ANSWERS TO QUESTIONS THAT ARE FREQUENTLY ASKED BY PATIENTS:
When is a patient considered a "NEW" patient? A new patient is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.
How can I find out when my last appointment was if I don't remember? You are always welcome to contact our office staff with any questions but the fastest and easiest way to review your UPCOMING or PAST appointments is to go to our website and log into your Square account.
On the scheduling page of our website there is an option to review your appointment history. Look for the "REVIEW YOUR PAST APPOINTMENT HISTORY" button and select it.
For your convenience we have also placed a link here on this page, click the button below to log into your Square account. Here you can review your information or update your patient profile.
What are the current rules governing patient-physician telemedicine encounters? During the COVID-19 public health emergency (PHE) the Drug Enforcement Administration (DEA) granted temporary exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which permitted physicians to prescribe controlled medications to a patient only after conducting an in-person evaluation of that patient. The exceptions allowed for such prescriptions via telemedicine even when the physician had not conducted an in-person visit with the patient.
As these waivers were set to expire with the PHE on May 11, DEA issued two proposed rules establishing new policies for controlled substance prescriptions based on telehealth visits, one for buprenorphine and one for other controlled substances. After receiving what it said was “a record 38,000 comments on its proposed telemedicine rules,” DEA decided to extend the same policies that have been in place during COVID for an additional six months, until November 11, 2023.
As a result, as of May 11, 2023 the temporary rule:
Extends the full set of telemedicine flexibilities regarding prescription of controlled medications that were in place during the COVID-19 PHE for six months, through Nov. 11, 2023;
For patient-physician telemedicine relationships established on or before Nov. 11, 2023, extends the full set of telemedicine flexibilities for one year, through Nov. 11, 2024. If a physician has established a telemedicine relationship with a patient on or before Nov. 11, 2023, the rule states, “the same telemedicine flexibilities that governed the relationship to that point are permitted until November 11, 2024;”
Allows for prescribing a 30-day supply of buprenorphine to treat opioid use disorder without an in-person evaluation or referral. DEA said it plans to issue final regulations permitting the practice of telemedicine under circumstances “consistent with public health, safety, and effective controls against diversion.
The DEA said it plans to issue final regulations permitting the practice of telemedicine under circumstances “consistent with public health, safety, and effective controls against diversion.”
When do lab orders expire? There is no law or regulation that defines the length of time that lab orders are valid. Most commercial health labs will honor a physician's order for lab work for 6 months after the date they are ordered, but it is up to the individual facility to determine what their policy is.
When do imaging orders expire? Payers that preauthorize or precertify imaging studies often include an expiration date. However, unlike prescriptions for medication, there is not a standard expiration date for imaging orders. Imaging facilities have their own policies regarding how long they will honor a physician's order for an imaging procedure, most facilities require that tests be performed within 12 months of the date the doctor ordered the procedure.
When do prescriptions expire? Prescriptions are valid for a certain period of time based on the classification of the drug.
Prescriptions for medications that are not controlled substances expire 12 months after the date they are prescribed.
Prescriptions for controlled substance medications that are schedule C-III, C-IV and C-V expire 6 months after the date they are transmitted to the pharmacy by a physician. They expire 3 months after the date transmitted if they were prescribed by a physician's assistant or a nurse practitioner in lieu of the physician.
Prescriptions for C-II controlled substance medications expire 30 days after either the transmission date or the date the physician, or provider, specifies as the "earliest fill date" (EFD)
What does it mean when a medication is a "controlled substance"? Controlled (scheduled) drugs, substances, and certain chemicals are ones whose use and distribution are tightly controlled because of their abuse potential or risk. Controlled drugs are rated in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA). The drugs with the highest abuse, and potential for psychological and/or physical dependence, are placed in Schedule I, and those with the lowest abuse potential are in Schedule V. These schedules are commonly shown as C-I, C-II, C-III, C-IV, and C-V.
What drugs are included in the controlled substance (scheduled) categories? Some examples of drugs in these Schedules are as follows:
Schedule I — drugs with a high abuse risk. These drugs have NO safe, accepted medical use in the United States. Some examples are heroin, marijuana, LSD, PCP, and crack cocaine. (see the update below for more information about marijuana's classification).
Schedule II — drugs with a high abuse risk, but also have safe and accepted medical uses in the United States. These drugs can cause severe psychological or physical dependence. Schedule II drugs include certain narcotics, stimulants, and depressant drugs. Some examples are morphine, cocaine, oxycodone (OxyContin®), , methylphenidate (Ritalin®), and dextroamphetamine (Dexedrine®).
Schedule III, IV, or V — drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States. Schedule III, IV, or V drugs include those containing smaller amounts of certain narcotic and non-narcotic drugs, anti-anxiety drugs, tranquilizers, sedatives, stimulants, and non-narcotic analgesics. Some examples are acetaminophen with codeine (Tylenol® No.3), paregoric, diazepam (Valium®), alprazolam (Xanax®) and pentazocine (Talwin®).
**Update 9/8/23** Following a request by President Joe Biden in August of 2023, the Department of Health and Human Services (HHS) issued a recommendation to the Drug Enforcement Agency (DEA) that marijuana be reclassified from a Schedule I to a Schedule III drug.
Since the 1970s, marijuana has been listed alongside heroin and LSD as Schedule I drugs, or substances that authorities say have no accepted medical use and a high potential for abuse. Today, marijuana has remained in this category – ranking higher than fentanyl, cocaine and methamphetamine – despite there being favorable momentum for pot in scientific research and state laws.
The DEA will consider moving marijuana down to a Schedule III drug, alongside ketamine, anabolic steroids and testosterone as a substance that has moderate to low potential for physical or psychological dependence. The recommendation, however, will not de-schedule marijuana. Ultimately, the DEA will have final authority over whether to reclassify Marijuana under Schedule III of the CSA, and such a process could take months under applicable federal rulemaking procedures and potentially subject to court challenge.
Can my doctor give me a written prescription for a controlled substance medication? No. Effective January 1, 2021, Texas Health and Safety Code, §§481.0755 requires that prescriptions for controlled substances to be issued electronically, except in limited circumstances, or unless a waiver has been granted by the appropriate agency.
Can my doctor, physician assistant or nurse practitioner authorize refills of a controlled substance medication?
Schedule C-II medications-
Refills are prohibited by law however a physician may authorize the pharmacy to dispense up to a 90 day supply of medication at one time.
A physician may also transmit up to 3 electronic prescriptions, each for a 30 day supply of medication, with specified "earliest fill dates" (EFD).
The patient must wait at least 28 days between filling each prescription.
The EFD indicated on a prescription is the date the prescription becomes valid, it automatically expires 30 days after the EFD.
A prescription automatically expires 90 days after the date it was transmitted by the physician. A pharmacy will not honor a prescription if the EFD is more than 90 days from the transmission date. Some pharmacies will not fill C-II prescriptions more than 80 days from the transmission date.
Schedule C-III, C-IV, C-V medications-
Physicians may authorize up to 6 month's worth of refills of C-III, C-IV and C-V medications. All refills, including any that have not been used, automatically expire 180 days (6 months) after the date they were transmitted by the physician. Pharmacies typically make patients wait 28-30 days between each refill.
Physician assistants (PA's) and nurse practitioners (NP's) may authorize up to 3 month's worth of refills of C-III, C-IV and C-V medications. All refills, including any that have not been used, automatically expire 90 days (3 months) after the date they were transmitted by the provider. Pharmacies typically make patients wait 28-30 days between each refill.
Can a controlled substance prescription be transferred from one pharmacy to another if the patient requests it? Yes. Effective August 28, 2023- The Drug Enforcement Administration (DEA) amended its regulations to allow the transfer of electronic prescriptions for schedules CII–CV controlled substances between registered retail pharmacies for initial filling, upon request from the patient, on a one-time basis.
Can a pharmacist fill my prescription if it has been ordered by a doctor in another state ? Yes, under certain conditions. A prescription issued by a doctor licensed in another state, but not licensed in Texas, may be filled in Texas, if a true doctor-patient relationship exists
Is it legal to possess or transport prescription medication in containers other than the prescription bottle provided by the pharmacy? Some states specifically forbid carrying prescription drugs in an unlabeled container. Texas has no express law on this subject but you can be arrested if you are found to be in possession of a controlled substance that is not in the prescription bottle provided by the pharmacy. In such cases, you would be charged with possession of a controlled substance. This is a Class A misdemeanor in Texas, which carries a potential jail sentence of one year, in addition to a maximum fine of $4,000.
Can a friend or family member pick up a patient's prescription medication for them from the pharmacy? Yes. A pharmacist may use professional judgment and experience with common practice to make reasonable inferences of the patient’s best interest in allowing a person, other that the patient, to pick up a prescription. See 45 CFR 164.510(b). For example, the fact that a relative or friend arrives at a pharmacy and asks to pick up a specific prescription for an individual effectively verifies that he or she is involved in the individual’s care, and the HIPAA Privacy Rule allows the pharmacist to give the filled prescription to the relative or friend. The individual does not need to provide the pharmacist with the names of such persons in advance.
Expect stricter laws and policies for picking controlled substance prescriptions. Many states require you to present a government-issued identification, like a driver's license or passport
Is it legal to store or possess someone else's prescription medication for them? Federal law allows caregivers to fill a prescription and transport it to the patient but you should NOT carry or store any one else's medication unless you are their parent, legal guardian or established caregiver. Once you pick up a prescription medication for someone else, you should give it to them as soon as possible. If police discover you in the possession of someone else’s prescription for more than 24 hours after the date the pharmacy dispensed it they might arrest you. They might assume that you intend to violate the law by using that medication or selling it, even if you had no criminal intentions.
Can I return or exchange prescription medication to the pharmacy if it's not working, it's causing side effects, the incorrect medication was dispensed or there are other issues with the medication? NO. Once a prescription has left the pharmacy, the pharmacist cannot be sure that the product is still safe. Therefore, in the interest of public safety, state law prohibits the pharmacist from accepting the return of a prescription drug, in whole or in part, and reusing the drug to fill another prescription.
Can I use my FSA or HSA funds to pay for my office or telemedicine encounters, office procedures, supplements or lab work? Yes, you CAN use your FSA or HSA funds to pay for any product or service we provide as part of your treatment but there are regulations that must be followed. Federal law prohibits prepayment for any medical service. Our office requires payment at the time an appointment is reserved, which is a prepayment. Patients must use a personal credit card to reserve an appointment. On the day of, or after, the appointment our staff can transfer the charges to an HSA or FSA account. If the HSA or FSA transaction is approved our staff will issue a refund of the charges that were originally charged to a personal credit card. Patients need to request and keep both a RECEIPT and a SUPERBILL for the encounter, procedure or lab work that was charged to their FSA or HSA.
What is an FSA? A flexible spending account (FSA) is a tax free savings account that patients can use to cover their medical expenses. Some employers offer FSA to their employees as an employee benefit. The employer may contribute funds and/or the employee may contribute funds to the FSA through payroll deductions. If the funds are not used or the employee leaves their job before the end of the year the funds may be forfeited. A FSA is created and managed by the employer for the employee. FSAs are only available through employers; unemployed or self- employed persons are not eligible to have a FSA.
What is a HSA? A health savings account (HSA) is a tax free savings account that patients can use to cover their medical expenses. The employer and/or employer may contribute funds to the HSA. A HSA is more flexible than a FSA. Money that is set aside for a HSA through payroll deductions can be invested and the account may earn interest. Unused funds that are put into a HSA are not forfeited at the end of the year, they can roll over into the next year and accrue. HSA funds are also portable, which means an employee can keep their HSA if they leave their job and the balance can roll over from year to year. HSA is only available to employed persons, including those who are self-employed, who have a high deductible health plan (HDHP). For 2023 you must be covered under an HDHP with a minimum deductible of at least $1,500 for individual coverage, or $3,000 for families, and a maximum out-of-pocket amount of $7,500 for individual coverage, or $15,000 for families.
Nova Wellness Center is a welcomed alternative to the fast-paced, impersonal, conventional-medical setting. Each patient who visits our facility is treated as an individual. We schedule adequate time to discuss your health concerns and wellness goals with you. We offer many evaluation and treatment modalities that utilize a holistic approach to medicine.
Our mission is to serve as an antidote to conventional healthcare. We educate our patients to promote wellness, prevent disease and decrease the need for prescription medications.
For your convenience we offer online scheduling for most of our services.