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Prescription Renewals?
#1
Question 
Was searching through the forums but was unable to get a solid answer for my question....

In regards to prescriptions, after the initial one to get the sleep study/XPAP, how often do you need to see your PCP to renew it? Does it vary from PCP to PCP? My fear is when I need to do a replacement of an item the DME stiff arms me because I have no script.

The reason I ask is I am about a month in and scheduling a PCP appointment next week. Wanted to know if I need to setup a recurring one while I am there. Or should I just ask the PCP what the requirement is?
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#2
The best bet is to discuss your CPAP therapy with your doctor and just make it a regular part of your ongoing care. An annual review of your usage and benefits of the therapy is enough, but it could also come up on a 6 month basis if you have regular appointments. It does not need to be the leading subject of conversation, but can be part of your wellness exam and general healthcare. The important part is to try to transfer the maintenance of your care to your PCP so that you don't rely on specialist, once you have a diagnosis and working prescription. You can discuss specific changes in your therapy approach like changes in pressure. This helps once it is time for renewal because you PCP is perfectly qualified to use your history and diagnosis to renew prescriptions. This gets things out of the sleep specialists realm where they are incentivized to request clinical studies, because that's how they do things for people that they don't expect to participate in their own care.
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#3
Well said Sleeprider. Thanks!
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#4
With my PCP, I bluntly requested that he manage my CPAP care. I provided complete records of my 2008 sleep study and prior prescriptions, and a written summary of my PAP usage and current pressures, along with a compliance report. All of this was scanned into my medical record with the PCP. That effectively means I have no specialist unless I request a referral.
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#5
(03-07-2017, 08:54 AM)Effers Wrote: Was searching through the forums but was unable to get a solid answer for my question....

In regards to prescriptions, after the initial one to get the sleep study/XPAP, how often do you need to see your PCP to renew it? Does it vary from PCP to PCP? My fear is when I need to do a replacement of an item the DME stiff arms me because I have no script.

The reason I ask is I am about a month in and scheduling a PCP appointment next week. Wanted to know if I need to setup a recurring one while I am there. Or should I just ask the PCP what the requirement is?

Hi Effers,
If you are seeing your doctor at least once a year, you should be fine.  Yes, a DME can be a real stinker especially if you don't own the machine yet.  If you are still in a compliance period, (usually 90 days), then you should see your doctor before that 90 day period ends, and then once a year thereafter.

You should also double check with your insurance company on the exact requirements.

And know that all DME's are different.  Some will give you a hard time and some don't seem to care.

I know that you will get advice that you don't need to see your doctor once you own machine, but once a year is not a big deal.   

Bottom line:  Follow the rules your insurance sets forth while you are in a compliance period.  After that, your DME may require proof of you seeing your doctor, but if not...it's totally up to you.
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#6
In California, the Rx belongs to the patient and may be requested by the patient at any time. I belong to an HMO that uses Apria as the mandatory DME. I've been working on the same Rx for my supplies for 7 years. There was a two year period in the middle where I maintained coverage from the HMO, but the group policy had changed and did not cover PAP supplies. I requested my Rx and went shopping around for PAP supplies. No problem. I am now Medicare Advantage with the same HMO and Apria is still working from the same Rx issued seven years ago.

Then again, the question is who's paying. When I got my Rx in hand, I was paying out of pocket and the vendor just wanted an Rx. If you're dealing with insurance in shop around, you have to call your insurance company.
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