How to handle a doctor who won't handle additional prescriptions unless 88 year old mom comes to his office for a visit?

You might ask her GP about palliative care. If prescribed by a dr, it’s covered by Medicare. For my in-laws, a nurse practitioner comes once a month to check on them. She can write prescriptions if needed, and she can also coordinate care with any of their regular drs. This might be a way to satisfy the mandate to lay eyes on a patient before okaying refills.

One great thing about Dad having home health care is that the visiting nurse can draw blood for ordered tests. It is fantastic, especially when Dad had anemia and needed his iron levels monitored for awhile while he was being treated for it. So helpful.

We all have different experiences. My aunt only sees her geriatric once a year. She’s on maintenance drugs and occasionally has an adjustment or change, all without seeing the doctor. We utilize home health, do blood work at home whenever I think she might have a UTI or worry the thyroid is acting up. Not a problem. She’s on six prescription drugs. She could get hers mail order but doesn’t save but a dollar or two to do so. She’s on original Medicare, a medigap and a sep drug plan. No problem with payments. 

Doctor's are required to see a patient every six months for prescription refills. Medicare requires the patient to be present for the doctor to bill for the visit. Mail order is an insurance thing. I have Blue Cross. First prescription you can use a pharmacy and 2 more times. But you need to go thru mail order by the 4th refill because its now a maintenance drug. Actually I found out recently I can use mail order the second refill. You will find it's much cheaper. The doctor is not doing any of this. You need to make sure once its a maintenance drug they are aware refills need to be called into the mailorder not to your regular pharmacy.

Call your primary and ask them if they know a doctor who makes home visits. I agree with Hospice. They will take over Moms prescriptions. You can get an aide thru them. Diapers are paid thru Medicare and other things.

Here is BC, it is pretty standard to Rx to be renewed for only 3 months, especially if it is to treat Diabetes, High BP or other condition that required lab testing and monitoring. Birth Control Rx are generally for 12 months. This ensures proper follow up and adjusting as needed.

My former mil has her Rx delivered by a local pharmacy, the doctor faxes over the Rx after the visit and they are delivered later that day or the next. I know he doctor (he is mine too) does nursing home calls, but I do not believe he does house calls.

Booklvr is correct- physicians are required to see the person before writing new prescriptions. I know at discharge from a hospital or LTC that patients are required to see their PCP within 2 weeks of the discharge.
That’s the way it is.

Holiday End, it isn't just the US trying to cut down on waste - we're seeing this in the UK's NHS too, and there are genuine reasons for it besides anxiety about abuse of controlled drugs.

On the repeat prescriptions issue - someone in public health research added up the overall cost of drugs prescribed but not used and had to go and lie down. BP meds, diuretics, statins, analgesics... millions of pills ordered by computer, conscientiously collected from the pharmacy, paid for from the public purse and then, to put a cherry on it, having to be correctly disposed of - again at public expense! - when they were at last found among the deceased patients' effects. The waste is immense.

To help reduce it, "review dates" started appearing at the bottom of px forms (my mother's ran to two pages, nothing unusual in that) to prompt GPs to check they weren't signing off on drugs that would sit uselessly in the cupboard for the next three years. And very occasionally a GP would comment "hm, time we had a look at that, Mrs H" - but mainly they just changed the date of the review.

Much more recently, all households have received direct mail, and there's been a TV ad campaign too, urging us to sign up to an exciting new repeat prescription delivery service. This service is run by a private company contracted to the NHS, which means that there is public resistance to overcome (you think British people don't get emotional? Try telling them the NHS is a basket case of a system and wants cutting in half - you'll be lucky to escape with your life. More to the point, you will DEFINITELY lose the election); but in fact there are worthwhile objectives to it, including fewer foul-ups leaving patients without medication, easier admin for pharmacists, just a more efficient and therefore cheaper to run process.

What nobody wants to address, because the answers are all extremely expensive and in the USA this demographic receives huge public funding too, is the reality that if you're going to claim that keeping elders at home is the best option, you also have to provide services they are able to access. And when they are immobile, frail, mentally frail or even just extremely tired, some smiling adviser saying "pop along to your GP and..!" - well, it grates, rather.

I hope Redroseman will find a practical solution. Just thinking about how you all have to organise healthcare gives me a migraine, so I do count my blessings really.

When my parents were alive, they went to a clinic that doesn't do house calls. This was their established clinic since I was a child, when mom was diagnosed with dementia, etc... Plus, at the time, their secondary insurance was ONLY for this clinic.

From what I remember, bedridden, vegetative-like mom was required to see her doctor annually - in order to renew whatever needed renewing (current Rx, home care nurses, etc..) The same when my dad had a stroke and became bedridden - the annual doctor's visit. Any changes on their health, needing prescriptions, they were required to go to the clinic.

From what I understand, Medicare requires that the doctor actually sees the patient before ordering new prescriptions or renewing it annually. I also understand that whenever they're released from hospital stay, I have a limited time period to take the parents to see their doctor and Medicare coverage.

We had to call for a private ambulance service for each of these visits. It was $300 per way + every miles. It was not covered by Medicare or their secondary insurance because it's Not an 'emergency.'

FYI, even with the home nurse visits, they tried really hard to treat dad without requiring his visit to the clinic. They were even willing to take his blood tests here at home and then drop it off at their clinic. Clinic admin said No. My dad has to go to the clinic for the bloodwork. Sometimes, these people don't understand what it takes to force an elderly to go to the clinic. And the expenses - $600some roundtrip! just for bloodwork???

My mother thought the heat would affect her meds, and didn't want them sitting out in her mailbox.

I meant to post this before, but forgot. I got the post office to allow a mailbox to be installed by her front door (there are cluster mailboxes in her condo development). If anyone has a cluster mailbox, there is a procedure for disability that one can use to allow a mailbox to be placed by the front door instead.

Not uncommon for doctors to request a patient to come into the office. One time I had to see one doctor every 3 months, take a blood test to make sure the prescription meds weren't damaging the kidneys.

I have a Cardiologist if I don't come in at least once a year, and if my meds have 0 refills, she will only refill my order for 30 days then none after that. I have to see her. She wants to make sure the heart is in working order or if I need to up my dosage or change to another pill.

My parents had used mail-order prescriptions and it was such a hassle, mainly because of user error. Since the pills were mailed to their post-office box instead of at home [folks afraid mailman would take the pills, or tell a neighbor that my parents were getting pills], I would need to high-tail it up to the post-office twice a day to see if their pills came in.

Finally Dad let me transfer all his pill requests to a local pharmacy so if he ran out it was easy to call in and pick-up the same day.

I've had mail-order meds for years. Very few problems.

My mother was forced to switch to mail-order meds a year or so ago. Lots of problems. But that was because she insisted on doing it all herself -- multiple issues with her doctor's office. No doubt part of that was her bad hearing and not following conversations. If she'd let me handle it, there wouldn't have been problems. I was called several times each day and had to hear about the "stupid" people who couldn't do what they were supposed to be doing.

Sigh...

The federal government has been continually changing the laws attempting to restrict physicians prescription writing and refilling of patients regular medications. They claim this is all part of their ‘war on drug abuse’. The feds don’t even see the older citizens as human beings in my opinion.

The forced change to mail order refills is the insurance company saving money. They too don’t even consider elders human. The US has a deplorable health system designed to make only the correct people rich.

There could be a legitimate reason, depending on which meds she's taking. Periodic monitoring might be required for some meds which have side effects.

My experience is that the doctors will prescribe for a given number of refills but generally won't extend after the refills options are used. They want to ensure that the meds are still needed, in some cases, or check for side effects.

We face the same thing. My husband is bedridden and on 10+ prescriptions. Getting him out of bed, onto the community bus and to the doctor is a nightmare, even with a lift. But his PCP won’t renew his scripts without seeing him, either. When we see his doctor in two weeks, I’m going to ask about house calls. It’s really the only way. Doctors are bound to see their patients once a year for prescription renewals. They have to do this. It probably has to do with malpractices. They’re all like that. There are even medical professionals who will come out for blood testing, podiatrists, etc. Both of our large hospitals here in Cleveland have home medical care departments.

Don’t fear the mail order prescriptions. I had moms set up that way and it was so easy. I ordered online thru aetnas pharmacy and the 90 day supply of meds were mailed to me in about 3 days. Good luck finding a dr who makes house calls however. I just tried to find one in upstate NY and none in my zip code. Good idea about having the rehab dr renew any scripts that are expiring soon.

As an interim solution, will the physician at the rehab center write a script for her on-going meds? Tell him/her what Mom's MD said.
As an aside, my employer went to mail house prescriptions several years ago. Like you, I wasn't happy about that. (Do any of us truly embrace change?) NOW, I LOVE it! I have it on automatic refills. I never run out! If I somehow wind up with too much of a med, I call and take it off automatic refill until I need it again.
AND I agree with the other posters, get a doctor who makes house calls. google it with Mom's zip code.

I soon figured out it was all about the money with my mother's doctor, my solution was to make and attend appointments myself as healthcare proxy for prescription renewal; ask if this may work for you. And much to my surprise I discovered mom's doc did make house calls. We also signed mom up for palliative care which brought a nurse into the house once a month (or more if I needed her).

What Barb said. What is the specialty of her doctor? Do you have a geriatric practice in your area. They would understand the difficulty of taking her to the doctor.

You find a doctor who makes house calls. Or a doctor who has a Physicians asst or nurse practioner who does home visits.

You also want this new person to be a geriatrics doc. Not a general internist.

Have you considered getting a hospice eval? That might be the answer to all of these questions.