Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-01-04 Encounter: Spruce text message CC: Ongoing impulse control difficulties on current guanfacine dose, with parent questioning whether a higher dose is needed. HPI: Miles had been on guanfacine for several months and continued to struggle significantly with impulse control over the prior few months, which the parent described as very hard. The parent asked whether they were at the maximum dose and also raised a concern from the pharmacist that the extended-release capsules should not be cut in half. As of 2026-02-06, the prescription was flagged by insurance requiring a prior authorization for the number of pills prescribed per day, complicating refill. Assessment: Dr. Hobbs noted the typical daily maximum for guanfacine is 4mg and that the current dosing strategy (cutting pills), while non-standard, was safe. Insurance was flagging the prescription as exceeding their covered quantity per day. Prior authorization was required for insurance coverage at the current dosing frequency. Plan: Dr. Hobbs sent a refill with refills noted. Insurance required prior authorization for the number of pills being taken daily; Dr. Hobbs noted this could take days to process. Advised parent to contact pharmacy about cash price as an alternative, as it might be less than the copay. Prior authorization process initiated. Medications: - Guanfacine current dose with refills sent; insurance PA required for dosing frequency (refill) Key clinical quotes: "4mg is the typical daily max." "It isn't if it works and he doesn't have side effects. We are using them in a less standard way, but it's safe to do so" "They want me to decrease the number of pills he takes a day so insurance will cover it. Or submit a prior auth, which I can do, but may not be processed for days" Source: Spruce conversation t_25GF4V55J8800