Hi there fellow PWer's...there is lots of speculation re: this date, and the future of telemedicine.
Per information from a smaller OCS, I asked point blank what the problems/issues are when it comes to consults/refills and the like.

The alphabets are watching the online pharms for disproportionate ordering/dispensing of controlled medication. This one OCS response is to have the consulting telemedicine doctor dispense along with the controlled meds, a NON-controlled med. The owner is looking at something like a naproxen, an anti-inflammatory med to be shipped along with the controlled medication. This would satisfy and keep the OCS and the on-line pharmacy under the radar so to speak.
This would NOT be an additional cost to you, per CJ, the cost would be the OCS and the dispensing pharmacies cost..at approximately 10.00 per patient.

I am not aware of this being a doctor's licensing issue, more of a ratio of dispensing of controlled vs non-controlled meds.

I think and hope that this will alleviate some worry in this online community.

questions? Please feel free to post here.

Hey Kat,
I know there has been discussions in the upper echelon about trying to branch out into non- controlled medications. Being able to prescribe some non-controlled, like you said. It's just hard to get the word out- this kind of system would really help out the OCS's, the pharmacy and the doctors from being targeted so much.

I would be curious to see the reception for this idea from the patients.
Would it be more convenient to get your pain meds along with an everyday med from the same consult?

quote:

Originally posted by OSS Quality Care:
Hey Kat,
I know there has been discussions in the upper echelon about trying to branch out into non- controlled medications. Being able to prescribe some non-controlled, like you said. It's just hard to get the word out- this kind of system would really help out the OCS's, the pharmacy and the doctors from being targeted so much.

I would be curious to see the reception for this idea from the patients.
Would it be more convenient to get your pain meds along with an everyday med from the same consult?

I think this is one OCS response to the obstacles to telemedicine. If a patient were still able to receive their controlled meds, then the non-controlled would be included with the scripts to make the ROP's and on line pharmacies maintain their business.

I am a little skeptical that some are reading to much into this amended or clarified regulation under the CSA. At first glance and a quick reading it sounds draconian. However, if you read it a little more closely it is talking about the doctor who dispenses from his office or the location of the pharmacy the doctor uses are in the same state or geographic area. I didn't see much if anything about the patient in it. I may be wrong, and I didn't take a long period of time to read it real closely, but I perused the entire thing and some people may be jumping to conclusions. Like any "legal" document, many terms are used that have specific legal meanings that are not in line with the more expansive common undertanding of the terms. I will be interested to hear more, but I don't think it is panic time. It is true that the DEA and others are in the middle of a multi year attack on internet practices. And I, like everyone, am wondering when are they going to go too far. In addition to this baby, the DEA has just signed an administrative ruling from back in 2004 that was uncontested by the doctor for Southwest Medical this month to go into effect January. Keeping in mind it was uncontested and the hearing only had the input of the DEA and its witnesses, it is trying to administratively build its case on what constitutes an legitimate doctor/patient relationship. In this just published ruling was over an ROP/OCS doctor's practices. Of course their witnesses were an agent who submitted fraudulent documents and others that used several OCSs at once, one of their witnesses admitting to using 10 at a time. However, like I said, it was published regardless that it as uncontested and only their side was presented. In fact, one of the things I found wanting was they used the fact that the doctor ended his conversations with the patient with the pleasantry of "is there anything else I can help you with" as being characteristic of a drug dealer. Getting a little flimsy there. Okay, thanks Kat and Sandi and keep us up to date if you hear anything else.
PB
http://www.deadiversion.usdoj.gov/fed_regs/rules/2006/fr1201.htm
http://www.deadiversion.usdoj.gov/fed_regs/actions/2006/fr1227.htm

This message has been edited. Last edited by: pharmboy,

Hey PB, excellent points, and I personally don't think there is much to be concerned about.

But there are some that are concerned and thats why I questioned CJ about it.

Thanks all.

Oh, I think we have to be vigilent or vigulent (spell checker please!). I am trying to keep track of things also when I have time. I just had what I thought was a dependable, no narcs or benzos nrop go down that I thought was stable. Lots of things are happening, so this is a good thread IMO.
PB

I agree that not too much will change in the immediate week. But, the nrop's are going down- and ocs's need to keep up to date on patient records and law changes. I appreciate all the info you find Kat!

Sandi

Will the soma/tramadol type of NROP's stay up? Do you know?

This message has been edited. Last edited by: ~Kat,

No worries...I do what I can when I can.

I appreciate all the info you provide too Sandi...Thanks for the chat, very informative!

OOOPPPSS..sorry Sandi for the accidental edit..didn't mean to edit, meant to quote. Mea culpa.

Hey Kat,
loved chatting with ya- I think all american nrop's will eventually become illegal by new laws and regulations. They might not be able to track outside the US- but most people know not to try that route- way too risky for your health- never know what that stuff is or if it's safe for ya.

Take care Kat,
Sandi

P.S. I had a good friend named Katrina- so I sometimes mix up your name- sorry for that, I actually like your name better "Katerina" sounds like a russian princess

Thanks Kat, Sandi and PB for all of this information. I really do appreciate how you keep us all informed!!
PB, I knew you wouldn't be completely gone, we all love you, and many of us here, have too much of a bond for you to take off on us... With that said, I don't want you to think I would ever expect the same from you as when you were a mod, because you did go way out of your way, and please, just kick around and be our friend ( that's what counts the most) Now, your knowledge is just a bonus!
Love all of you guys!!
Amy

I have done some reading about this at another place where they are having a good discussion about it. There at least one attorney was commenting on these matters and I believe it is a guy, but he is concerned. There are really two administrative rulings here.

First, let me back up a little here. And, of course, I am not an attorney (although I play one on tv...J/K!). However, much of my work is in the legal field and I do work with attorneys all the time (although in a field not remotely related to federal drug enforcement or any type of law enforcement). But I do have a basic understanding on how things work.

First, these are what they call "administrative" rulings. They are not "laws". Only Congress, at the federal level can pass laws. However, when the Controlled Substances Act was passed, I believe in 1970 and effective 1971, that was a law. It has been amended a few times over the course of the last 35 years I am sure. But enforcement of the law then passes to he executive branch. To enforce the law, the agency created under that law, in this case the DEA, promulgates rules and procedures to enforce it, or, "administer" it. Over the course of time, an agency develops and changes the procedures and rules under the law on how they are going to enforce it, one reason being to meet changing situations it can encounter over time and without going back to Congress to constantly amend the law.

Not all enforcement of the law are criminal or even end up in court. They are "administratively" dealt with. For example, the suspension of a doctor's license or a pharmacist's license, or a cease and deceit order to a pharmacy are administrative affairs and if challenged (or in the one case I have talked about, even when not challenged)usually go to an administrative hearing presided over by an Administrative Judge that is an adjunct of the agency. Now there may be legal avenues to bypass this and challenge it in an actual court of law, but usually, if someone is not satisfied with the outcome of an administrative hearing, the ruling can be brought to, or appealed to, in this case a federal circuit court, where standards of evidence can be dramatically different, and issues my be brought up that couldn't be brought up at an administrative hearing. However, great leeway is given to the enforcing agency if their rules are generally reasonable to the intent of the law. There are lots of other technical/legal considerations and something called the Federal Registry, which is a place where changed regulations are published. Okay, enough of the civics lesson, I am sure I bored you to tears.

There are two DEA rulings we are talking about in this thread, both of which I gave a quick read to, but are lengthy and contained many legal references that I just don't have the time to read. One has to do with what Kat brought up. It has something to do with the location of the doctor and the dispensing of controlled substances. I still think it has more to do with where the doctor is licensed and where the medications are dispensed. The location of the patient is still not quite clear in my mind as being relevant to the ruling, although I have read that some think it is. Basically, if the worst interpretations are correct, it means that the doctor has to have a license to practice in the state of the patient. I just don't read that myself, but others have.

The second ruling, which I think is of more concern, is the Dr. Lockridge ruling. That is the one concerning Southwest Medical Group's doctor until recently. It was a suspension of his DEA license to dispense controlled substances brought against the doctor in 2004. First, the doctor was licensed in New Jersey I believe, but was never licensed in Florida where he actually practiced for the ROP. I can see that somewhat, that he wasn't licensed in the state he was actually practicing in. Second, he never contested the action of the DEA and let his license with them to dispense controlled substances expire and apparently isn't practicing anymore.

So an admistrative law judge, in 2005 made findings and probably most thought the matter moot because the doctor was out of the business. But the DEA went ahead with publishing the finding and in effect making the ruling, administratively, what they wanted all along. That is about the "proper" face to face, as we call it, doctor patient relationship. The ruling was signed the first part of December and is to take effect sometime in the first part of January this year.

The worrying part of this, over and above it being an old case and uncontested (which means just the DEAs witnesses testified)is that is formally establishes in administrative law that the practices that most of us think of when using a ROP/OCS are not legal. That it amounts to little more than being a drug dealer.

Now, this doctor looked a little sloppy sometimes in his practice and maybe wasn't the best example of ROPs. And the DEA used an undercover agent who admittedly submitted falsified documents and got a script of hydrocodone. They also used a couple of witnesses who used the OCSs and also admitted to fraudulently submitting records, etc. But now this ruling is on the books. It doesn't necessarily mean all things end. It is certainly a bigger gun for the DEA unless and until it is challenged in one way or the other.

What is going to happen I don't know. Frankly, I think there are enough nrops still out there offering apparent controlled substances that they could keep their priorities on them. But it should also send a signal for now to many OCSs and prescribing doctors to take a close look at, probably with the advise of an attorney. Also this type of ruling flies in the face the way prescriptions are written and received by patients under many insurance plans and government plans. How the DEA proposes to bring all these different pratices in harmony I don't know. They may be stretching a bit here because the implications are really not fully appreciated. Anyway, that is what I have been reading and my thoughts so far. Interesting to see the reactions of some of the OCSs.

As for me, I would just like to get my refill at the end of this week or next week without any hassles. So here is hoping it isn't that bad...
PB

PB- thanks for the concise summary of a lengthy and sometimes confusing issue. I am merely a tiny fish working in this industry so I really can't input as to what the plans are for my particular OCS company. I do know that there are usually many meetings with attorneys to keep updated with each new story and each new incidence of trouble in the industry. It certainly isn't for the faint of heart! We are just trying to help those people out there who need help to get out of bed each day and who don't have doctors who are willing to listen to them. I will try to keep you updated if I hear anything, but it usually seems to be you guys who keep updating ME!

So thank you PW family for ALL the information you bring! Sandi

Hello PW members:
An announcement from OnlineScriptSpecialist.com and our pharmacy partner concerning the new law that took effect today.

Until we can know fully the ramifications and possible consequences of this new law concerning doctors treating patients and writing scripts for patients only within their geographic "area", Our doctors will only be able to consult with patients who are within a state that they are licensed in.

It will take a week or 2 to get the required DEA licenses for each of the states, but this is the current list of states our doctors are licensed in:
Florida
New York
New Mexico
Oregon
Missouri
soon-- Conneticut

I will keep you posted as quickly as I get information- It will become more critical to ask which states the OCS's doctors are licensed and have DEA licenses in.


Our pharmacy partner has also announced that they WILL continue to send any REFILLS with our CURRENT PATIENTS, but from this point forward can NOT fill scripts for new patients unless the script is written by a doctor licensed and with a DEA license in the state that the patient is residing.

Take Care,
Sandra
OSS

Apparently RxScriptOnline is not taking any new patients at this time until they have a chance to review the situation also, I have just read.
PB

Yuck- what a mess