This is long-its for our European friends: I think people over the pond need to be careful when saying. “In America...”. The truth is, we are individual states, like you are countries. We are united in most ways by the constitution/federal government-however we also have many individual differences state to state.
Healthcare can be different depending on where you are. To complicated state laws, each individual insurance company has its own rules and procedures. Kaiser is very different than Blue Cross, for example.
Frankly. I know nothing about how psychiatry or mental problems work, but have a lot of experience in a harder science/disease. (scans and tests determine 100% what is wrong.)
So prescriptions: in my experience a doctor can prescribe something and the insurance can say no, which you can appeal, or they make you try and fail on a different drug first. They have a list of meds to try before you get to the one you may want. This necessity depends on the illness, of course, and doctors can write up reasons why only that drug works. Same thing for tests-a doctor might request an MRI scan and insurance may say a CT should be done instead.
California , for example, is very strict with controlled substances. They are tracked by the attorney general’s office. (Each time a doctor prescribes one, he logs into the AGs office, which then sends his phone a code, once he inputs the code he can prescribe the drug. ) Any doctor can see this, so doctor shopping is rare in CA now. (Doctors are supposed to look, but sometimes they don’t.) If your insurance covers it ,the pharmacy requests from the insurance, (and now The IDC10 has to be written on the prescription). If they don’t approve you can pay cash but the pharmacies also track it. So much of the problem is illegal drugs from China and Mexico these days.
But I know other states don’t have this system yet. The hope is “big data” will tie all this together. Medical privacy is non-existent in my state despite all the HIPPA stuff
Where I am a nurse practitioner can prescribe even highly scheduled drugs under the supervision of a doctor.
Again, I don’t know about psychiatric, but most aren’t scheduled so it’s probably much easier.
What other state’s do could be very different. This is why there is so much argument about it. I suspect in rural Kentucky there aren’t enough doctors, and across the entire country there aren't enough PCPs, so in those areas it may be very common to have a PA prescribe something at first appointment. I imagine that they have the kind of patients who don’t keep up with regular care, have trouble getting around , cant afford or they don’t have convenient testing facilities so they use their judgment, and so they may prescribe a month’s worth of drugs to see if it helps.
Anyway, long story short-US healthcare is not heavily regulated by the federal government yet (with exceptions like Medicare, etc) and so a lot of it is up to insurance companies and states.
Since Amber doesn’t have insurance, they probably just stick with normal rules and routines, with the only difference they bill her instead of insurance.
Sorry for the TLDR.
