8. #8
    OptiBoard Professional Robert Wagner's Avatar
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    Written Rx

    Here is another question on the same topic:

    If you get an outside Rx and it is written like any-other Rx with the wording under the last add power says Trifocals or PAL.

    If the patient wants to purchase lets say 3 different pairs of glasses and the patient wanted:

    1. Single vision for distance
    2. Distance with bifocal for reading (no trifocals)
    3. Intermediate only for computer use (no bifocal)

    Are we "breaking some rule or law" if we fill the Rx as is mentioned above?

    I know the prudent thing to do is to call the prescribing Dr. and get permission to fill his/her Rx as the patient wishes,or should you fill it exactly what is written and then send the patient back to the Dr. after you fill the Rx and have him/her write another Rx(s) accommodate the patient's wishes.

    Myself, I will not change any power (s) of the Rx, but I do however listen to the patient and try to fit the glasses to the patient's life style without calling the prescribing Dr. and in 30 years I have never had a Doctor call me and chastise me for doing what the patient wishes (keeping the Rx numbers correct and unchanged as written.

    Example, Golf , tennis, swimming, shooting, bird watching, etc...

    Have I been doing things "against a rule-law" ?:finger:


    Robert W.
    ;)

  9. #9
    Master OptiBoarder Texas Ranger's Avatar
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    Robert, the incident I mention earlier was the "only" time a doc has called about this situation. I would think "common sense" should prevail, and usually does...the pt. is your client, thay are tryimng to fill a need for better vision within their lifestyle. saying that anything the patient wants contrary to what's on the rx is out of bounds, is a disservice to the patient...

  10. #10
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    As long as we are on the subject, can you make several pairs of glasses for specialized use (near, intermediate, computer, etc.) from an single Rx.

    Another related subject for those who are "sticklers for the law" , whatever happened to the common roof law? You know the one that states: "All precriber owned dispensaries can only fill Rx's by those precribers who 'share a common-roof' with the dispensary."
    Unless this has been struck down a precriber owned office cannot fill outside Rx's anyway.

    Chip

  11. #11
    Sawptician PAkev's Avatar
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    I'm really not sure why this is construed as a problem.

    Unfortunately more Dr's have a greater impact on influencing patients than opticians. The result; many a patient walking through our doors believe if the Dr. doesn't recommend something then it is not necessary.

    But in this case when the doc recommends a premium lens manufacturer, the dispensers (in or out of Dr. office) job is much easier to sell a premium product and recognize a little extra profit margin.

    Kevin

  12. #12
    Master OptiBoarder Joann Raytar's Avatar
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    Re: Written Rx

    Robert Wagner said:

    If you get an outside Rx and it is written like any-other Rx with the wording under the last add power says Trifocals or PAL.

    If the patient wants to purchase lets say 3 different pairs of glasses and the patient wanted:

    1. Single vision for distance
    2. Distance with bifocal for reading (no trifocals)
    3. Intermediate only for computer use (no bifocal)
    I believe you are interpreting the Rx and filling it with lenses that meet a patient's lifestyle needs. I believe the only exception would be going from SV to a multifocal, plano over near, when the Rx states only the near vision correction. You cannot presume that there is no distance prescription. Of course, folks can buy bifocal readers. Go figure.

    I have one problem with prescribers heavily recommending brands. What if the Optician determines that the brand recommended isn't the best choice for the patients tasks or Rx frame match? You now have to deal with a patient who has a built in negative impression of any other lens you might chose. It is almost a non-adapt wish fulfillment.

  13. #13
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    here's two cents worth

    As a doctor, I don't see a problem with occasionally indicating a specific lens design. Why would that be different than indicating a specific base curve, material, or p.d.? For most prescriptions it's not necessary, but there are some people out there that you know will have problems adapting to something other than what they have got, or conversely, what they've got does not work and you want to be sure that they don't get it again. There ARE differences between PAL designs, materials can make a difference, and a PD or Base curve change can make or break an Rx. I also frequently prescribe over the counter items like specific dry eye treatments and vitamin supplements. Just because its not a controlled substance doesn't mean that just any generic will do fine. Again, for most patients, it's not necessary. The last thing I want is a patient back for an Rx check or nonadapt problem that could have been prevented.

  14. #14
    Master OptiBoarder JennyP's Avatar
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    As relates to life style questions: I remember my pharmacist asking me several years ago if my young daughter could swallow pills or still needed the liquid version of her antibiotic. Supposed to be the same medicine, but she tolerated the liquid and kept more of it in her system than she would the pills, so that was our choice. Lens choice can also be a matter of individual acceptance. If the doc knows what has worked for this patient before, I am all for the doc writing it on the rx recommendations. But specifying a lens brand? That's like my car dealer saying I should only buy beige Chevrolet vans since that is what I currently drive! Maybe I want to try something red! And maybe I want a sports car this time! (Please note, I do not mean to imply dealers = doctors or vice versa. )
    "The Good Lord gave us mountains so we could learn how to climb". ~ Lonestar

  15. #15
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    Here in PA, going back 15 years to dispensing and fitting, if someone brought in an outside Rx to our store with a PAL manufacturer specified we would explaine to patient that we would fill Rx with a lense that was equivalent.
    After talking with patrient we would make near RX if patient wanted reading, or make intermediate if patient wanted, without contacting the Doc. This was what we were there for.
    Curious to know how different things are today and different in your state.
    Joseph Felker
    AllentownOptical.com

  16. #16
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    When an rx contains specifics, such as base curve, material or a particular brand of lenses, I call the prescriber to discuss any issues that may arise. My job is to know how to correctly interpret an rx to provide optimal vision for my customer. If there are reasons why the specified parameters won't work, the prescriber should be informed so that the patients record can be noted. Conversely, if the specified parameters are there for a reason, I need to know that also.

    The prescriber and dispenser should be working together to provide vision services to the consumer. Everyone should win. Prescriber makes a profit, dispenser makes a profit, consumer gets what s/he wants and needs.

  17. #17
    Bad address email on file Susan Henault's Avatar
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    Regarding "common roof" laws, I do work with some dispensaries that adhere to such a policy, and though I am not positive, I think it might vary by state. I find MD owned opticals are more likely to follow that guideline. In fact, while waiting to see a customer recently, I found a frame that I really liked. I told them I wanted to purchase it (the frame) off the board, and they refused to sell it to me. They said that they are not permitted to sell ANYTHING to ANYONE that is not a PATIENT of their clinic. In my umteen years in the business, I had never heard of such a thing!

    Also, regarding whether you can accurately fill an rx with multiple pairs with only one prescription: in many cases you cannot effectively solve all of a patient's visual problems with just one pair of eyeglasses (especially presbyopes). If the (one) rx includes both distance and add power, you should be able to accurately fit multiple pairs, including most of today's computer lens options. As Jo stated previously, if there is no separation and you are given only a SV prescription for distance, mid-range or NVO to work with, then all bets are off.

  18. #18
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    I thought that several years ago that with the prescription release laws, that it said that recommendations of name brands of lenses were not part of the prescription. They are recommendations. A prescription is a wrtitten order of lens power and is not to have disclaimers. My favorite disclaimer is... Dear Mr. Optician: Do not fill this rx unless you are prepared to remake lenses at no charge.

  19. #19
    Master OptiBoarder Texas Ranger's Avatar
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    Can you imagine if GP's started doing that? "Well, Mr. Pharmacist, if this Rx doesn't do the trick, you will be responsible for providing whatever other Rx we desire to experiment with, at your expense" See how that flys? same thing, so how did it get to be Mr. Optician's responsibility? the docs seem to think of it like this: "well, you made all the money on the glasses, so you should pay for my mistakes", makes perfect sense...and when the doc makes a mistake, they usually find a way to implicate Mr. Optician as the "culprit" who did something wrong, but, since they were going to have to be made over anyways, might as well tweak the rx while we're at it, like add an extra .50 to the add...right!!

  20. #20
    Master OptiBoarder
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    I only have one OD in the area that still uses that disclaimer. I have had customers point it out to me, and I've hammered the guy, and will continue to do so. He also has a 1 year expiration date on EVERY rx. I thought that they had to be a minimum of 2 years and no more than 4, unless there was a condition that required more frequent lens changes. I can live with an occassion 1 year expirtion....but every rx?

  21. #21
    Bad address email on file optigoddess's Avatar
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    re: Expiration Date -

    Our policy is:

    1) we won't fill if the Rx has an expiration date & it is past that -

    2) we won't fill if the Rx is beyond 2 years


    Some people get bent out of shape over that but when we explain we are, to an extent, like a pharmacy and we are not able to fill an expired Rx.

    We try to emphasize that an eye exam may not reveal a new prescription for glasses but that regular eye exams are needed for EYE HEALTH.


    (back to our regular programming...)

  22. #22
    Master OptiBoarder OptiBoard Silver Supporter varmint's Avatar
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    Wow a lot of spin-offs on this subject.
    I think the lens type should be the patients informed choice. Sometimes depending on the circumstance the prescribing Dr may need to be called. I always like the same BC recommendation. With todays new aspherics and technologies, I think sometimes its in the Pt's best interest to disregard that recommendation. I agree with Judy's response to this issue.

    As far as Rx expiration, I'm with the belief that I have the ability to duplicate the patients eyewear regardless of age of the Rx, and I believe our state license permits us to do so. Of course the patient is always recommended to have a new exam when we know the Rx is over 1-2 years old, but that is the patients choice as well. I like the business I get from offices who have refused to do this, and the Pt's are usually very angry at those offices.

    I've seen the same disclaimer on a local discount price competitors Rx saying you will be responsible for any Dr changes by filling his Rx. I just point out to the patient I will not take responsibility for any Doctors mistake made while he did their exam, but I will take responsibility for filling the Rx correctly & accurately, however if your Dr does make an Rx change, there will only be a small lab cost necessary to be covered.
    Not everyone needs to be told what is best for themselves. That is why we have too many laws written to protect us from ourself.

  23. #23
    Master OptiBoarder Texas Ranger's Avatar
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    Part of the problem with rxs expirations is that the FTC says that when an eye doctor performs an exam and refraction, that the 'written Rx" be given to the patient "even if there is no change". I see at least 2 people every day, so 10-12 a week, 50-60 a month, that say, "oh, I had an exam last month, and the doctor said "there wasn't enough difference to justify a new Rx", so they didn't write on at all, so yes the pt. has had an exam, but in violation of regulations of Rx release, the pt wasn't given the Rx. so we have nothing to compare, and if the old Rx was expired, nothing to make...so, now the pt has to go back to the Drs office and request the written rx...

  24. #24
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    I will not fill an expired rx either. In CA we cannot neutralize so if I do not have an rx than is valid, I'm out of luck. I also have people come in wanting new glasses but Dr. says no change, so, they did not get a new rx. Most of the Drs. in my area are real cooperative and a phone call is all it takes to get the rx. Except for "Dr." that uses the disclaimer that I mentioned earlier!

  25. #25
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    It is funny to me that in places like Nevada for example, it is legal to neutralize a pair of old glasses and make new ones according to that Rx, yet it is of course not legal to fill an Rx that expires after one year. But all that aside......


    It is reasonable to say that there are only two things on a spec. Rx that cannot be fooled with.

    1) The expiration date. This is up to the doctor as long as it is at least one year.

    2) The actual Rx itself. This is excluding adding or subtracting the entire or a portion of the add to accomidate the patient at differant focal lengths that he/she may need. This is not CHANGING the Rx, it is manipulating the focal lengths.

    As far as brand is concerned, there is no way that a doctor can specify a brand as part of an Rx. Any specification of brand is a "recommendation" or in some extreme cases of courtesy; information letting the dispenser know what PAL has been used in the past that the patient is comfortable with.

    Always specifying a brand as part of an Rx is easily ignored and if the doctor is doing it with the intent of eventually having the patient come back for what they reccomended.......it doesn't work that way.

    :shiner: ad

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