Anatomy of a Rx

Ohio OD Prescribing Abilities

• Can use any topical medication for diagnostic or therapeutic ophthalmic use: to treat disorders of eye, adnexa, and visual system

• Categories of Oral Meds:

  • Anti-infectives

  • anti-glaucoma

  • anti-allergy

  • Anti-inflammatory (with restrictions on oral steroids)

  • Analgesics (with restrictions on Schedule II,III, and IV controlled substances including requirement of DEA number)

• Can Rx for ocular conditions ONLY

• Can Rx for disorders only, NOT for cosmetic use

• Can only dispense smallest sample dose available

• Cannot charge for samples or for the Rx itself

• Must report extreme or unexpected adverse reactions to Ohio Vision Professionals Board

Lines of Prescription

1st line: Inscription

2nd line: Subscription

3rd line: Signa aka “SIG”

Refill allocation

Special instructions

Prescriber’s signature and license #

Superscription

Rx symbol

Inscription

Medication prescribed including

concentration/strength and formulation

Subscription

Dispensing directions to the

pharmacist (i.e. how much to give)

Signa

Directions for patient use

B.I.D.

twice a day

H.S.

at bedtime

p.o.

by mouth

p.r.n.

as needed

gtt(s)

drop(s)

q.h.

every hour

Q.I.P.

4x a day

sol.

solution

susp.

suspension

T.I.D.

3x a day

ung.

ointment

How many drops are in 1ml of topical ophthalmic solution?

20 drops

Additional optional instructions to consider for prescriptions

▪ Shake well before each use

▪ Take until medication is gone

▪ Discard after X days

▪ Generic substitution allowed

▪ Dispense as written (DAW)

Phase I of FDA Approval

small scale study on normal human volunteers to determine safety

Phase II of FDA Approval

small scale study on humans with target disease to determine efficacy

Phase III of FDA Approval

large scale study on humans with target disease for longer duration

Phase IV of FDA Approval

post approval studies conducted outside the FDA

Yellow (0.5%)/Light Blue (0.25%) caps

Beta blocker

Dark blue cap

Beta Blocker Combo Agent

light green cap

Non Beta Blocker Combo Agent

red cap

Mydriatics/Cycloplegics

green cap

Miotics

Pink cap

steroids

gray cap

NSAIDs

brown/tan cap

anti-infectives

Orange cap

Carbonic Anhydrase Inhibitors

Teal cap

Prostaglandin Analogs

purple cap

Alpha2 Agonists

off-label prescribing

• when a drug is used for a purpose other than what is stipulated in the FDA labelled indication

• Requirements:

  • Must have scientific evidence of efficacy & safety

  • It must be accepted practice by expert consensus or practice guidelines

  • Must inform patient

Requirements of Generic drugs

• Do not have to have FDA trials repeated

• Must be same active ingredient

• Must produce the same therapeutic effect!!

• Must be labeled with same warnings

• Must follow FDA manufacturing and quality guidelines

• Generic equivalents may improve compliance d/t dec. cost

FDA Pregnancy Labeling

Provides a “Risk Summary” and “Clinical Consideration” of the following:

• Disease-associated maternal and/or embryo/fetal risk

• Dose adjustments during pregnancy and the postpartum period

• Maternal adverse reactions

• Fetal/Neonatal adverse reactions

• Labor or delivery

FDA Lactation Labeling

• Summarizes information on the effects of a drug and/or its active metabolite(s) on milk production

• The presence of a drug and/or its active metabolite(s) in human milk

• The effects of a drug and/or its active metabolite(s) on the breastfed child

FDA Reproduction Labeling

• There are recommendations or requirements for pregnancy testing and/or contraception before, during, or after drug therapy; and/or

• There are human and/or animal data suggesting drug-associated effects on fertility

Deductible

Out of pocket cost a patient must reach before any benefits apply

co-pay

Patient responsibility toward the cost of each prescription

Tiered Plans of Rx Coverage

• Tier 1: No co-pay or lowest co-pay (usually all generic)

• Tier 2: Moderate co-pay (Preferred brand name meds)

• Tier 3: Higher co-pay (Non-preferred brand name meds)

Prior Authorization (PA)

• An insurance plan can deny coverage unless the prescriber completes a PA

• PA approval often requires that all generic meds have failed to provide an adequate effect

Private insurance plans

• employee provided

• Purchased from Marketplace

Government sponsored plans

• Medicare Part D

• Medicaid