The following medication policy applies to prescription Controlled Substances. Controlled Substances are medications regulated by the Drug Enforcement Administration (DEA) and are considered to have the potential for abuse, dependency, addiction, or misuse. In order to prevent potential complications, Dr. Beer has enacted the following medication policy regarding the prescribing of Controlled Substances.
Federal and Iowa State Laws place restrictions and regulations on the prescribing of Controlled Substances. Important restrictions and regulations include the following:
Dr. Beer must have an established Physician - Patient relationship in order to prescribe a Controlled Substance.
Dr. Beer is required to maintain a current Medical License to practice medicine, maintain certification by the Drug Enforcement Administration (DEA), and maintain a certification in the prescribing of Controlled Substances.
Controlled Substances are categorized into Schedules based on their potential for addiction. See below for the definitions of the Schedules.
Schedule I Controlled Substance prescriptions can NOT be filled according to Federal and Iowa Law. Note, this includes THC, the active ingredient in Marijuana.
Schedule II Controlled Substance prescriptions can not exceed a 90 - day supply. Multiple prescriptions can be provided, however, the total amount of Schedule II Controlled Substance cannot exceed a 90 - day supply.
Schedule II Controlled Substance prescriptions have no expiration date.
All prescriptions, including controlled medications must be sent to the pharmacy electronically (Effective 1/1/2020). Prescriptions can not be called, faxed, or written.
Iowa State Law gives prescribers the discretion to determine how many prescriptions can be written for the Schedule II Controlled Substance, however, the total supplied amount cannot exceed a 90 - day supply.
Schedule II Controlled Substances cannot be called into a pharmacy.
Iowa State Law does not require patients to see Dr. Beer, however, for a Controlled Substance prescription to be considered valid, there must be a clear Physician - Patient relationship.
Schedule III-V Controlled Substance prescriptions are only good for six (6) months.
Schedule III-V Controlled Substance prescriptions are limited to five (5) refills every six (6) months.
Acute Condition: Dr. Beer may prescribe a Controlled Substance for an Acute Condition (condition is temporary). The amount of the medication prescribed will depend on the condition, it's severity, and the patient's personal health history. This prescription will NOT have any refills, regardless of medication's Schedule. If more medication is needed than originally prescribed, a follow-up office visit is required to re-evaluate the medical condition and make any adjustments that are needed for the appropriate treatment of the condition.
Chronic Condition Requiring Intermittent use of a Controlled Substance: Dr. Beer may prescribe a Controlled Substance to be used intermittently for a chronic medical condition. This condition may require a Controlled Substance to treat symptoms as they arise, but the Controlled Substance is not used on a regular, or predictable, frequency.
Schedule II Controlled Substance: Intermittent Use
This prescription will be sent electronically to the pharmacy for what is determined to be a 90 - day supply of the Schedule II Controlled Substance
If the total amount to be dispensed for 90 days exceeds 270 pills, the prescription will be divided into three 30 - day prescriptions with the appropriate amount, and will also indicate the appropriate "fill on or after" date.
A follow-up appointment WILL be made for ANY changes in the medication dose or directions.
According to Iowa State and Federal Law, Schedule II prescriptions have no expiration date, and cannot have refills
Patients will require an office visit every three (3) months for a Schedule II Controlled Substance prescription.
Schedule III-V Controlled Substance: Intermittent Use
If the prescribed medication is a Schedule III-V Controlled Substance, the prescription will be electronically sent to the pharmacy for what is determined to be a six (6) month supply.
If the total amount to be dispensed for 180 days exceeds 270 pills the prescription will be electronically sent to the pharmacy for a 90 - day supply with 1 refill.
If the total amount to be dispensed for 90 days exceeds 270 pills, the prescription will be will be electronically sent to the pharmacy for a 30 - day supply with 5 refills.
A follow-up appointment be made for any changes in the medication dose or directions.
According to Iowa State and Federal Law, Schedule III-V prescriptions are only valid for six (6) months and limited to five (5) refills.
An office visit is required every six (6) months for Schedule III-V Controlled Substances that are used on an intermittent basis.
Chronic Condition That IsNot Controlled: Some medical conditions require chronic, or regular, use of a Controlled Substance. If the chronic medical condition being treated by a Controlled Substance IS NOT controlled, the patient will need to be seen in the office every thirty (30) days to assess the condition and make appropriate adjustments. The quantity of the prescribed Controlled Substance will not exceed a 30 day supply and will require an office visit if more medication is needed before 30 days.
Chronic Condition That Is Controlled: Some chronic medical conditions require chronic use of a Controlled Substance. If the controlled substance is controlled, the following is required:
Schedule II Controlled Substance: Chronic Use
Schedule II Controlled Substance prescriptions will be prescribed for a 90 - day supply.
If the total amount to be dispensed for 90 days exceeds 270 pills, the prescription will be divided into three 30 - day prescriptions with the appropriate amount, and will also indicate the appropriate "fill on or after" date.
An office visit is required every three (3) months for a Schedule II Medication to assess the condition and treatment plan, as well as, assess for any signs or symptoms of medication side effects or potential problems with usage.
Schedule II Controlled Substances will require an office visit to make any adjustments to the dosage or directions, or if the medication is needed before 3 months.
Schedule III-V Controlled Substance: Chronic Use
Schedule III-V Controlled Substances prescriptions will be prescribed for a 90 - day supply with 1 refill.
If the total amount to be dispensed for 90 days exceeds 270 pills, the prescription will be electronically sent to the pharmacy for a 30 - day supply with 5 refills.
An office visit is required every six (6) months for a Schedule III-V Medication, to assess the condition and treatment plan, as well as, assess for any signs or symptoms of medication side effects or potential problems with usage.
Schedule III-V Controlled Substances will require an office visit to make any adjustments to the dosage or directions, or if the medication is needed before 6 months.
Dr. Beer will not prescribe a 90-day supply for any Controlled Substance if:
The total quantity prescribed exceeds 270 pills.
There is concern that the patient is having difficulty understanding and following the directions for the medication.
There is a concern that the Controlled Substance can not be properly secured.
The condition being treated with the Controlled Substance is NOT controlled.
For any Controlled Substance:
LOST MEDICATION: If the medication is needed before 90-days for Schedule II Controlled Substances, or 180-days for Schedule III-V Controlled Substances, or if the prescription is lost, an office visit will be required
CHANGE OF MEDICATION: If changes are made to the dose or directions of a previously prescribed Schedule II Controlled Substance, any prescriptions that have not been submitted to the pharmacy will need to be returned.
STOLEN MEDICATION: If the medication is stolen, this should be reported to the Police immediately and a copy of the Police report is required before a new prescription will be written for the controlled substance.
Dr. Beer is required to review the State of Iowa Prescription Monitoring Database. This database is maintained by the State of Iowa and provides important information regarding potential medication misuse, risk of overdose, or monitoring if multiple healthcare providers are providing controlled substances.
Definition of Schedules [Adopted from deadiversion.usdoj.gov]:
Schedule I Controlled Substances Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.
Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").
Schedule II/IIN Controlled Substances (2/2N) Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.
Examples of Schedule II narcotics include: hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®). Other Schedule II narcotics include: morphine, opium, codeine, and hydrocodone (Lortab, Vicodin).
Examples of Schedule IIN stimulants include: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®).
Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.
Schedule III/IIIN Controlled Substances (3/3N) Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.
Examples of Schedule III narcotics include: products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®).
Examples of Schedule IIIN non-narcotics include: benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such as Depo®-Testosterone.
Schedule IV Controlled Substances Substances in this schedule have a low potential for abuse relative to substances in Schedule III.
Examples of Schedule IV substances include: alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).
Schedule V Controlled Substances Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.
Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and ezogabine.
Prescription Refills
Please give us 3 days to refill your prescriptions. You can always have your Pharmacist call us to refill your prescriptions. Please note though, if it's been a while since you've been in, we may ask you to make an appointment to see us.
Follow-Up Visits
Dr. Beer asks all patients who are on chronic medications to have at least one visit a year. Some conditions (Diabetes, High Blood Pressure, High Cholesterol) may require visits at least twice a year.