ࡱ> MOL R"bjbjss .8&&iiiii}}}8$4}?8  (5557777777[:<7i7ii55h7333Xi5i573733575` } X>6780?8V68=a=07=i7@H3"77a?8=& /: Medication Refills Protocol Medication refill turnaround time should be no more than 72 hours. Exception: Patient Assistance Program (PAP) requires 4-6 weeks to process. In order to assist providers and patients with meeting this goal, PMA and RNs may authorize refills, under the patients regular provider, based on the guidelines below. Protocol: PMA will review request and follow attached refill protocol to authorize appropriate refills. Any request that needs additional review for authorization will be forwarded to Primary Care Provider (PCP) if in clinic within 2 days or available provider who is in the clinic on the day the request is processed. Refill requests will be processed or patient contacted within 3 business days. It is the patients responsibility to contact the clinic one week prior to running out of medications from local pharmacies or one month if PAP refill needed. Refill requests from: Pharmacy via fax: Enter key information from request and forward via EMR according to current workflow. Patient request via phone: Patient message should be forwarded to the PMA with key information and may require PMA phone follow-up, then process per EMR workflow. Patient request in person and not during a visit: Inform patient or family member that we request 3 business days to process requests and they should check with their pharmacy in 3 days. Verify contact information with each request. Key information needed: Name of medication Dose Pharmacy Patient contact information confirmed as printed on fax or by individual on phone/in person Date of last office visit (review chart for recommended RTC; > 1 year automatically needs a visit) PMA Protocol: Refill requests initiated by patient or pharmacy request. PMA will process request using the guidelines below and reviewing chart for last visit, last set of required Care Management or monitoring labs and accuracy of medications. Medications that are requested but not listed in the medication list should be forwarded to provider for review and reconciliation of list. Any patient not seen for greater than one year will need a follow up visit prior to any refills. Maintenance: Patient has had regular follow up appointments as recommended by last clinic note and appears to be in compliance with care plan based on timing of refill requests Non-adherent: Any patient who has not followed up as requested in last documented clinic note or there is a lapse in timing of medication refills Acid Reflux/GERD Maintenance: 3 months (Needs appointment if using > 1 year) ADHD/ADD Need appointment no less than every 6 months and forward to PCP for written prescription if controlled substance. Allergic Rhinitis Maintenance: 1 year Non-adherent or increase in seasonal symptoms: 1 month and appointment Ok to refill nasal sprays and antihistamines without decongestants Anti-Anxiety Need Appointment no exceptions Antibiotics Need appointment EXCEPT medications for chronic acne Maintenance: 1 month with 2 refills for acne antibiotics Antidepressants Maintenance: 6 months if seen within 6 months Non-adherent: 1 month with follow up appointment Anti-Seizure Maintenance: 6 months or until next scheduled visit if seen every 6 months by PCP. Non-adherent: Must have labs drawn and schedule appointment. To provider for review. Antiviral (Herpes only) Herpes antiviral therapy: PRN refill for 1 year if adherent Arthritis Maintenance: 6 months NSAIDS (ibuprofen, naproxen, diclofenac): Kidney function every 6 months New diagnosis within 3 months: 1 month and follow up appointment Non-adherent: 1 month and follow up appointment NO refills on indomethacin without provider approval Aspirin PRN refill for 1 year Asthma Maintenance: 6 months Non-adherent: 1 month and appointment Birth Control Pills Maintenance: If complete physical within one year and normal blood pressure at last office visit (if pap abnormal, ensure follow up occurred), can refill until next annual physical is due Non-adherent: If pap or annual physical is overdue, patient must schedule appointment and refill until appointment/1 month. If no-showed last appointment, forward request to PCP. Diabetes Maintenance: 6 months if visit within 3 months and HbA1c at goal and BP at goal of <130/80 on last visit and LDL at goal of <100 within 6 months Non-adherent: Labs not done or any parameters not at goal or no visit in >3 months, then refills can be given until next scheduled appointment Diabetic Supplies PRN for one year Erectile Dysfunction Maintenance and no nitrates on medication list: 1 month (#6) with 2 refills Fiber Pills, Fiber Powder, Colace PRN for one year Folic Acid, Prenatal Vitamins PRN for one year Hormone Therapy Forward to PCP HTN Maintenance: 6 months if last visit BP at goal <140/90 (non-diabetic, see above for diabetic) and BMP within one year Non-adherent: 1 month refill with scheduled appointment within one month Hyperlipidemia Maintenance: 12 months from last lipid panel if labs at goal within one year and normal liver enzymes (diabetics see above) Non-adherent: 1 month refill with appointment for labs/office visit Hypothyroidism Maintenance: 12 months from last TSH if TSH at goal <3. Non-adherent: Forward to PCP Insomnia Forward to PCP Laxatives Forward to PCP Lice treatment RN protocol Migraine Maintenance: 6 months Non-adherent: 1 month and follow up appointment within one month Muscle relaxers Forward to PCP Neuropathy (non-narcotic, ie-gabapentin, Lyrica, Savelle) Maintenance: 3 months Nitroglycerin Maintenance: 6 months (no erectile dysfunction medications) NSAIDS Review plan of care in last note (for arthritis see above), can refill for up to 3 months or until next appointment Osteoporosis (such as Fosamax, Actonel) Maintenance: 1 year Pain Medication Need appointment and forward to PCP Plavix Maintenance: 3 months Psych meds Maintenance: 3 months and follow up appointment scheduled with PCP or therapist Smoking Cessation Maintenance: 3 months Topical Treatments (eczema, acne only) Maintenance: 6 months Any other topical will need appointment unless detailed in specialist dermatology note or PCP to continue long term. Warfarin therapy Maintenance: 3 months from last INR if lab at goal within one month and normal blood pressure Non-adherent: 1 week refill with appointment for labs/office or RN visit Date Initiated: January 12, 2012 Date Revised: February 21, 2012, January 30, 2013 Next Review: January 2016, Medical Director Emily Anderson, MD Date Medical Director Reviewed and approved at Provider meeting on: February 5, 2013     Lake Superior Community Health Center Medication Refills Medical Medication Management Page  PAGE 4 of  NUMPAGES 4    6 V W ` a  & d m   nz -58z*6ȿ~ hbq6^J h=*^Jhbq56>*^J hI-=^J hbq>*^J hI-=5^Jhbq6>*^J hbq^J hbq5^Jhbq5RHk^J hQhbqh~RHk^JhbqRHk^J hhbqhbq5>*CJaJhbq5>*CJRHn^JaJ1V W a  '^ & FgdI-=^gdI-= & F^`gdI-= & FxgdI-= mn z*7Vb? & F gdI-= & F gdI-=^gdI-= & F ^gdI-=6Va?KLU [byp@H_ax{iz =O^nq2@np68fp~ h=*^J hI-=^J hbq>*^J hbq5^J hbq^JX?LKLVl&[cy@Ii{gdI-= & F gdI-= & F gdI-= >O_nr2AIgp#3m & F gdI-= & F gdI-=#2mGVnp/BW  !!!%!&!D!E!F!G!O!P!T!U!c!!!!!!!!!ȼIJȠțh~h~>* h=*>* h~>*h~h~6CJhQhbq>* hbq>* hbq5hQhbq5hbqh~hI-= hQhI-= hQhbqhbqCJOJQJ^JaJ hbq>*^J hbq5^J hbq^J7mHp0BX  y !!E!gdI-= & F gdI-= & F gdI-= & F gdI-=E!F!G!U!r!!!!!!!!!!!!!! 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