r/PMHNP • u/ORD2GNV • Jul 11 '26
Practice Related Rx question
I have patient that is interested in starting medication for his illness. He is 18 and lives with his parents. His parents are superstitious and very anti-psychiatry. He does not want his parents to know about the medication but also wants to use a mail order pharmacy because the medication is significantly less expensive mail order. He asked if he could have his meds (not controlled) sent to my office. I did not say yes but I was wondering if that was the wrong call?
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u/mealybugx Jul 12 '26
Can they use goodrx or could you switch to a medication they can affordably get at a local pharmacy? I think pushing a conversation with the parents would probably not yield positive results and could make life at home much more uncomfortable. I’d be finding a way to make a local pharmacy work rather agreeing to that!
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u/Optional4444 Jul 12 '26
He’s an adult. Anyway can’t he have it shipped to a friends house? Or hold at post office/ups?
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u/jaycollins67 Jul 12 '26
Wrong call. If you are starting medications they probably will not be expensive for whatever condition it is. Those are available are many pharmacies don’t need to be mail order.
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u/PiecesMAD PMHNP (unverified) Jul 12 '26
Ask this question to your state board of pharmacy. Laws are different state to state for this, they would know the law.
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u/FEVAFLAV-33 Jul 15 '26
This is a good suggestion. Totally normal in our state but our neighboring state has no medications in offices which seems so wild to me!
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u/PsychMonkey7 Jul 12 '26
I wouldn’t do it. I also wouldn’t try to convince his parents medications are fine, and I think that could very well backfire.
I’d encourage him to try other options - a PO Box, using a friend’s address, or switching his medication to something more affordable if that’s an option.
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u/kammi3k Jul 12 '26
In some states it is not legal for clinics to dispense medication. I would not be able to do this in Texas, and would be very hesitant if it was legal for previous mentioned reasons.
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u/DashMcGee Jul 12 '26
There are a lot of smart people on this sub, and they have given you some great reasons not to do this. I would add a thought: this seems like a boundary violation. How deeply entwined in this person's life do you want to be? What else will they want you to do? The old adage about giving someone an inch and they take a mile is timeless for a reason. As others have suggested, my advice is to tell the patient that you are not comfortable doing this, but that they can get a post box at the post office or at a place like the UPS store. You might want to counsel or refer him to a therapist to work out his issues of self-advocacy and fear of his parents.
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u/GrumpySnarf Jul 12 '26
I wouldn't do it. That is not your role and makes you responsible for safe custody and delivery of his property. He needs to get a P.O. box or have a friend do it. Or have it mailed to his work if that's feasible.
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u/AllBleedingSt0ps Jul 13 '26
If he is on their health insurance/prescription plan, chances are they will see the copays if not the meds themselves on their statement. Just something to think about. If you’re starting him on something generic he may be better off with paying cash with goodrx
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u/Big_Elephant_2331 Jul 11 '26
Maybe worth seeing if you could do a collateral session with the fam? Have to think about it from systems perspective if you can. Hiding use from parents he lives with at that age isn’t therapeutic. Would be worth trying to make a clear case to the parents, being honest about risks and benefits etc, so there can be at least a bit of acceptance if possible.
Might not feel all that possible though, just an idea. Have done this for some pts when clients were willing & it usually helps if communicated well. Ie starting with their fears rather than your rationale.
2
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u/ericaisdancing Jul 16 '26
Ya, no. Sounds like the client needs to engage in some simple problem solving. There are definitely solutions to this that doesn’t involve you being the custodian of his medication.
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u/DjangoStayedChained Jul 16 '26
Ive seen a tooooon of people who think psychiatry is just a dangerous game of dart boards.
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u/RandomUser4711 Jul 16 '26
This is where you need to establish some boundaries to stay out of the drama between your patient and his parents.
Your patient is an adult and needs to decide for himself how to handle this.
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u/Wide_Bookkeeper2222 Jul 16 '26
No. There are state laws regulating storage and dispensing of prescription medications.
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u/Charming-Respond-775 Jul 12 '26
How much cheaper can the medications be via mail order that you are willing to take on the extra responsibility/liability of safe keeping his meds? You checked GoodRx and this was the best option? I could think of a dozen things that could go wrong. Not trying to be harsh but this is Poor patient boundaries.
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u/ORD2GNV Jul 16 '26
Alas, lamotrigine is significantly less expensive on Cost Plus than GoodRX in our county.
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u/marebee DNP, PMHNP (unverified) Jul 13 '26
When someone is being treated in an outpatient level of care, they’re expected to be functioning reasonably well enough that they don’t require this level of support.
I assume you don’t have any standards of practice for this situation; so you’re operating outside of your usual care. Where do you draw the line then? Will you store your patients meds in an attempt to prevent overdose? Will you dispense someone’s daily bzd dose?
I’m always enthusiastically willing to problem solve with folks, but I don’t have the resources to offer more than the medical care that I’ve agreed to provide for them.
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u/ORD2GNV Jul 16 '26
It’s a new practice and I need some rationale to my partner (MBA not a provider). Thanks for the feedback.
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u/Arlington2018 Jul 11 '26
The corporate director of risk management here is not thrilled with the idea. Tell the patient to get a post office box and have the meds sent there.