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Maryland Optometric Association works with Drug Enforcement Administration, pharmacy and insurance to halt the misuse of DEA numbers
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In May 1995, legislation was passed to allow Maryland optometrists to prescribe therapeutic pharmaceutical agents (TPAs). The bill allows them to use most topical drugs and to use oral drugs for treating infection, including antibiotics.
According to Kristin F. Jones, legislative/association coordinator for the Maryland Optometric Association (MOA), optometrists in Maryland operate under specific prohibitions against using steroids and antiviral, antifungal, antimetabolite and antiparasitic agents. Glaucoma treatment must be comanaged with an ophthalmologist. According to Ms. Jones, the MOA will not seek another expansion for its approximately 600 optometrists until 1999.
Ms. Jones said that optometric-ophthalmologic relations in Maryland can be categorized as "professionally cooperative." Many ODs and MDs work closely together, she added, although some "old school MDs" remained resistant to optometric practice expansions. "They still perceive their practices to be threatened by therapeutically certified ODs," she said.
Ms. Jones said to become therapeutically certified in Maryland, an optometrist must take a 110-hour course and pass the national Treatment and Management of Ocular Diseases examination. Optometrists who have graduated after July 1, 1992, are exempt from these requirements.
Rigorous certification requirements
"The certification process has been somewhat of an administrative headache for the board," Ms. Jones said. "Maryland's certification requirements are rigorous, but they ensure the health department that every doctor who earns TPA certification is qualified and prepared to treat eye disease and injury."
Because Maryland's law is relatively new, "some ODs have been a little hesitant to start prescribing," Ms. Jones said. "They are probably still referring when they could prescribe, out of caution. But I also think there's a core group, especially younger ODs, who are prescribing to the full extent of the law right now."
Ms. Jones said therapeutic utilization has been tough to gauge for the MOA for two reasons:
- the state's optometrists have not had TPA legislation for long and,
- ODs cannot obtain Drug Enforcement Administration (DEA) numbers, because they cannot legally prescribe controlled substances at this time.
Lack of DEA numbers brings problems
The lack of DEA numbers has caused problems, said Ms. Jones. "Many times figures are distorted concerning what optometrists are prescribing and when they are prescribing," she said, "because insurers use dummy DEA numbers that pharmacies put on their screens just to get the prescription through. In the end, it doesn't appear to be an optometric prescription even though it was."
She said ODs also often write prescriptions from ophthalmologists' prescription pads. "That kills us with our utilization stats and with the pharmaceutical companies," Ms. Jones said.
According to Ms. Jones, the DEA's system is being abused by those who misuse the DEA numbers as some kind of provider identification number. However, she said the DEA said its hands are tied.
The MOA has worked with the DEA, state pharmacy and insurance agencies to make changes in the use of DEA numbers. "We're trying to work with the pharmacy associations, but they're in a bad position, as well, because it's not their idea to collect the DEA number; they do it because otherwise they can't get reimbursed."
The DEA has issued a number of letters to insurers, Ms. Jones said. One said that the DEA considers insurance usage to be an inappropriate use of the DEA numbers; however, it is not illegal.
Ms. Jones is hopeful that a new national provider identifier, which is being developed by the Department of Health and Human Services, may eliminate these problems. "I hope the Health Care Financing Administration will require this new identifier," Ms. Jones said.
For Your Information:
- The Maryland Optometric Association can be reached at 720 Light Street, Baltimore, MD 21230; (410) 727-7800; fax: (410) 752-8295.