Internal Medicine Renewal Guidelines
Family Medicine - Renewal Guidelines Jan 2015 For any renewal requests – when it is unclear – TASK to PCP/Coverage
1 year renewal (or as noted) on the following categories of medications using criteria. If not met - local pharm, #30/1 ref(or # 90NR if pt gets 90d supply) or if mail in, #90NR
|Prescription Category |Visit/Lab criteria |
|Antacid/Reflux - H2 blockers/PPIs |ROV within 18 months |
| |Pradaxa - OV within 12 mos Plavix – Task to provider each time! |
|Anticoagulants – Warfarin, Pradaxa, Plavix |Warfarin – forward request to FP Protime nurse bucket |
|Anticonvulsants/Bipolar Meds/Antipsychotics |ROV within 1yr AND CBC, CMP and yearly Depakote (Valproic acid) , Lamictal, Carbamazepine, Dilantin(Phenytoin), Kepra |
| |(Levetiracetam) levels |
|Antidepressants |This criteria for > 18 yrs of age only patients |
|to include SSRI’s (Paroxitine [Paxil], Fluoxetine [Prozac], Sertraline [Zoloft], Citalopram |No telephone refills if within 6 months of starting therapy; needs office visit |
|[Celexa], Escitalopram [Lexapro]) Duloxetine (Cymbalta) and Non-SSRI’s (Venlafaxine [Effexor], |ROV within 12 months – refill for 12 months at a time. |
|Mirtazapine[Remeron}, Bupropion[Wellbutrin]) | |
|Antivirals |ROV within 18 months |
|Acyclovir, Zovirax, Valacyclovir | |
|Arthritis Medications, NSAID’s, Allopurinol & B12 |ROV within 18 months |
|Asthma Medications – includes all inhalers |ROV within 1 year with this issue reviewed for all routine inhalers. |
| |PRN inhalers - #1 with 2 refills |
|Bladder Medications |ROV within 1 yr |
|Ditropan (Oxybutynin), Vesicare, Detrol | |
|Dental prophylaxis & Seasonal allergy meds incl steroid nasal sprays |Renew as needed |
|Epi-Pen | |
|Diabetic Medications |ROV with PCP w/in 12 months and/or Collaborative Care Nurse w/in 6 months; If HgA1C is >7 order every 3 months; if HgAIC is |
| | 12 months |
| |All U-500 Insulin scripts to ENDO for renewal if rx’d by them |
|Erectile Dysfunction (i.e. Viagra, Cialis etc) |ROV within 18 months |
|Gabapentin |ROV within 1 yr |
|Gout medications |AS NEEDED |
|Colchicine , Indocin, Allopurinol |For Colchicine – BMP every year |
|Hypertensive Medications, NTG, K+ supplements, Cardiac, CHF meds, and Diuretics – ie Furosemide, |ROV with PCP within 12 months and/or Collaborative Care Nurse within 6 months; If overdue Rx for 3 months and schedule |
|Bumex, HCTZ, (Digoxin**) |follow up – Needs annual BMP and CORO/Lipids once every 5 years - **Digoxin needs annual Digoxin level WITH BMP |
|Insomnia/Used for Pain mgt (NOT scheduled i.e. narcotics) |Annual OV – 12 mo renewal |
|(trazodone, Amitriptyline, Desipramine, Nortriptyline, Doxepin | |
|Lipid lowering medications |Renew but order CMP annually and CORO/Lipids once every 5 years. |
|Migraine - Triptans – (ie Maxalt, Imitrex) and Meds used for migraine prevention (ie Topamax, |ROV within 12 months with this issue reviewed |
|Cardizem, beta blockers) | |
|Narcotic medications - If chronic - Min visit of q 6 mos with PCP or team Assoc provider for pain |All requests must be tasked to provider or printed for signature for authorization. For tasks – use task template – med |
|management review |renewal |
|OCPs/Hormones |Refill x 1 year if OV & B/P within 12 months. If overdue, refill 3 months and schedule visit for needed screening. Pap |
| |starts at 21 yrs of age |
|Osteoporosis Medications – Biphosphonates |All requests must be tasked to provider |
|Parkinson’s Medications |ROV with PCP in 18 mos or Neurology within 1 yr |
|Sinemet, | |
|Thyroid Medications |TSH within 1 year; if overdue refill for 1 month pending lab then refill x 1 year at same or new dose upon review of lab |
|Topical Steroid Creams/Lotions/Shampoos | |
|Low Potency steroids: (Desonide, Hydrocortisone) & Medium Potency (Betamethasone Valerate, |Can be reordered for if office visit within last 1 year and issue addressed, otherwise task to provider. |
|Mometasone, Fluocinolone) |Task to provider |
|Higher Potency steroids: (Betamethsone Diproprionate, Fluocinonide, Triamcinolone, Clobetasol, | |
|Halcinonide) | |
January 2008 –amended 10-26-09, 4-11, 02-12, rev -1-13, amended 1-2014, 10-2014, 1-2015
| | |
|Barbara Bates, MD |Don Mazanowski, MD |
|Susan Beringer, APRN |Jenifer Hanrahan, APRN |
|Don Caruso, MD |Suzanne Nabi, MD |
|Joseph Capobianco, MD |Currier Neilly, APRN |
|Robert Cochran, MD ______________________________________ |Marika Ostroski, MD |
|Rachel Croteau, DO |Leslie Pitts, MD |
|Remeline Damasco, MD |Lisa Profetto, APRN |
|Emily Delldonna, APRN |Carole Putnam, APRN |
|Carl DeMatteo, MD |Pamela Rosen, APRN |
|Theresa Desilets, APRN |Gabrielle Schuerman, APRN |
|Sharon Ferguson, DO |Katheryn Scoville, APRN |
|Leslie Goldman, APRN |David Segal, PA-C |
|David Hall, MD |Diane Sette, APRN |
|Jo Ann Hertford, MD |Heather Shafer, MD |
|Sharman Howe, APRN |Heather Shlosser, APRN |
|Michael Kasschau, MD |Andrew Tremblay, MD |
|Douglas Keene, MD |Alexandra Van Dyck, MD |
|Christopher LaRocca, MD |John Walter, MD |
|Carrie Lundeen-Young, MD |Amaris Weller, PA-C |
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