Refilling prescriptions can be a money-wasting process

Danna MacDonald wants as little to do with the health-care system as possible.

“I try to avoid it as much as I can.”

But the Coquitlam woman has fibromyalgia and needs sleeping pills to help her get through the night. She has been on the same pills prescribed by her GP for 15 years, but when the doctor left her practice, MacDonald had to resort to a walk-in clinic, where the doctor only gave her a prescription for 20 days.

MacDonald said she was told walk-in clinics can only prescribe refills for a maximum of three months.

“It seems like a waste of government money to have it like that where I have to come in four times a year now rather than once for a recurring condition that’s not changing,” said MacDonald. “It’s silly. I’ve been on this medication for years.”

MacDonald is not alone. The Province received dozens of emails from patients fed up at having to visit their doctor every month or three months to renew prescriptions for medication they’ve been taking for years, even decades. The cost of a visit is $30-45, depending on the patient’s age.

The issue was the second most common source of complaints, second only to specialist re-referrals. Some are befuddled. Some believe it’s a cash grab. Many say it is a waste of time and public money.

“These unnecessary visits not only cost valuable health care dollars to pay the doctor for a visit but also jam up the physicians’ offices and may result in other patients with real needs having to wait longer,” said Don, who wanted his last name withheld because his GP was “touchy” when he tried to broach the issue with him.

Paul, 56, of Kelowna said his doctor issues zero refills for the high blood pressure meds he’s been on for 10 years, requiring a visit every three months that lasts mere minutes: “Why can’t I phone him and he phones my pharmacy with the updated prescription? Seems like a waste of time and resources to me.”

Not so, countered doctors.

According to the B.C. Medical Association, doctors can give refills for up to a year, except for birth control pills, which can be given for up to two years.

The prescription length depends on a patient’s specific condition and the GP’s comfort level, said Victoria’s Dr. Bill Cavers.

Even for patients who have been on the same drugs for years, doctors may need to see them more frequently in order to monitor dosage and side effects, or as part of ongoing care for chronic conditions. Doctors at walk-in clinics would be more reluctant to provide longer prescriptions because they do not know the patient’s past history.

Complaints about prescription renewals are a common beef GPs hear, said Cavers, co-chair of the General Practice Services Committee, which is made up of representatives from the B.C. Medical Association and the B.C. health ministry.

“Many patients don’t realize the professional, legal implications of prescriptions,” said Cavers, noting doctors are held professionally responsible and legally liable for the scripts they write by the regulatory College of Physicians and Surgeons of B.C. “They think they’re entitled to them.”

Cavers suggested patients talk to their doctors if they feel they’re needlessly coming in for refills.

“It’s a good conversation to have. Because if the family doctor has a reason, then it will be clear to the patient and there won’t be as much resentment.”

He said the conversation could also be an opportunity for the physician to re-evaluate whether the patient can go with a longer course.

The College said patients’ concerns about prescription renewals are sometimes valid, but often a “misperception because health conditions change over time,” said deputy registrar Dr. Galt Wilson.

Visits every three to six months for chronic conditions like diabetes and high-blood pressure are usually appropriate, said the College.

“In the rare instance that a physician requires a patient to attend without medical justification, the College would be critical,” said Wilson.

Paul, who has been on high blood pressure meds for 10 years but still goes in for a visit every three months to get a renewal, acknowledged his dosage could change. It has changed twice in the last decade.

“I think now it’s probably not going to change. It’s hard to say,” he said, sounding skeptical but resigned. “It could be different, I guess.”

Patients also have other options if they do not want to come in for a visit.

Some doctors may offer phone renewals for a fee, usually around $30. Phone renewals are not insured under the traditional fee-for-service system.

Since 2009, pharmacists are able to renew routine prescriptions for up to six months for patients with stable conditions.

According to the B.C. Pharmacy Association, the number of pharmacist-issued renewals has almost doubled from about 90,000 in 2009/10 to 170,000 in 2011/12.

“There are more opportunities for people to use this,” said CEO Geraldine Vance. “It helps reduce access problems people might have in getting to see a family doctor.”