Should a prescription be required for CPAP?

[SuperSleeper]

Netskier, I'm probably as guilty on this as you, (and I have strong political beliefs also) but it is best to post thoughts on the political end of this discussion in the Off-Topic forum. You can always post a reply here with a link to a new thread on the Off-Topic forum and folks can reply to the political aspect of the discussion in your new Off-Topic thread. That way, we're keeping the original post on-topic and also allowing for open discussion of the politics of "free" healthcare and "free" education and such. I personally think that would be an interesting discussion for the Off-Topic forum and I would probably participate in it, but some folks don't like to talk politics in a sleep apnea forum, which is why we have the the opportunity to post stuff like that in the Off-Topic forum, separate from the Main Forum.

Your above post is fine, but I'm just heading-off any further trend towards a major political discussion in the Main Forum. If anyone wants to address the politics side of this in a major way, Off-Topic Forum is best for that.

We're having too many threads go off topic here lately. We will not restrict the discussion of politics as you know, and I don't bother with simple short political statements here in the Main Forum, but when threads tend to go into long explanations that have only a distant relationship to the original post, they should really be posted in the Off-Topic forum.

Thanks.

[greatunclebill]

Getting back to the original question about needing a prescription. I think the term prescription itself is probably a source of confusion. When talking about drugs classified as controlled dangerous substances by a regulatory authority (e.g. the FDA in the USA) it is generally understood that a Medical Doctor's prescription is needed, however there are other cases where prescriptions are needed but may or may not be a legal requirement. For example if you participate in a Medical Reimbursement account you can not claim reimbursement for over-the-counter drugs unless you have a physicians prescription, however you can freely purchase these drugs at your local grocery store. Likewise insurance carriers may also require a prescription for medical tests and equipment, in these cases the prescription is being used as a form of approval for coverage rather than legal acquisition of a service or device.

there is no confusion on cpap's if that's what you are saying. it is not about insurance compensation or approval. it is about it being a controlled medical device. if it was only about insurance, mainstream companies would sell them for cash without a prescription. there was another discussion in another thread about the fda requiring prescriptions on more than just the machine. the question was should a prescription be required for cpap. my answer is yes.

[Dreamcatcher]

As it keeps getting stated sometimes I would just like to point out that over here in europe we do not pay for our equipment and that includes renting. We have no renting over here.

From being sent to the doctors to getting all our equipment including replacement parts masks etc we do not pay anything. If I need a new mask or machine I just phone my clinic and they post it out to me. In the UK we have an extra tax called National Contributions which comes of your wages and its this that pays for our health service, so technically I supose you could say we do pay in around about way.

As for perscriptions I think for now its best that they stay but I still feel hard done by when I have to go to Israel and canada for extra parts that our hospitals wont give out.

[mcbre1]

I had to argue for it, and in the end, buy it outright because my Dr. wouldn't submit that I needed one.

So how did you buy it w/o the prescription from the Doctor?

[Shastzi]

The machine can be closely regulated and not require a prescription.

You can buy an airplane without any prescription or even a license and yet it is a very tightly regulated vehicle able to pruduce massive property damage and multiple deaths if misused.

[Allen]

I believe initially a prescription should be required for a cpap machine, but I also believe it should be the individuals choice as to whether they want a cpap or apap machine.
Fortunately for me as I can afford to pay out of pocket without need for insurance, I can order any machine I want from the US without a prescription. Even though I do have a prescription, it isn't required when ordering from a US online store because I live in Australia.

[2Tim215]

Sort of a tough Poll due to the international audience we have here. So I will have to limit my comments to USA. Without the politics underlying my current opinion I have to vote Yes. This is a vote considering how many people would probably not receive needed therapy if they have to pay "out of pocket". Currently our insurance pays 80% and during the "Rental" period our payments are spread out over several months. For a person with several health issues and several co-pays every month, it would have taken quite a while before I would have been able to save enough to buy "out of pocket". Keep in mind this would mean, machine, humidifier, hoses, filters, masks, etc. Of course I could have lived without the humidifier until I could afford it but might lessen my ability to succeed with proper therapy. I personally believe at this point and time that many people would not be able to obtain the equipment they need without a prescription to obtain the life saving equipment they need NOW. Interesting Poll, I've learned a lot!

[jgjones1972]

I'll spare everybody the political rant that is swirling around in my tiny little head right now and just stick to a reply.

No, I don't think a prescription should be required for any of it - NONE. And that goes for all durable medical equipment and supplies as well as many medications.

As far as insurance goes - you pay for the coverage you get; and while some bargain basement, catastrophic coverage policies might not cover it (and don't now), I bet most policies would. Insurance companies would be foolish to make a practice of excluding PAP coverage if the policies they write still cover the numerous health complications resulting from untreated obstructive sleep apnea; so it would only make sense that this coverage would be standard, though they might require a medical diagnosis and/or statement of medical necessity (kind of like the way they require a referral to pay for a specialist). Any govt. health program SHOULD see it the same way - pay for it if the Doctor says it's needed.

If somebody wants to self-diagnose and pay out of pocket to buy one, I'm OK with that. The only one they could harm is him/herself.

I love my APAP, but seriously, how many people would buy one out of pocket and use it if they didn't need it?

Foolish people can harm or even kill themselves with many things you can buy without a prescription and there isn't a whole lot we can (or should, in my opinion) do about that.

There are OTC drugs at any drug store that pose a greater risk to the health and well being of idiots who misuse them than a machine that generates air pressure and a mask to direct it into their airway; so does that mean that a prescription should be required for acetaminophen? I think not.

That's my two cents worth.

[SuperSleeper]

I love my APAP, but seriously, how many people would buy one out of pocket and use it if they didn't need it?

Foolish people can harm or even kill themselves with many things you can buy without a prescription and there isn't a whole lot we can (or should, in my opinion) do about that.

Very good points, JG... There are many over-the-counter drugs that, if taken in large quantities, can kill you within hours. Sleeping pills comes to mind as one example. Can CPAP kill you within hours? I dunno... pretty unlikely, it seems to me, unless you're going to be stupid with it, like you would be if you took 50 sleeping pills. So why are CPAPs prescription-only, yet sleeping pills are not?

Laws that are designed to "protect us from ourselves" seldom work properly and have unintended consequences and increased costs.

Some say that they need to be prescription-only in order to fit within the current medical payments system, or to make sure the machines are kept safe or manufactured with minimum standards of safety. But my question is why couldn't that be done outside of a prescription system? I would think it could.

Anyway, I tend to be more of the libertarian type when it comes to stuff like this. Many times, over-regulation only increases patient costs (and health insurance costs).

Yeah, I'll abide by the law as long as it's not infringing upon my God-given rights. That's why we abide by the prescription laws for CPAPs and masks here on Apnea Board and don't allow folks to sell, trade or transfer prescription-required items on the forums. That said, I still think it's a stupid law.

[jgjones1972]

According to an FDA report looking at the years 1990 to 2001 - 26,000 people were hospitalized and an average of 458 deaths were caused each year from acetaminophen overdoses. Issues leading to these overdoses included taking more than the recommended amount of a medicine containing acetaminophen and taking recommended doses of multiple medicines containing acetaminophen at once.

Other sources cite an FDA study showing acetaminophen abuse as a leading cause of liver disease and failure.

I'm not trying to pick on Tylenol here - I'm simply pointing out these statistics because Tylenol and generic equivalents seem so innocuous and are so readily available without a prescription...which finally brings me back to topic:

Does anybody know any statistics for or have any information showing accidental or intentional death or serious injury as a result of PAP use or abuse. It seems to me that one could harm him or herself by using insufficient pressure to properly treat obstructive apnea which would allow the complications of untreated obstructive apnea to cause harm, but I don't think this counts because we don't blame other medications for deaths that are caused by insufficient doses to treat the conditions they are intended to treat. PAP may be more dangerous for people with certain pre-existing medical conditions, but I don't think this counts either because we don't require a prescription for peanuts just because some people have peanut allergies. Many may point to excessive pressures leading to increased instances and/or duration of central apneas. Are there any stats on this? Any demonstrated instances of this leading to death or serious injury? I don't know the numbers and can't seem to find any.

Seems to me I once heard something about a ResMed machine being able to do bodily harm if the user accidentally pulled it onto their own head though.

As far as obeying the law goes though, I'm with you on that SS.
I obey it; but, I gripe, whine and moan about it too.