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Medications & Prescription Treatment

Medicare Rx Requirements

  • By 84yrab

    I went to call in a Rx for the antidepressant I’m on to help with the migraine, only to be told that the doctor needed to see me. He just saw me recently, and we discussed the migraine then, but because I had also come in to have my ears cleaned that it was a “sick visit and I needed to come in for a “well” visit. That is was a Medicare coding thing and he could lose his license if he didn’t comply.

    I called Medicare and the woman I spoke to could not find any information about doctors requirements on how often they need to see a patient in order to write a Rx refill. I can’t seem to find the information online either. Can anyone else? Also the woman said that Medicare can’t cause him to lose his license, only the state licensing board can do that.

    So now I’m even more confused, I don’t know whether it is a Medicare requirement, or just a way for him to make more money off me? He’s already gone the route of concierge medicine. So that’s $200 a year just to be a member of his practice, the $120 dollar fee (what Medicare didn’t pay) for the “sick” visit and now if I want my Rx refilled (I have been on this medicine for years) I have to shell out another $120? Not to mention Medicare has to pay him as well.

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  • By Nancy Harris Bonk Moderator

    Hi 84yrab,

    Thank you for reaching out to us. I’m afraid I don’t have the answer, and am concerned you are getting two different answers. Have you been taking this medication for a while? If my doctor and I forget to discuss refills at my visits and I realize one is needed, all I do is call his office. Something sounds off here, but hopefully other will be along shortly to share their experiences with you.

    Keep us posted,
    Nancy

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    • By 84yrab

      I’ve been on the medication for years. I was off it for a period of time while my doctor tried something else, before that I had been on it for years as well.

      I have found another GP. She said that she did need to see me every so often but that if I had come in for something as simple as an ear cleaning she would’ve had no problem writing me a new Rx. She was willing to write me an Rx for a 90 day supply as well. I’m going to stick with this new doctor.

      It seemed that with my old doctor I could just call in if I need an Rx refill in the past which is why I don’t understand the need to see me again. After all, if his liscense was on the line why be so blasie in the past?

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