Communication with Patients through ChARM Connect & Push Health
Push Health is only one of many applications I use as a physician to communicate and review sensitive medical information for my patients. I am not an employee, nor do I work for Push Health. I pay to use their secure technology as do you when you authorize a request. If you are having any issues with their technology or the application, please reach out to the Push Health customer service (855) 787-4432 / 855-PUSHHEALTH or questions@pushhealth.com.
After our initial physician and patient contact in Push Health, I will also give you the opportunity to sign up for ChARM Connect as another mode of communication if any techincal difficulties happen with Push Health. ChARM is my private practice management application. You can download the ChARM Connect app from the Apple Store for iOS devices, and from the Google Play store for Android devices.
When it comes to your medical request or questions, I will typically respond to messages in Charm Connect or Push Health if I am online within business hours. However, due to the large number of requests currently, it is not always possible to respond immediately to a question.
I will usually be able to have seen and responded to all of my many messages within 24-48 hours. If you have not heard back from me after 48 hours, please feel free to call or text my office (808-726-2461) with your name only and ask that I review your chart.
Unfortunately, technology does not always work as well as we would like and some messages do get lost, so please feel free to reach out.
I will fill your prescription once you have responded and given me confirmation that you would like me to move forward. I will wait a minimum of 24 hours for your response. If I do not get a response from you, in most cases, I will assume that your request is still valid, that you understand the risks of your request, and I will fill your prescription.
PLEASE NOTE: Fusion Medicine & Wellness is based in Hawaii although I am licensed in several states, and so my staff and I are working with you in the Hawaiian time zone. Please keep this in mind when you are communicating with us.
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Weight Loss Medications
There is a new class of injectable drugs that have been found to significantly help people lose weight. However, many of these newer medications were designed to help improve type 2 diabetes and are how they got their FDA approval.
So although weight loss is a significant benefit to these medications, it is for this reason that many insurance providers will only cover them for Type 2 diabetes.
It is your responsibility to check with your insurance provider to determine if coverage is available to you. Also check with each manufacturer for cost savings, as many have coupons and programs to get these expensive drugs covered.
The Push health platform does not offer refunds if you request a medication that you do not have insurance coverage for so please check with your individual insurance provider. It also does not allow me as a provider to issue refunds.
FDA Approved Weight Loss Medications:
Zepbound is the newest FDA approved weight loss once-weekly injectable on the market. It is known as Tirzepatide and is the same exact medication as Mounjaro but approved now for weight loss only under this new brand name. Please read the manufacturers important information on the risks and benefits of this drug.
Currently there is a savings plan by the manufacturer for those with commerical insurance and coverage for the drug: Click here.
Wegovy is a once-weekly injection that escalates in dosing each month. Please read the manufacturers important information on the risks and benefits of this drug.
Saxenda is a once-daily injection that escalates in dosing each week. Please read the manufacturers important information on the risks and benefits of this drug.
Off-Label Weight Loss Medications (FDA approved for Type 2 Diabetes)
Mounjaro is a once-weekly injection that escalates in dosing each month. Please read the manufacturers important information on the risks and benefits of this drug.
Ozempic is a once-weeekly injection that escalates in dosing each month. It is the same exact medication as Wegovy but with a slightly different dosing. Please read the manufacturers important information on the risks and benefits of this drug.
Compounding Pharmacies & Weight Loss Medications:
Some people are choosing to use compounded weight loss medications when they are unable to afford the commercial brands or they are unable to get them due to supply issues.
Compounding pharmacies are typically smaller pharmacies that cater to the patient and their needs so that they can create a medication that is considered a compound for the patient in particular as opposed to a commercially available medication that's just standard across the board. Some do also provide commercial medications.
In the case of weight loss medication, they typically are working from the base of the medication (tirzepatide or semaglutide) and adding B12 or B6.
Also because the medication is a compound most pharmacies put it in a vial as opposed to an auto injector. You need to be comfortable pulling up the correct dosage of medication similar to what diabetics have to do.
The only compounding pharmacies that are allowed to do this in particular are what are called sterile compounding pharmacies and they are even more tightly regulated by their state.
To be clear, these are not FDA approved medications although they are the base of the commercial brands like Mounjaro, Wegovy or Ozempic. If you chose this route, you are accepting the risk associated with non FDA approved medications.
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Risks of These Medications
Please make sure to familiarize yourself with the risks of the medication that you are requesting and feel free to ask questions. In general, all of these medications do have similiar risks that can be mild to life threatening and you are accepting these risks by filling your prescription and taking the medications.
Some major risks/side effects include:
- Possible thyroid tumors, including cancer. Do NOT use this medication if you or your close relatives have had thyroid or endocrine cancers.
- Inflammation of the pancreas (pancreatitis). Stop this medication immediately and seek medical treatment if you develop significant abdominal pain in the stomach area that will not go away.
- Low blood sugar (hypoglycemia)
- Kidney problems (kidney failure)
- Severe stomach problems
- Changes in vision
- Gallbladder problems
The most common side effects include nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion, and stomach (abdominal) pain. These are not all the possible side effects.
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Your Pharmacy
It is solely your choice and responsibility to choose the pharmacy you want to use.
Pharmacy Changes
Changing pharmacies after a prescription has already been approved can be done only in the Push Health app. You simply need to go in and make the request in the app yourself and then I will aprove it. The system will then send it on to the new pharmacy.
Pharmacy Communication
I do not make personal calls to pharmacies, nor do I call in medication. I do have a small office staff that will make daily calls during regular business hours, which are Monday through Friday, from 9am-5pm Hawaii time.
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Insurance Company Communication
I do not complete prior authorizations (PA) or communicate with your insurance company about your request from within the Push Health platform. If you are attempting to use insurance to cover this medication, it is your obligation to find out whether your insurance company will cover the medication for on or off-label use for weight loss or type 2 diabetes. Many will not. At that point, it is your decision whether to move forward with the request.
If you determine that you would like me to complete a PA, this has to be done in my private ChARM patient portal, outside of Push Health. You will need to complete more detailed intake information, which I will send you separately and then review. There is an additional charge of $150 for my time spent in this process. There is also no guarantee that your insurance company will accept the PA.
If you would like to request an appointment to start the process of your PA, please visit my website, drchacha.com, to check availability or message me directly in the app.
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Other Treatments
Although these newer medications are effective, sometimes they simply cannot be covered financially despite our best efforts. There are oral weight loss medications that can be helpful. If you have any issue getting coverage, please inquire about alternative weight loss prescriptions.
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Family Member Requests
Requests for other members in your household will not be accepted under another person’s application. Legally, ethically, and from a safety standpoint, each person must have their own prescription and chart review before any medication can or should be prescribed. You can link your family's chart to your own within the Push Health app so that I can review it quickly and promptly.
If you want to refer patients to me in Push Health, my code is CCHARFEN. If you provide their email, I can send them a direct invitation. This app can be glitchy, so if neither of those options work, I can also use my private portal to help you (or them).
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Your Medical History
I will ask you to supply information about your medical history before prescribing any medication. This information is part of your permanent health record and may be shared, at your request, with other health care and insurance providers. Falsifying information may adversely affect your ability to get insurance coverage and/or affect the rates you would pay for coverage. By signing this form, you acknowledge that the health information you will provide is accurate and truthful.
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Please stop using the medication and always seek immediate medical attention if you develop significant symptoms such as shortness of breath, dizziness, severe abdominal pain or chest pain.
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Thank you for reading and acknowledging this important information.
With gratitude,
Dr. Charlotte Charfen