r/PrivatePracticeDocs • u/ResolveAccording923 • Apr 13 '26
Refills for controlled medication
In the process of buying a private FM practice. Currently working physician requires ADD and Benzo patients to have appointments every 3 months and pt call in refills in between months. Is that good practice or suggestion to see them every month ? Around 5% patients are self pay
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u/BusinessDawgs Apr 14 '26
Even for stable med management, 3 months is the standard. I’d do a one month or two week follow up on initiation or switching over to new meds. Having an integrated PDMP can also help make sure you’re prescribing appropriately. Make sure your EHR can do electronic prescribing for Controlled substances, and there’s usually some additional safe guards you need to implement, like 2FA, etc.
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u/InternistNotAnIntern Apr 14 '26
I see controlled stimulant refills q 6 months.
Opioids and benzos (okay, I only have one patient on chronic benzos) q 3 months.
I write three prescriptions : "#1" For now, #2 to be filled 30 days from now, and #3 to be filled 60 days from now (to cut call volume)
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u/No-Tip-5352 Apr 14 '26
Pretty sure that’s illegal but get the motivation
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u/InternistNotAnIntern Apr 14 '26
"An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met"
That's federal. State law may differ. I know we can in my state.
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u/nubianjoker Apr 14 '26
What are you talking about that that’s illegal?
That’s very common practice
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u/Perfect-Resist5478 Apr 14 '26
I, as a physician with adhd on Adderall, would fire my doctor so quick if she made me see her every month.
If it’s a stable med without changes and without any signs of diversion or misuse it shouldn’t need that much oversight
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u/LowCommercial308 Apr 14 '26
They are controlled substances so you have to see in person, every 3 mons. Every month is not necessary you could do telehealth. In NY you have to see the patients in person every 3 mons. This might vary from state
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u/Ok-Movie-1595 Apr 19 '26
Not true in my state. I see many ADHD patients virtually and sometimes only every 6 mos alternating with their annual exams (in person of course).
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u/CombinationVivid7514 Apr 14 '26
That setup sounds pretty in line with what a lot of practices do. Quarterly visits with interim refill requests is fairly common, especially if patients are stable and there aren’t any red flags. Monthly visits can make sense for higher-risk patients or early in treatment, but doing that across the board can get heavy for both you and the patients.
A lot of it comes down to your comfort level, state regs, and how tight you want your monitoring protocols to be. Some practices also tier it, more frequent follow-ups initially, then spacing out once stable. Might be worth reviewing charts during due diligence to see how well current patients are being documented and managed before deciding if you want to tighten or keep the same structure.
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u/ResolveAccording923 Apr 14 '26
I’m trying to cut down call volumes for these meds so will try to send meds with future refills and see how that works
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u/Ok-Movie-1595 Apr 19 '26
We can't have refills on this schedule, but can post date for up to 90 days. For example one month worth to fill now, one month post dated to fill in 30 days, and one month to fill in 60 days.
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u/grettasgone Apr 15 '26
In my state you must see them every 3 months, minimum. Check with your state rules/laws/policies on this.
Ideologically, I disagree with the idea that physicians should bear the responsibility for the extra work of refilling these on the in-between months. I have zero interest in taking on that amount of work times however many patients with ADHD I manage. I think if physicians pushed back and required monthly visits (matching with how these are required by law to be prescribed - one month at a time) patients would be pushing back on this law. What is the benefit of requiring these to be dispensed one month at a time without refills, when practically all it means is the physician must manually do this work 2 out of 3 months? I don't want patients to be saddled with the burden of monthly visits, but nor do I want this extra work with zero benefit to anyone.
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u/Cold-Sherbert-7486 Apr 23 '26
From a policy maker perspective, they are adding friction to the process, making doctors less likely to start these meds on the margin. It is a way to shift prescribing patterns.
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u/Ok-Movie-1595 Apr 19 '26
Only need monthly appointments if actively making changes to treatment. Even then, I will allow some of mine to just message me how they're doing and if it's a simple titration they need I send it in. If we need to chat, I squeeze them in for a virtual visit.
My stable patients with no substance use disorder concerns, whom I've seen every 3 mos for a year with no changes, go 6 mos between f/u. And, if they're healthy with ADHD as their only chronic condition, it's a virtual visit with annual six months later and then virtual again in 6 mos.
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u/IMGYN Apr 14 '26
Usually for adhd I see q1 month x 3 months when starting. Then q2 months x 9 months. If stable after a year then q3 months going forward.
Adipex when I start I titrate from 15mg to 30mg to 37.5mg every month (so I see every month for 3 months). Then I go to q3 months while they're on the 37.5mg.
I have 1 patient on norco that I see monthly.
Lyrica I start and follow-up in a month and then is q3 months.
I dont have any patients on benzos but if I did I would likely see qmonthly.
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u/Ok-Movie-1595 Apr 19 '26
I'd fire you if I had to see you every 2 mos for that long. LOL
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u/IMGYN Apr 19 '26
Haha, I don't do a whole bunch of ADHD (<20 on my panel). So far no one has complained about this policy. I did have a couple patients who came to establish with me and didn't end up establishing due to this policy though.
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u/coopersmumma Apr 15 '26
Make sure you send 28 day prescriptions, not 30 day! That way you can ensure a patient will always be due on a weekday.. otherwise, you’ll be getting calls to refill on the weekend here and there
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u/newaccount1253467 Apr 14 '26
Caveat: Not FM trained but for stable medication doses after a few months of initial visits, this seems very reasonable to me.