Are you actually buying Proscar, a 5mg generic or is it 1mg Finasteride?

If it's Proscar or a generic version, that's something totally different. Spex's doctor-contact is prescribing Proscar off-licence and therefor taking more medico-legal responsibility. Any doctor can do this if they wish too, however, that is exactly the main reason why Dr. Reese won't, because it would be off-licence in the States as it is here in the UK.

If you are buying 1mg Finasteride, could you tell me which brand please?

P.S. I suspect the doctor is also supplying the medication, if so - that has no bearing on a cost-effective generic Propecia being available in the UK on prescription.

Ah I am buying the 5mg, whats the point in buying 1mg? so you dont have to spend 5 mins cutting it up?

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Lol. No, I also buy 5mg but that isn't what was being discussed in the thread.

ok

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When I read this tread I think that there may be confusion as to what constitutes insurance fraud and what constitutes prescribing a medication off label.
Prior to becoming a hair transplant surgeon I had vast experience in medical administration and had to be very conscious that my employees never engaged in insurance fraud. I worked for Glens Falls Hospital as a Medical Director of their Rural Health Clinics, and then as Associate Medical Director of the New York University Student Health Center, and also as a Medical Director of a Home Health Agency.
When a drug gets approved by the FDA, the drug company needs to study the drug and prove that it is efficacious for the treatment proposed. Then it gets approved by the FDA for only the treatments that the drug company proved it was effective for. Prescribing that drug for any other reason is considered prescribing off label, but not fraud. A good example of this practice is a drug called Neurontin (Gabapentin). It is a drug that has been approved by the FDA to treat post herpetic neuropathy (the pain one gets after having shingles). But it is common in pain management to prescribe it for patients with chronic pain such as sciatic back pain. That is prescribing the drug off label, but it is not illegal.
If I prescribe Finasteride 5mg at a does of ?? pill daily for hair loss and document in my note that I am prescribing it for hair loss with the instructions to split the pill into fourths, I am not doing anything fraudulent or illegal. I am writing an off label prescription. When the insurance company sees the Finasteride is prescribed that way it can then chose whether or not to cover it. If I prescribed it at the dose for benign prostatic hypertrophy which is 5 mg a day and some how indicate that I am prescribing it for the prostate when the patient does not have benign prostatic hypertrophy, then that can be considered insurance fraud. Also it would send a message on the patient's medical record that they have a prostate problem which isn't correct and could cause problems down the road since it seems like they have a pre-existing condition.
Logically it makes sense that splitting the 5mg Finasteride into fourths would be as effective as taking the drug as Propecia. But since this has not actually been studied clinically I usually advise patients who are taking the medication for the first time to take it as Propecia at least for the first year. Then if it does not work there is no question as to whether the cutting of the pill in any way affected the outcome. The FDA just recently put out a good article of why tablet splitting can be risky: http://www.fda.gov/ForConsumer...pdates/ucm171492.htm
Also, if there is a female in the house hold who is trying to get pregnant; one has to be especially careful that she is not exposed to the powder from cutting the pill.
Merk has a good rebate plan for patients who are taking Propecia for the first time. This rebate program helps reduce the cost of the Propecia for the first year and I find it is a good incentive for first time users to use the brand name Propecia.
I do agree with Dr. Reese that if I prescribed the Finasteride at the 5mg dose and did not document that I am instructing the patient to cut the pill into fourths and that the prescription is for the treatment of hair loss that could be considered insurance fraud. But with the correct documentation and writing on the prescription clearly that I am instructing the patient to cut the pill into fourths and take one fourth pill a day I do not believe I am doing anything illegal or fraudulent.
I hope this is helpful
Dr. Paul Shapiro

The way it sounded on this thread is that if Dr Reese prescribed it for anything except for prostatic hypertrophy, he would be breaking the law, until now no one has mentioned writing that it is being prescribed for hairloss, and that the pill will be cut makes it ok. Surely Dr Reese's representative should have mentioned this at some point in the thread.

Thanks for the clarification Dr Shapiro!

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Dr. Paul,

Your explanation really helped shed some clarity on prescribing medication for other than its intended use. Thanks for helping make sense of a confusing topic.

All the Best,

Bill

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To prescribe medication "off-label," for a physician, indeed is an "ethical issue"; you can drop it into the box of "medical ethics," if you must, but indubitable it falls into a philosophical category. Some doctors (i.e., some people) are more "practical," and may write for you a prescription such you can better afford a drug; others may feel it is wrong to steer from a more stringent path.

Let's bear in mind, this is a cosmetic issue; we aren't talking about expensive meds. you need to stay alive. If Dr. Reese will not prescribe for you a drug off-label ??” to "cover his ass," to stay within his moral zone, for whatever reason ??” you can be annoyed, fine, but it's certainly odd of you to accuse him of immoral conduct (even in this more recent post, you imply he benefits financially from not prescribing generic finasteride in place of Propecia).

CuriousGeorge:

The "cover is ass" comment was regarding him lying to me about his assistant missing the removal of sutures followed by his explanation of ethics, and nothing to do with his actual stance on prescribing medication. You apparently missed that part...

As for "To prescribe medication "off-label," for a physician, indeed is an "ethical issue". Physicians have been prescribing and pharmacies have been filling off-label\generic medications ever since I can recall... I'm not sure if there are any laws that look differently upon whether a medication is for cosmetic purposes or not so I have no idea where you are going with this...


As for your next accusation..., I accused him of nothing. I merely speculated about how his motives could appear to others. Especially as it sharply contradicts the FDA. Does he have stock in Merck? I don't know nor do I care. Nor am I annoyed about his stance. I have great respect for Dr Reese and his practice. But no more than the other Doctors who disagree with him. My audacity to question a Doctor really seems to stir the pot for some...

What I was annoyed with, as I will repeat for the last time in this post, was his failure to be up from with me about the sutures not with his stance on Propecia.

It is amazing how quickly these forums can digress.

I wasn't quoting you when I said "cover his ass" ??” just giving an example of a reason for which he may refrain from prescribing medication off-label.

"Off-label" prescriptions have nothing to do with "generic medication" (not directly). Yes, doctors often do prescribe drugs off-label (i.e., for uses not approved by the F.D.A.), but whether or not to do so is a moral concern for one. As for this specific medicine's (finasteride's) being used cosmetically, I only mean to say, it isn't being prescribed for a life-supporting purpose, which may make a doctor less willing to prescribe it in the "off-label," arguably shady way.

You did accuse him of something when you "wondered" "who" owns stock in a pharmaceutical company (Merck): the accusation implicit is he is persuaded from financial gain not to prescribe Proscar off-label.

I don't feel your "audacity" (I don't see it as such) to question a doctor has "stirred anyone's pot"; simply, some of the things you said in your initial post have ended up feeling unjustifiably accusatory. Now, if you felt the doctor wasn't being up front with you about the sutures, fine; if he wasn't, he was wrong not to. Even if he was, it's wrong you were sent home without every suture's being removed (it's possible, but not really "OK"). If this was your main point, I agree, the thread indeed has digressed terribly.