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Consumers Union SWRO reexamines Access
to Contact Lens Prescriptions since implementation of the Texas Contact
Lens Prescription Act. We find that most optometrists will now release
prescriptions, but some use loopholes in the Act to keep consumers from
taking their prescription elsewhere to be filled. And state prescription
requirements prevent many consumers from using low-cost 1-800 and Internet
discount contact lens dispensers.
Introduction:
The Contact Lens Prescription Act
In March 1997, the Southwest Regional Office of Consumers Union released
a survey of optometrists and ophthalmologists ("eye doctors")
from nine Texas cities to see if consumers could obtain their contact
lens prescriptions from their eye doctor and use them to buy lenses from
the dispenser of their choice. At that time, Consumers Union found that
most eye doctors would not release a contact lens prescription directly
to patients. We also found that since the cost of contacts varied widely,
eye doctors' refusals to release prescriptions limited a consumer's ability
to find the best price.
In June 1997, the 75th Texas Legislature passed House Bill 196, "The
Contact Lens Prescription Act" (recodified in 1999 as Chapter 353
of the Occupations Code). This Act made the release of contact lens prescriptions
mandatory, but it also contained a number of loopholes that enabled eye
doctors to manipulate the law to protect their contact lens sales.
If a patient requests a contact lens prescription during the initial or
annual exam, the eye doctor must provide the prescription at the time
he or she "determines the parameters of the prescription."(1)
The legislation gave eye doctors the flexibility to determine a contact
lens wearer's needs based on the ocular health of individual patients.
For example, a new user might need to try new lenses for a week and return
for a follow-up visit to be sure the new lenses worked properly. An existing
wearer making no changes in the lens type might need only an exam and
verification that the current lenses are comfortable.
Some eye doctors, with the blessing of the Texas Optometry Board, have
instead used the flexibility granted by statute to create procedures that
apply to every patient-in particular the follow-up visit requirement.
Eye doctors who require a second visit can refuse to provide the contact
lens prescription to those who did not return for the follow-up.(2)
Under the statute, the patient can request the prescription at any time
while it is valid (prescriptions cannot be written for less than a year)
(3) but if the prescription has already
been filled by the eye doctor, the eye doctor can refuse to provide it.
(4) Although the statute specifically requires
eye doctors to extend the prescription time upon request of a patient,
it does not specify that this extension applies to patients who have already
purchased a full one year supply of lenses.(5)
Because the prescription specifies the number of lenses, people losing
or tearing a lens cannot replace it without another exam.
A "valid" prescription must be an original and picked up in
person or mailed. A faxed prescription is not "valid."(6)
Further the eye doctor is only required to provide the prescription once,
according to Optometry Board interpretation.(7)
The statute actually says that an eye doctor must provide the prescription
"at any time during which the prescription is valid," and does
not limit the number of times eye doctors must give out an original prescription.(8)
Eye doctors can refuse to release prescriptions for medical reasons, if
financial obligations have not been met (including pending insurance claims),
or if the request is made after the first anniversary of the patient's
last eye exam. If the doctor refuses to release the prescription he or
she must tell the patient the reason and document it in the patient's
record.(9)
Eye doctors cannot charge a fee in addition to the examination and fitting
fees as a condition for releasing the prescription. Eye doctors cannot
make the release of a contact lens prescription conditional on a patient's
agreement to buy contact lenses from the eye doctor.(10)
However, Optometry Board action on consumer complaints indicates
that eye doctors may be able to refuse patient requests for their prescriptions
if patients do not agree to attend (and sometimes pay for) ongoing follow-up
care. Eye practitioners who place unnecessary burdens on their customers
in the name of "ocular health" violate the spirit, if not the
letter, of the Contact Lens Prescription Act.
Survey 2000
In order to determine if eye doctors are complying
with the new statute, Consumers Union conducted a new survey in October
2000 and reviewed 44 complaints filed with the Optometry Board related
to contact lenses. While the complaint information is largely anecdotal,
the files reveal interesting details about the process some people have
to go through to get their contact lens prescription.
Consumers Union again surveyed optometrists in the same nine cities: Austin,
Corpus Christi, Dallas, El Paso, Houston, Laredo, Midland/Odessa, San
Antonio and Tyler. This survey found that while eye doctors now say they
will release prescriptions to patients, most require a follow-up visit
before releasing the prescription, even for long time contact lens wearers
with no medical problems. In addition, complaints filed with the Optometry
Board provide anecdotal evidence of a number of other barriers to competition
in the contact lens market.
Notes:
1 Occupations Code, Chapter 353, Contact Lens Prescription
Act, Article 353.156(b).
2 Texas Administrative Code, Title 22, Part 14, Chapter 279, Rule 279.7(b)(1).
Also ibid.
3 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.153 and 353.157(B)(5).
4 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.103(d) and 353.152(6).
5 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.155(b) and Optometry Board interpretations as expressed to consumers
in responses to complaints, TOB complaint # 00065, March 1, 2000, and
TOB complaint #00009, October 5, 1999.
6 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.101 and 353.152(5).
7 Texas Optometry Board complaint, TOB#00047, December 2, 1999, letter
to complainant, 1/3/2000.
8 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.156(c).
9 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.157.
10 Occupations Code, Chapter 353, Contact Lens Prescription Act, Article
353.158.
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