IMPORTANT: PATIENT PORTAL CHANGE
NOTICE TO PATIENTS
On July 12, Dr. McCarthy emailed patients an invitation to activate their new SimplePractice portal (sent from "yourprovider@simplepractice.com"). Please call or email Dr. McCarthy (703-288-3535 / operations@catherinemccarthymd.com) with any questions.
Thank you for your patience!
NOTICE TO PATIENTS
REFILL POLICY
NATIONWIDE ADHD MEDICATION SHORTAGE:
If nothing is ready at your pharmacy 3 business days after you submit a refill request:
⒈ Confirm with your pharmacy that:
🔵 Dr. McCarthy's request has been received (pharmacy backlog sometimes prevents this)
🔵 The medication is in stock
⒉ Keep Dr. McCarthy updated (703-288-3535)
REFILLS DURING APPOINTMENTS
All refill requests should be made during your appointment
Dr. McCarthy will make arrangements during your appointment to ensure you have medication to last until your next visit (up to 3 months max).
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.
NO WORRIES if you are a current patient and you are “out-of-sync” with the 3-Month appointment schedule
When you submit your refill request, you will also schedule the next available appointment.: In compliance with federal regulations, and to minimize prescription delays, the next available appointment may be scheduled as a “parent-only” visit in my office or by telemedicine, especially if a child patient is unavailable.
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 due to ongoing shortages, prior authorization hassles, and ever-changing insurance formularies. The rules about refills vary significantly between states.
REFILLS OUTSIDE OF APPOINTMENTS
Although the refill request form uses a secure administrative email server, it is not HIPPA compliant. 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 it worked marvelously well before the medication shortage.
Due to the ongoing national medication shortage, the refill request process can be much more time-consuming and complex than before. Below is an overview of the process. The national shortage, DEA regulatory obstacles, electronic prescription complications, and logistical delays are beyond the control of doctors and patients.
OVERVIEW of THE REFILL REQUEST PROCESS
(it's more complicated due to the shortage)
1. Call your pharmacy to confirm the medication is in stock.
2. Submit an online refill request and notify Dr. McCarthy (703-288-3535).
3. Keep checking with the pharmacy after 2 business days (can take 3) to confirm:
a) The prescription was received (pharmacy backlog sometimes prevents this)
b) The prescription has been filled and is not in "backorder limbo."
4. Give Dr. McCarthy voicemail updates (703-288-3535).
Refill requests require 3 business days’ notice (M-F, 7:30-5:30)
The medication shortage often requires extensive additional physician processing time per additional refill. Three business days notice means that 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. Soon electronic prescriptions will be required for all prescriptions and paper ones will be obsolete. Electronic prescribing is already the rule in most states and for controlled medications.
Call your Pharmacy after 3 business days (M-F) to confirm your Refill is Ready for Pickup
Dr. McCarthy is meticulous about sending prescriptions for compliant patients within her 3-business-day response window. After 3 business days from submitting your refill request, start contacting your pharmacy for status updates. Do not rely on your pharmacy to contact you, even if you are signed up for autmatic notifications. Be prepared to reach out repeatedly if necessary.
Unfortunately, the system used to send the prescriptions electronically is far from perfect, and on some occasions, even though everything checks out on Dr. McCarthy's end, the prescription seems to disappear into some sort of electronic Bermuda Triangle. Always call the pharmacy FIRST to confirm it is ready before calling Dr. McCarthy. If your pharmacy says they do not have your prescription after the 3 days have passed, PLEASE CALL Dr. McCarthy at her office immediately at (703-288-3535), and follow emergency contact instructions, 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.
We appreciate your patient understanding during such frustrating instances. There is nobody who wants your prescription filled efficiently more than Dr. McCarthy!
$25 processing fee for repeated prescription requests and pharmacy reroutes outside of appointment times
Processing fees will be automatically billed to your credit card to cover Dr. McCarthy's time to process, submit, and document multiple electronic refills and pharmacy reroutes not planned during a regularly scheduled appointment.
Due to increased DEA regulations, charges for clinical time may also apply for extensive prior authorization processing.
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 extra medicine from missed appointments outside of the policy window of three months.
No additional charge for treatment dosage adjustments or refills arranged at an appointment within past 3 months
If Dr. McCarthy decides to adjust your dose for titration between appointments or change your medication altogether, this is part of your treatment plan. 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.
PLEASE: DO NOT TEXT DR. MCCARTHY TO REQUEST PRESCRIPTIONS
Texts are not HIPAA-secure most likely will not be seen by Dr. McCarthy, and can cause delay.
Review the full Refill Policy, starting at the top of this page, to be sure you understand it. Ask her if you have questions.
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.
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.
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.” A few of them have been around for over 80 years! Nonetheless, these medications are considered “controlled substances,” and they are tightly regulated by the DEA. Therefore, the rules below must be strictly followed for these medications:
All patients who are prescribed controlled substances (most ADHD meds) must agree to the following policy, which is based on federal law:
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THREE-MONTH APPOINTMENT MINIMUM. Patients must see Dr. McCarthy at least every three months. Instead of canceling, it is advisable to keep the appointment by phone or as a parent telemedicine appointment to stay within the three-month DEA refill window.
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NO EARLY REFILLS. Medications must be taken as directed and cannot be refilled before their refill date. There are no exceptions, even for lost or stolen prescriptions or if you run out early. As frustrating as these very human incidents can be, this federal law is sadly out of Dr. McCarthy’s control.
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NO DOSE CHANGES ON YOUR OWN. If you believe your medication may be ineffective, you must first consult with Dr. McCarthy before making any changes. If you run out of medication early from taking extra doses on your own, Dr. McCarthy cannot refill it. Additionally, patients who self-adjust their dose will likely be referred out of Dr. McCarthy’s practice.
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
In the lucky event that your insurance still 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. If your insurance allows us to do that and you have confirmed they have enough medication in stock, Dr. McCarthy will be delighted to order 90-day prescriptions during your appointment 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).
Pesky Prior Authorization (PAs)
Not as easy as it sounds. 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 the medications Dr. McCarthy 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.
Repeated extensive time spent >10 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 rate.
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.
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.
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.