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Medication Management at Family Psychological Services: FAQs

The decision to take medication yourself or to have your child take medication is a serious one. Family Psychological Services offers an integrated approach to medication management, increasing compliance and efficacy. Over the course of 2021, FPS is undertaking a substantial buildup in our medication management capacity. Please follow @fpsmedassist on Twitter or simply bookmark this page for up to the minute tweets on developments.

Our Psychiatric Mental Health Nurse Practitioners (PMHNPs) prescribe under protocol, a document signed annually by Lawrence physician Ryan Neuhofel, DO MPH. During the COVID-19 pandemic, medication appointments were exclusively held via Zoom. However, we will be moving back to office-based services during May and June as we expect insurance to downgrade telehealth reimbursement as the risk of transmission remits. This will entail a rate reduction that we are unwilling to accept.

Marilee McCleery, DNP is working full time now and we are adding another APRN in June. We'll be adding a full time Medication Administrator in July to oversee client contact with the NPs, prescription requests, preauthorizations, billing, and appointment scheduling. We hope this will greatly smooth problems we've struggled with as our client load grows and we pledge to keep improving our services as we go.

To get the most out of your experience at our office, please read the following guidelines listed in the form of Frequently Asked Questions. Our goal is to balance our NPs' accessibility to their clients with efficient time management. You can help your medication team (you, your child, your therapist, the nursing staff, and the office staff) by following these protocols. Please bookmark this page so you can come back to it later when the need arises.

1) Walk in/Zoom in Clinic
We are temporarily suspending walk in clinic so our new NPs can become familiar with cases. Everyone needs to make an appointment for refills and changes. We hope to return to walk-in clinic by the summer.

2) Do you provide medication management services to people who are not seen in psychotherapy at Family Psychological Services?
No. We only see clients for medication management who are in ongoing psychotherapy at our office in Lawrence. We do not do medication management for other providers in the community. This policy does not mean that you will simply see a therapist once or twice before you get to see the prescribing NP. It means that we integrate medication with psychotherapy from the time you come in to see us until the time you complete treatment. If you reach a point where you've completed your psychotherapy plan and your therapist releases you, the treatment team will discuss whether to continue maintenance med management or refer you to your primary care physician. If you discontinue psychotherapy against the advice of your therapist, the NP will assist you over a maximum of ninety (90) days to transfer services to another prescriber.

3) What if I or my child experience a mental health or medical emergency?
Please contact your nearest emergency room or urgent care. Never use email or voicemail as an alternative to seeking in-person medical attention. If you have an urgent (not emergent) concern, use our dedicated medication line (785-371-1396) and leave a message explaining the concern in as much detail as possible. Never use this line for scheduling or to simply ask for a callback. You may wish to consult with your therapist if you're uncertain whether your situation constitutes a crisis.

4) What if we need to contact the NP about a non-emergent side effect or to discuss the effectiveness of the medication? 
Please schedule a face-to-face appointment or FaceTime or Zoom video chat appointment by calling the main office at 785-371-1414. In the summer we will have more flexibility once or RN begins practicing. She will be able to consult with you directly about side effects and relay messages to the NPs as necessary.

5) How long can I go between medication appointments?
We are revising our protocols for appointment intervals. You will begin with an interval of one month between appointments. Once your medication is stablized (you and the NP agree it's doing what you want it to do and the side effects are tolerable) you will move to sixty (60) days between medication appointments. If you are stable and don't need major changes over three cycles (six months) we will move you to a 90 day interval. Thereafter you must be seen every 90 days to be continued on medication management at FPS. We realize these might be shorter spans than your primary care physician (PCP) allows. A key value of having your medication done at Family Psychological Service is that we follow your case closely, so you must be seen by our NP a minimum of four times a year and only after you are on the 90-day plan. If you prefer a longer interval between medication checks, our NPs can transfer your medication to your PCP. However, they cannot transfer you back and forth if you need a re-evaluation in a short order (e.g., within the same year).

6) What should I do when I need a refill of medication?
You will have enough refills to take you to the next med check appointment. The best way to be sure you get refills is to make an appointment before leaving the office and to plug that into your calendar. You can also ask our office staff or your therapist to make an appointment with an NP if you're unable to do so before you leave the office. We suggest you put an alarm into your phone that reminds you about two weeks in advance to make the appointment. If at any time your pharmacy states that you are out of refills, first ask them to double check this. If they are certain you are out of refills, move on to FAQ #7 below.

7) What if the pharmacy says we don't have any more refills?
First check your calendar and see if you are over your med check deadline. based on where you are in the interval protocol (30, 60 or 90 days). This is nearly always the case if the pharmacy says you are out of refills. You can also = ask the pharmacist. Every time we reject a refill request, the NP enters a note that explains why. That note is electronically transmitted to the pharmacy. If the pharmacist claims they don't know why the refill was denied, ask them to check that note. Immediately make an appointment by calling 785-371-1414. Much time is wasted by clients and our staff hunting down prescriptions that we've already sent but which, for reasons we cannot discern, do not appear at the pharmacy. Our NPs get a receipt of each prescription sent if you need any proof to help your pharmacy avoid situations like this in the future. Once you've made an appointment, our nurse administrtor wilil contact the NP and let him or her know to provide a "short" prescription, meaning just enough medication to get to the next appointment. If you do not attend the next appointment for any reason other than a health concern, the NP will not extend the script again and will refer you to your primary care doctor. NOTE: Please don't contact the NP or the nurse administrator to request a refill. No refill requests made via email or voice mail will be honored and the entire process will bog down if you try to go this route. 

8) Do refills work differently if I'm prescribed a controlled substance like stimulant medication for ADHD?
Yes, but it's more a matter of electronic management than an actual difference in how prescriptions work. Stimulants are regulated under different federal guidelines than other medications, so when you ask about refills at the pharmacy or examine this on their portal, you and the pharmacist will always see “0 refills” or “Dr. Authorization Required” listed on every stimulant prescription bottle. It will make more sense if you to think of each stimulant “refill” as a new prescription. In the days before electronic prescribing you actually had to carry three different pieces of paper, and at one point you weren't even allowed to do that. Thinking of your prescriptions this way explains why you never seem to have refills of stimulants, when you actually do. As with all other medications, the NP will not provide more than three scripts at one time for stimulants (i.e., a 90-day supply). If you are not yet stable on medication, the interval will be shorter. Because you cannot rely on the refill date to gauge your remaining medication, it's doubly important for you to make your follow-up appointment before leaving our office and then mark it on your calendar or set an alarm in order to keep track of when you are authorized to fill your stimulant medication. When it comes to these medications, there aren't any other good workarounds.

9) Does a parent need to accompany their minor (under 18 year old) child to medication appointments?
Yes. A custodial parent must attend the first medication evaluation with the child. This cannot be step-parent unless that person presents a document indicating the court has allowed him or her make medical decisions. The NP may allow older teens deemed competent minors to attend their medication checks by themselves after they are stable on medication, but this is at their discretion. For anyone twelve (12) and up, assume that a parent needs to attend.

10) Can I use any pharmacy I want??
Yes and no. We have elected Sigler Pharmacy at 4525 W 6th Street Lawrence, Kansas as our community partner. In the last six years we've found Sigler to be the most prompt and reliable pharmacy in Douglas County. Our goal in this partnership is to ensure you have a reputable, consistent, knowledgeable pharmacy team to help guide you through medication issues, from insurance delays to refill authorizations. These issues are not only frustrating and time-consuming they can lead to a lapse in medication use. In the event that an insurance-mandated prior authorization is required for a certain medication, some delays are unavoidable.

At Sigler, efficiency, stellar communication, professionalism, and flexibility are offered at each and every turn of the medication journey. High-quality care is their standard of practice. We encourage you to examine Sigler's website to learn more about the services they offer, including electronic refill requests through the Rx2Go app, free home delivery, prescription mailing, and bubble packing for those taking multiple medications and/or supplements. Sigler will also honor manufacturers and GoodRx coupons. 

You are free to select a different pharmacy. However, if you do so, we may elect to provide only paper prescriptions, thus taking us out of the middle of an electronic prescription process that we cannot guarantee will work on any given transaction. Sigler allows us to feel confident in the electronic prescription process. If you elect a different pharmacy, and thus to use a paper script, you will need to be even more diligent in making and keeping your regular med-check appointments because we will not fill electronic prescription refills anywhere else. You will not be able to refill a prescription until you meet with the NP face-to-face and and take the paper script(s) with you.



Medication Integration
In order to improve the overall quality of service and outcomes, we only see clients for medication management who are also being seen for psychotherapy. We encourage new clients to transfer their med management to our office to improve the communication between prescriber and therapist. Occasionally, with complex cases, we require this as a condition of service. We think you'll like this team approach to treatment.