Which doctors can prescribe MS meds?

[onlyairfare]

For the most part, any properly licensed physician can write any legal prescription, although there are some exceptions. Some insurers will only pay for specialty drugs that have been prescribed by a network physician in the relevant specialty, such as a neurologist for an MS med. Most doctors will not write a script for a drug they are not familiar and comfortable with. So it can be complicated, and really, you have to check with the individual physicians you would be seeing to ask how they feel about your prescribing situation.

In the past, my PCP has written my Copaxone prescriptions, as well as other MS-related medications, once I had a neuro consult and my plan of care. Several years ago I moved to a new state and when I found a new PCP, guess what? She has MS too, and she knows a lot more about MS than some neurologists I have dealt with! So there are some primary care physicians who do know quite a bit about MS and MS medications, and she wrote all my meds until I got set up with a new neuro - the same one she sees.

Years later, I continue to see that same neurologist even though I now work in another state (we move a lot). I would have to pay a higher co-pay if my neuro in North Carolina wrote the prescription for the Gilenya I receive where I work in Arizona, but thanks to the Novartis assistance program my co-pay is covered, so it doesn't matter.

My North Carolina neuro HAS to write my Provigil prescription because the hospital group where my PCP works does not allow any of their doctors to write for "stimulants." That has nothing to do with state or federal law, or with malpractice, it's just a hospital rule.

[lusciousleaves]

I'm aware of how difficult it is to get stimulants. We've gone through that for years with our son. For the first few years, we had to drive an hour away from home to pick up a written script for a refill we needed the next day, usually on a school night. It was ridiculous. They finally loosened the law to allow a script to be good for 60 days. I'm surprised they're lumping Provigil in with that group since it's supposedly not a stimulant, but then again not.

[Temagami]

I was in an HMO for the last several years- this year the employer changed to an open access plan. I have no complaints about the HMO- they covered all the testing, ER, one week in hospital, copaxone, Gilenya, neuro visits. Yes, I had co-pays, but I was covered. So I´m not understanding why folks are knocking the HMOs.

[MSer102]

I've had some of the WORST doctors I've ever had through my HMO. I've also had some of the BEST doctors I've ever had through my HMO. My rheumatologist and neuro-ophthalmologist are both gifts from God. Really. And I've never had any trouble getting medications from my HMO.

I think what's damaging is for people to spread misinformation about which doctors can and can't diagnose diseases or write prescriptions.

A medical license allows medical doctors to legally do pretty much anything medical. Malpractice doesn't have anything to do with what specialty a doctor is or isn't in. The policies of medical insurers or medical groups - or the FDA and Biogen in the case of Tysabri - are completely different from what medical doctors are and aren't legally allowed to do.

As poster onlyairfare said, "For the most part, any properly licensed physician can write any legal prescription..." That includes MS DMD's, even injectibles.

[22cyclist]

No, it doesn't. Show me one that has written them.

Thanks
Lisa

[TLC_31]

In Oregon, there are no state restrictions on the scope of what an MD (or some others) can prescribe.

http://www.oregon.gov/pharmacy/Impor...ibers50609.pdf

[onlyairfare]

Lisa, my family doctor wrote my Copaxone for several years after my first neurologist (in another state) got me started on it. I found another neuro closer to home, but had to "fire" him because he failed to diagnose my brain tumor, and he refused to continue to treat me for MS if I went to Mayo for the brain tumor instead of staying in Seattle. I saw doctors at Mayo Clinic in Minnesota about my brain tumor, but not for MS. For several years Mayo took care of my "brain tumor business" and my primary care took care of my MS.

When we moved to North Carolina, as I mentioned above, my new primary care doctor wrote my MS scripts for more than 6 months, until I got settled in with a new neurologist. As has been noted many times here, it can take a while to get in with a good neuro, especially an MS specialist, so those two family docs I saw wrote my Copaxone rather than interrupt my treatment.

While I don't think either of them would have initiated my MS injectables, or oral meds for that matter, I think they did not have a problem with writing Copaxone scripts since I had been seen by neurology and started on it. I suspect that is not so rare - you pay cash to see a top-notch neurologist outside your network and his script isn't covered by your plan, or your specialist is in a distant city in another state and your health plan requires the script be written by an in-state physician, so your primary care doctor writes the prescription.

Most of the time, most MS meds will be written by a neurologist, and that is what makes sense because it is their specialty and most primary care physicians won't have much experience or comfort with DMD's. But sometimes there are circumstances where a different practitioner will need to write the prescription, like AF PA or my own family doctors.

Lusciousleaves, my neurologist couldn't believe that the hospital group had such a stupid rule as to disallow their docs from writing Provigil scripts. First, he says it is not a stimulant; technically it is a "wakefulness promoting agent." Secondly, it is a Schedule IV drug (relatively low risk of dependence), not a Schedule II drug like amphetamines, which have a much higher risk of dependence. So my neurologist is now prescribing my Provigil.

[Kimba22]

I suspect that is not so rare - you pay cash to see a top-notch neurologist outside your network and his script isn't covered by your plan, or your specialist is in a distant city in another state and your health plan requires the script be written by an in-state physician, so your primary care doctor writes the prescription.

A few years back, I had to see a general neuro at my local hospital, because my insurance wouldn't pay for my DMT if my MS Specialist wrote the script ... which made no sense, since they'd pay for my visit to the MS Specialist. (I had an HMO linked with my local hospital, the MS Specialist was at another one).

None of the PCPs I've ever had would prescribe my DMT (they would prescribe the other meds). They just wouldn't do it, regardless of the fact I'd been on it for years. It was my PCP who gave me the referral to see the MS Specialist to begin with (after having some issues regarding the neuro I was seeing at the time).

The general neuro I finally saw followed the recommendations of my MS Specialist, so there was never a conflict. But, it did mean I had another dr. to see on a routine basis.

Although some PCPs will prescribe DMT's, I've never found one around here who would. I live in a big suburb of a large city, not too far from several large hospitals. So, maybe the reason none of them will is because neuros are plentiful around here? I suppose none here feel there's any need to prescribe something outside their scope of practice. I think that's probably more of the norm, at least it is where I live.

[onlyairfare]

I think you are probably right about location Kimba. In places where there are lots of neurologists, there is no need for the PCP to write prescriptions for DMD's. But if you live in a rural area where it's a long drive to a neuro, maybe to another state, it can be different.

And then there are screwy things with insurance. I work on an Indian reservation (very rural area) and the Indian Health Service pharmacy here requires all prescriptions be written by one of our clinic doctors, all of whom are primary care physicians (actually some are primary care NP's or PA's). The patients bring in their prescriptions from the specialist they have consulted, our practitioner rewrites the script, and then the IHS pharmacy will fill it.

If we had a neurologist on staff, he or she would probably write the DMD prescriptions, but we don't. And if the patient takes the prescription written by a specialist to another pharmacy, they will have to pay the cost out of pocket.

[lusciousleaves]

Onlyairfare, I think the only docs you can get a provigil script from here are neurologists. Maybe psychiatrists and pulmonologists would be allowed to prescribe them? I was told my PCP wouldn't refill one of my scripts because he wasn't prescribing that type of med anymore. Then was told by the neurologist he wouldn't write a refill for another type of med because he doesn't prescribe that type of thing. Our son's pediatrician will refill a stimulant script in a pinch, but he won't prescribe them long term.

They seem to be getting stricter on where they draw their dividing lines in terms of prescribing. I think it was Fiorecet the PCP wouldn't refill for migraines.

[MSer102]

I think this has come up before... A lot of doctors choose not to write certain prescriptions because of hassles involved and their level of comfort with the medication. But with the exception of controlled substances (and Tysabri because of the TOUCH program) any medical doctor can legally prescribe anything. Except for maybe a few states that might have restrictions that I don't know about, there are no legal "scope of practice" restrictions for medical doctors and what they can prescribe. Medicine IS their scope of practice.

I think a lot of doctors and medical groups are becoming stricter about what they choose to prescribe or not prescribe because they aren't getting paid enough anymore to make it worth their while to prescribe anything they can't do on "automatic pilot". Not worth the hassle if there's a problem.