REFILL POLICY
NATIONWIDE ADHD MEDICATION SHORTAGE:
If nothing is ready at your pharmacy 3 business days after you submit a refill request:
â’ˆ Confirm with your pharmacy that:
🔵 Dr. McCarthy's request has been received (pharmacy backlog sometimes prevents this)
🔵 The medication is in stock
â’‰ Keep Dr. McCarthy updated (703-288-3535)
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Number 1 Takeaway:
All refill requests should be made during your appointment
Dr. McCarthy will make arrangements with you during your appointment to ensure you have plenty of medication to last until your next visit (up to 3 months max).
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With over 2 decades of experience, Dr. McCarthy is a pro at dealing with any prescribing glitches. Usually, refills are easy, but sometimes, especially with some of the ADHD meds, it gets a tad complicated, as described below.
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The refill arrangements depend on the type of medication, pharmacy, your medical insurance pharmacy benefit coverage, and your insurance formulary. The insurance companies seem to change the rules randomly and this can be very confusing and stressful for parents. A new obstacle is that in the DMV, many of the most frequently prescribed and useful medications are sometimes out of stock. This backorder sort of thing is frustrating with things like furniture delivery dates but can be scary for health-related products like medications. REST ASSURED! Dr. McCarthy will clarify your unique situation during the appointment and adapt to any glitches that pop up between appointments. She is determined to make your medication plan as easy for you as possible.
If you have not had an appointment within three months, Dr. McCarthy will be unable to fill your prescription
Federal law does not allow physicians to prescribe “controlled” substances (including most medicines for ADHD) unless patients have been seen within three months, and thus this DEA policy is completely out of Dr. McCarthy’s control. For this reason, it is imperative that you plan accordingly, well in advance, for any foreseeable appointment scheduling changes. Remember: medications cannot be filled outside of the three-month appointment window.
Remember: Because Dr. McCarthy’s schedule is very full, it is important to always plan ahead and ensure you have an appointment scheduled well ahead of time so that your medication can be refilled.
NO WORRIES if you are a current patient and you are “out-of-sync” with the 3-Month appointment schedule
“It’s me, not you”. Dr. McCarthy is forever grateful for her long-term patients who have waited patiently. If you have not had an appointment within the past 3 months, it is probably because she has not been able to give you one! Dr. McCarthy continues to steadily dig out from the high volume of pandemic-related crisis patient needs. She is working to get current patients back into the pre-pandemic appointment rhythm and referring out the patients who demand a higher level of care. During the height of the pandemic, many other providers were not accepting patients, so referring to other providers has not been an option for many. For current compliant patients, Dr. McCarthy of course will provide enough medication to hold you until your long overdue and much-deserved follow-up appointment. Dr. McCarthy is so excited to get her entire patient flock back on track with regularly scheduled appointments!
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When you submit your refill request, there is a box to check that you indeed need an appointment. Over the next months, Dr. McCarthy or her clinical director will contact you to schedule your long-awaited reunion appointment, and also thank you profusely for your patience and understanding throughout the pandemic and this transition.
The refill “arrangements” that Dr. McCarthy makes during your appointment can vary widely depending on the situation
The way you and Dr. McCarthy set up refills depends on many factors. Arrangements may also change per your current insurance pharmacy benefit, prior authorization hassles, and ever-changing insurance formularies. The rules about refills vary significantly among VA, MD, and DC, but Dr. McCarthy will make this as easy as possible during your appointment. This should become increasingly easier over time if you are coming to appointments as required by the office policy, and you should always have plenty of medication to last until your next appointment.
Dr. McCarthy wants you never to worry about having enough medication! So, no matter what curveballs the insurance plans or pharmacy challenges life throws at you, Dr. McCarthy will be relentless to get the medication that you need. She is determined that compliant patients NEVER run out.
Submit Refill Request:
Check out the online REFILL REQUEST FORM!
Because of the medication shortage, the refill request process is much more time-consuming and complex than before.
Be sure you understand your responsibilities in this process, and also that delays are out of Dr. McCarthy's control.
BRIEF OVERVIEW OF THE REFILL REQUEST PROCESS
1. Read the complete Refill Policy.
2. Call your pharmacy to confirm the medication is in stock.
3. Notify Dr. McCarthy (703-288-3535) that you are submitting an online refill request.
4. Keep checking with the pharmacy after two business days to confirm:
a) The prescription order was received.
b) The prescription has been filled and is not on backorder.
5. Give Dr. McCarthy updates by voicemail (703-288-3535).
Refills outside of scheduled appointments for current patients should be requested by submitting a Refill Request. Although the refill request uses a secure administrative email server, it is not HIPPA compliant like the Luminello Portal. Nonetheless, most patients prefer this system. It is entirely up to you and your cybersecurity comfort level. Alternatively, you are ALWAYS welcome to call the Office at 703-288-3535 for refills and leave a confidential voicemail for Dr. McCarthy or her director. This voicemail method was Dr. McCarthy’s previous longstanding refill policy, and before the pandemic chaos, it worked marvelously well.
Refill requests require 2-3 business days’ notice (M-F, 7:30-5:30)
The medication shortage now requires extensive additional physician processing time per refill. Dr. McCarthy must process hundreds of requests each week, and her response time is now 2-3 business days instead of her previous 48 business hours. This means if you request a refill on a Saturday, it will be processed and sent to your pharmacy by the following Wednesday or Thursday. Excepting true emergencies, REFILLS WILL NOT BE PROCESSED ON WEEKENDS OR AFTER BUSINESS HOURS. Dr. McCarthy must be at her secure prescribing office hours (M-F, 7:30-5:30) to submit electronic prescriptions. The old days of “call-ins” are no more, and soon (spoiler alert), rumor has it that the law will not allow paper prescriptions either. Soon only electronic prescriptions will be allowed for all prescriptions and paper ones will be obsolete. Electronic prescribing is already the rule in several other states.
Call your Pharmacy after 2-3 business days (M-F) to confirm your Refill is Ready for Pickup
Be sure to contact your pharmacy to be sure that the eagle has landed after requesting your refill. In addition to the many other tradeoffs of the tech world we live in, some pharmacies seem to no longer reliably contact patients to tell them whether the prescription is ready or not. This happens even when patients sign up for pharmacy notifications. Dr. McCarthy can only process and submit the prescription to your chosen pharmacy when you give her 2-3 business days' notice. She has no information about what happens on the “other side” at the pharmacy itself. It is your job to call the pharmacy to confirm when they are filling the medication. Call the pharmacy FIRST to confirm it is ready (not Dr. M).
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Unfortunately, the satellite and doctor’s national server used to send the prescriptions electronically is far from perfect, and on some occasions, the prescription seems to disappear into some sort of electronic Bermuda Triangle. Dr. McCarthy is meticulous about sending prescriptions for compliant patients within her 2-3 business day response window. If your pharmacy says they do not have your prescription after the 2-3 days have passed, PLEASE CALL Dr. McCarthy at her office immediately at (703-288-3535) so she can resubmit the prescription that was seemingly erased from the pharmacy electronic system. She will resubmit the refill that VERY SAME business day (M-F). The same goes for any other electronic prescribing snafus that you encounter.
Please use common courtesy when communicating with Dr. McCarthy or her director about such understandably frustrating instances: while Dr. McCarthy can see on her side of the electronic system that she has indeed ordered a prescription, she cannot control what happens on the other side when a pharmacy does not receive or fill the medicine she already ordered. There is nobody who wants your prescription filled efficiently more than Dr. McCarthy!
$25 processing fee per prescription requested outside of appointment times
The $25 prescription processing fee will be automatically billed to your credit card by the administrator after the electronic refill is submitted. It covers the time required for Dr. McCarthy to process, submit, and document an electronic refill that has not been arranged for during a regularly scheduled appointment.
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Any new prescription requests not addressed during appointment times are granted on a case-by-case basis. This includes requests for frequent pharmacy changes, backorder/stock problems, camp med changes, lost prescriptions, or to cover extra medicine from missed appointments outside of the policy window of three months. As we move toward a post-pandemic streamlined policy machine, if you are a patient in active treatment, you should rarely (hopefully never) need a prescription outside of appointment times and thus not incur any prescription processing fees.
The refill Fee does NOT apply to treatment dosage adjustments or any planned refills already arranged during an appointment less than 3 months ago
If Dr. McCarthy decides to adjust your dose for titration between appointments or change your medication altogether, this is part of your treatment plan and of course, would not incur any prescription fees. If there are back-order issues out of your control for camp medications discussed during your appointment, or insurance mail order problems, no worries either. Always remember Dr. McCarthy wants to make you happy and reduce your stress level as much as humanly possible.
DO NOT TEXT DR. MCCARTHY TO REQUEST PRESCRIPTIONS
(See No-Texting policy)
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Texts most likely will not even be seen by Dr. McCarthy, and she will be bummed when she learns you could not get your medicine by not following this refill policy. Texting for refills will only delay the time to get your medication.
Review the full Refill Policy, starting at the top of this page, to be sure you understand it. Ask her if you have questions.
Be super clear and confirm the details of your preferred pharmacy during each appointment
During your appointment, please confirm the pharmacy you use for prescriptions, or mail order insurance pharmacy if indicated. You need to provide the full name, address, and zip code of the pharmacy for Dr. McCarthy to manually enter and route your prescription. Dr. McCarthy loves to find you the most economical way to get prescriptions and gets rather excited when your insurance allows her to order you 90-day supplies through the mail or your favorite local pharmacy.
If your regular pharmacy is out of stock and cannot fill your medicine
FIRST, be sure you tell your pharmacy to cancel the first prescription that they could not fill (strange, but necessary). The prescription can only be canceled by the patient, not Dr. McCarthy, so call them to be sure. Only then can Dr. McCarthy start over and resubmit your prescription to a different pharmacy. Leave a voicemail detailing prescription and new pharmacy information on her office number (703-288-3535). This will ensure Dr. McCarthy gets notified and can respond to your problem the same business day M-F). You also need to resubmit a Refill Request on Dr. McCarthy's website. Use the message box to clearly state that you are changing pharmacies and give all the new pharmacy information (name, address, and ZIP CODE). Since time is of the essence, be sure you call Dr. McCarthy immediately and keep her in the loop.
Switching pharmacies sometimes is ODDLY complicated
Switching pharmacies can EASILY be done DURING your appointment time or with plenty of notice before the next prescription is next due. There can be only ONE pharmacy address under your name in the system. Sometimes certain pharmacies run out of certain medications, and we MUST switch pharmacies: no worries, we can do this, but it can be tricky, so read below.
Since there can only be one pharmacy in the system per patient, changing pharmacies can result in confusion for filling future prescriptions, often messes up the electronic system, and has bigger issues transfer involving out-of-state pharmacies. Thus, always remind Dr. McCarthy of your current pharmacy during your appointment to be sure any previous changes have not caused prescriptions to go rogue to default pharmacies.
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If you lose your medicine or forget your prescription on vacation, be aware that certain states (for example CA, HI, and TX) NEVER allow doctors not licensed in their state to prescribe in their state. So, if you forget to bring your medicine to Hawaii, your need to figure out how to have a friend FedEx your home prescription. Other states will allow emergency short-term refills through an override appeal through Dr. McCarthy. Your insurance will likely make you pay out of pocket for the extra medicine early refill override. On these occasions (same business day urgent unusual prescription needs) leave a voice mail on Dr. McCarthy’s office number 703-288-3535. During office hours (M-F), she will immediately process your vacation override short-term refill if allowed by the DEA.
If you are scheduled to be away/out of town when your medicine refill is due
Easy Peezie. You can get a vacation override for an early refill so long as you plan ahead. Call Dr. McCarthy and she will order your medication with a “vacation override” request. Usually, the pharmacy calls the insurance company to facilitate this after Dr. McCarthy places the override order, but sometimes the insurance company creates roadblocks. In this case, YOU will need to call the insurance company to raise a ruckus and explain why you need the medicine early.
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If you need an extended refill (e.g., for a trip to study abroad), YOU need to first call your insurance company to figure out their policy about this and tell Dr. McCarthy what to do. This can be highly time-consuming (like calling an airline to make changes), so plan ahead. If you get a representative who seems to be clueless, call back and get someone else. After you have clearance from your insurance company, along with instructions, Dr. McCarthy will follow orders once you tell her what to do.
Controlled substance Policy (Most ADHD meds)
Some of the most evidence-based, safe, rigorously researched, and optimal medications for ADHD are called “stimulants”. Some have been around for more than 80 years! Stimulant medications for ADHD are considered “controlled substances”. There are very strict federal regulations under DEA law that affect the prescription rules with these “controlled substance” medications. It is imperative that you understand the following directions as there is no wiggle room with the law and safety of dispensing this kind of medication. If you have any questions at all, please bring them up during your appointment and Dr. McCarthy will make this whole process super clear and easy!
Dr. McCarthy requires that all patients who are prescribed controlled substances (most ADHD meds) understand these federal guidelines and agree to the following policy:
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As per federal law, patients must be seen for visits with Dr. McCarthy at a minimum of every three months to obtain a prescription for these medications. If you reschedule your appointment at the last minute, this could affect your ability to get a new prescription as medicines cannot be refilled without an appointment within the three-month limit. If you need to reschedule, it is usually better to keep the appointment as a phone or a parent telemedicine appointment to remain within the three-month DEA window for refills.
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If you are scheduling a psychiatric consultation with Dr. McCarthy and you have been prescribed a controlled substance by a previous provider, Dr. McCarthy may need to contact your previous provider before prescribing you a controlled substance. You will need to bring documentation supporting the previous treatment with this medication.
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If Dr. McCarthy does provide you with a prescription for a controlled substance, and there is concern that the medication is not working or the dose is ineffective, you must first speak with Dr. McCarthy or her clinical Director. DO NOT adjust your dose on your own. If you run out of medication early from taking extra doses or increasing your dose on your own, Dr. McCarthy will not be able to refill it.
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Controlled substances are to be taken strictly as directed, and cannot be refilled before they are due for refill. This applies even if your prescription is lost or stolen, or if you run out before your refill date. Remembering this is the federal law and is sadly out of Dr. McCarthy’s control. It’s exasperating when the law gets in the way despite the very human things that can happen, like when forgotten during travel or lost right before exams.
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Patients who adjust the dose on their own are in violation of this controlled substance policy, and likely will be referred out of Dr. McCarthy’s practice.
Nuts and Bolts of getting “Controlled Substance” prescriptions seamlessly during appointments
Another fact (not a fun one) is that DEA law does not allow for “refills” on controlled substances. NO WORRIES, Dr. McCarthy is an expert at workarounds!
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During your appointment, Dr. McCarthy will send an electronic prescription for the controlled substance through her secure server to your chosen pharmacy in the system. If your dose and treatment plan are stable, Dr. McCarthy will arrange with you to ensure you have enough medicine for the three months until your next appointment. The means by which this is arranged can vary, depending on factors such as your insurance plan, your state, and your pharmacy. For example, the laws for post-dated controlled substance prescriptions are constantly in flux, and vary between states. But in general, one of the following arrangements is usually made:
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If the prescription is sent to a local pharmacy in Virginia or Maryland
Dr. McCarthy can send a prescription at the time of the visit for 30 days directly to your pharmacy. At the same time during the visit, she can send two additional separate “post-dated” electronic prescriptions for the following two months. This is different from refills that can be ordered for non-controlled substances. With the rare exception of some insurance policies that allow 90-day prescriptions, controlled substance prescriptions are allowed a maximum of 30 days, so to cover you for 3 months, two additional 30-day prescriptions will be issued with a future date that is written as “Do Not Fill” until ___ (one or two months post-dated). When you are close to the end of the month of your current prescription, you will need to call your chosen pharmacy to let them know that you want to activate the pre-ordered, post-dated prescription.
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Usually, it’s easiest to have post-dated prescriptions sent electronically through the secure server during the appointment. Sometimes it’s better to have the post-dated prescriptions in paper form, depending on the rules with your pharmacy and state. Once sent electronically, the prescriptions cannot be re-issued or moved to other pharmacies. Paper prescriptions must be kept in a safe place because Dr. McCarthy is not legally allowed to re-issue repeated paper prescriptions. As you will see during your appointment, sending a controlled substance through the electronic server can take up to 10 minutes per set of prescriptions for Dr. McCarthy, with multiple passwords that change every 30 seconds. Therefore, all prescriptions that need to be resubmitted for reasons beyond your control (lack of med stock at a particular pharmacy, the RARE lost or stolen prescription occasion, camp meds, prescriptions issued outside the 3 months visit window) will incur the $25 ordering fee for Dr. McCarthy’s additional time and documentation.
If the prescription is sent to a pharmacy in the District of Columbia
Prescribing post-dated refills for controlled substances through DC pharmacies is sometimes confusing to many, including Dr. McCarthy, despite her 25 years of being a doctor.
If you reside in DC and prefer a pharmacy close to your home, Dr. McCarthy will order a prescription for one month during your appointment time, and then discuss with you her personal tricks of the trade to manage the following months of refills in DC pharmacies. As confusing as it sometimes can be in the Nation’s Capital, Dr. McCarthy ALWAYS figures it out, and will make it work so you do NOT need to worry!
Controlled substances medication cannot be “called in” from anywhere at any time
They must be ordered electronically from the secure server and computer in Dr. McCarthy’s office during business hours only (M-F, no evenings or weekends)
Prescriptions and refills cannot be sent on weekends or outside of office hours. This “weekend rule” applies to all medications, but it is absolutely unbendable for ADHD medications because of the complicated security process that requires such prescriptions to be sent through a secure server. By law, these prescriptions can only be refilled by Dr. McCarthy herself and not her clinical director. Some states will not allow physicians who are not licensed in that state to order controlled substance prescriptions in their state (California, Hawaii and Texas). This applies to Dr. McCarthy, so if you lose your prescription while staying in those states, there is sadly nothing Dr. McCarthy can do.
Mail-order pharmacies and 90-Day Prescriptions (hooray!)
In the lucky event that your insurance allows you to have a 3-month refill at a time, or even better, controlled substance 90-day prescriptions through mail order, it is sort of like winning the lottery. OK, that’s an exaggeration, but still. . . If your insurance allows us to do that, during your appointment Dr. McCarthy will be delighted to order you 90-day prescriptions through your mail order to be sent to your home. You need to check with your insurance after she orders it to be sure that everything is set up for you to receive it including payment to your insurance company and confirmation of the order. Since it is a three-month prescription that is all that Dr. McCarthy can order, and you will not be allowed to have other prescriptions sent locally (DEA law).
So, you must check with your insurance company that they received the order and that they are sending it to you because of the federal law preventing Dr. McCarthy from ordering more than three months at a time. When your insurance allows the 90-day option, it’s simply awesome: all of your prescriptions can be sent to your house every three months at the time of your appointment.
Pesky Prior Authorization (PAs)
Not as easy as it sounds. This section of the prescription policy will be written in more detail later. For now, know that Dr. McCarthy has an additional full-time administrative assistant whose job is to deal with insurance companies all day long to relentlessly get authorization for Dr. McCarthy to be able to prescribe the medications she recommends for your child. The bottom line is this: if you need a “PA”, it sometimes takes at least a week to get it through. And after the PA, the insurance company still may not authorize the medication, especially if they demand “step” care with their formulary. In effect, sometimes the insurance company insists on managing the treatment plan.
Although insurers can be difficult to deal with, Dr. McCarthy will go to bat for you in resolving the PA problem. Many insurance companies are simply not covering the most excellent ADHD medications on their formularies, and Dr. McCarthy must go through the hoops to appeal and push for you to get your needs met. If the medicine is not on the formulary at all, this PA appeal process often feels like kind of a sham, and in the end, the insurance company says it was never covered in the first place. In summary, if your pharmacy tells you Dr. McCarthy needs to do a PA, it will take several days to try to get it through. Dr. McCarthy works relentlessly with her administrators on all PAs within 48 hours during business days, but it is up to the insurance company how long they make us wait for their response.
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Repeated extensive time spent >15 min for Dr. McCarthy calling your insurance company or time writing up appeals for medication Prior Authorizations will be billed at the standard session rate. Very rarely, insurance companies demand extended telephone calls with Dr. McCarthy, called “peer to peer” appointments. This demand requires Dr. McCarthy to schedule an appointment time with the insurance company doctor who makes decisions about your care so that she can explain her reasoning for wanting to start a specific medication. This will be billed at the regular hourly rate and is thankfully a rare insurance demand.
Abuse Potential and Dangerous Combo with “Real Drugs”
Because of the abuse potential, most ADHD medications, like pain medications, are “Controlled Substances” by the DEA and Federal Law. There are multiple reasons why these medications are so tightly controlled by the government. Unfortunately, there is a serious problem with the diversion and abuse of these medications by people who have never been diagnosed with ADHD. For example, there is a problem with students selling their medication on college campuses. Dr. McCarthy has never known any patient with ADHD in her practice in the history of 25 years who has wanted to abuse these types of meds, nor has she known any patient to do anything but cringe at the idea of taking extra ADHD meds as any form of fun. However, she has known patients to sell the medication she has prescribed, thereby risking injury or death to other individuals for whom it was never prescribed. Furthermore, combining these and other psychiatric medications with alcohol, marijuana, or illicit substances that also cross the blood-brain barrier can have dangerous and lethal effects.
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Dr. McCarthy requires a commitment to wellness for teens and young adults who want to work with her to get better. This includes a contract stating that they will not abuse substances while taking the medication she prescribes. Starting September 2022, Dr. McCarthy will routinely order drug screens as part of ensuring wellness, safety, and treatment compliance. In the future, she will likely test randomly during office visits. Medications cannot work if toxic substances are competing for target brain receptors.
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Furthermore, alcohol and marijuana cause damage to developing brains, including the hippocampus and white matter. Such damage can cause learning disabilities, lower IQ, and more serious, irreversible psychiatric conditions. Finally, brand new research shows that marijuana and even CBD can cause elevated or even toxic levels of many psychiatric medications, including most of the medications Dr. McCarthy prescribes. This means amplified side effects or potentially dangerous adverse effects. Marijuana also affects the efficacy of anxiety and depression medicine and screws up the neurotransmitter and nerve cell receptor stuff, thus making treatment response less possible. Knowing these findings, Dr. McCarthy works in a compassionate, non-preachy, and motivationally enhancing manner to help support today’s teens who have it so hard, growing up in a world where drug use is normalized around them.
Final notes about prescriptions
Dr. McCarthy is meticulous about refills and takes great pride and responsibility to ensure she will give you enough medication to last you until your next visit. Her goal is to reduce your stress and worries and make refills as seamless as possible. If you are about to run out and require a refill, she will work with you to understand why this happened, and hopefully prevent it from happening to you in the future.
REMEMBER: If there are problems with any refill, contact Dr. McCarthy IMMEDIATELY at the Office Number (703-288-3535)
BRIEF OVERVIEW OF THE REFILL REQUEST PROCESS
1. Read the complete Refill Policy.
2. Call your pharmacy to confirm the medication is in stock.
3. Notify Dr. McCarthy (703-288-3535) that you are submitting an online refill request.
4. Keep checking with the pharmacy after two business days to confirm:
a) The prescription order was received.
b) The prescription has been filled and is not on backorder.
5. Give Dr. McCarthy updates by voicemail (703-288-3535).