Greetings!

Exciting transformations are on the horizon at Balanced Rock Wellness.

As you may be aware, recent weeks have ushered in significant shifts in the prescribing and dispensing practices for GLP and BHRT medications. These changes have impacted us all, and after some time, I have successfully adapted my system to align with the new regulations.

**Medical Weight Loss**

The dispensing of Semaglutide and Tirzepatide now requires utilization of a 503b pharmacy, mandating direct delivery to the patient and prohibiting office dispensing. These prescriptions will henceforth be processed through Texas Star Pharmacy. I will send the prescription directly to the pharmacy, which will then prompt you via text and email to establish your account. You will handle payment directly with them, and they will ship the medication and injection kit to you, which includes single-use insulin syringes. Alternatively, for those preferring the vial adapter method, injection kits containing syringes, vial adapters, needles, and alcohol swabs are available for $10 at the office. Participants in the weight loss program must attend monthly appointments for the initial six months and every three months thereafter. Missing an appointment outside of this schedule will result in the withholding of your medication order. Allow approximately one week for medication processing, though a two-week lead time is advisable. Prescriptions will cover four weeks during the first six months and will then include two refills post the six-month period for your convenience. Current memberships will be discontinued and restructured according to our new pricing.

**Hormone Replacement Therapy**

Recent amendments to Colorado State Law have altered the prescribing of testosterone, now restricting injectable testosterone dispensing to specific pharmacies. Additionally, testosterone dosing is no longer recorded in PDMP reports, necessitating more vigilant in-office monitoring to ensure compliance. Testosterone prescriptions will be dispensed through Wells Pharmacy and billed directly to you at $66 per vial, inclusive of injection supplies. Though recent changes have slightly delayed pharmacy processing times, the situation is stabilizing. A two-week notice for prescription processing is still recommended. You are required to inform me when a refill is needed. Hormone patients must be seen every three months unless there is a dosage adjustment, which will require an oversight appointment. Pellet therapy remains unaffected by these changes.

**New EMR**

A transition has been made to a new EMR system, Charm Health, which replaces Jane and offers a plethora of features for a smoother experience. This includes a patient portal for messaging, payment processing, accessing lab results and treatment notes, and requesting medication refills. Pharmacies can now electronically request refills, previously unavailable.

You'll receive an email with instructions to establish your portal via your provided email address. Alternatively, registration can be done through the link on our website at [www.balancedrockwellness.net](http://www.balancedrockwellness.net).

This system also facilitates direct phone calls and text messages, addressing recent delays with Spruce. Incoming texts or calls will reach me directly during business hours, and the system supports HIPAA-compliant texting of lab orders or other PHI. Consequently, a new phone number and email have been established for direct contact. Spruce and my cell phone usage will be discontinued. This unified system eliminates multiple contact points.

Our new phone number is (970) 900-1812. Our new fax number is (800) 303-5521. Kindly note, text messaging is preferred for prompt communication.

**Availability**

Due to a family emergency this month, I am required to spend more time at home, limiting my office presence to appointments only. As always, we operate by appointment only, with no walk-ins accepted. Appointments can be scheduled via your portal or our website. I will be available during business hours as follows:

- **Monday:** 9 am to 5 pm

- **Tuesday:** 9 am to 5 pm

- **Wednesday:** 1 pm to 7 pm

- **Thursday:** 9 am to 5 pm

- **Friday:** 10 am to 1 pm

The efficiency of this new system enables real-time receipt of calls and messages, which I will endeavor to respond to promptly. If I am attending to a patient, I will receive an alert and will return your message at the earliest opportunity.

**Packages and Memberships**

To clarify the offerings of our packages and memberships, I've prepared a detailed menu of services included in each, with adjusted pricing to accommodate medication cost changes for patients. Please see below for details.

**Memberships**

- **Male BHRT - Pellet Therapy:** $247.00/month

- Two Consultations

- Three Pellet Insertions

- Two Comprehensive Lab Panels

- One Basic Lab Panel

- **Female BHRT - Pellet Therapy:** $183.00/month

- Two Consultations

- Four Pellet Insertions

- Two Comprehensive Lab Panels

- One Basic Lab Panel

- **Male/Female BHRT - Compound Therapy:** $100.00/month

- Four Consultations

- Four Comprehensive Lab Panels

- (Medication cost not included; prices vary)

- **Male BHRT - Pellet Therapy and Medical Weight Loss:** $422.00/month

- Four Consultations

- Three Pellet Insertions

- Four Comprehensive Lab Panels

- One Basic Lab Panel

- Six Monthly Check-Ins

- (Weight loss medication cost not included; prices vary)

- **Female BHRT - Pellet Therapy and Medical Weight Loss:** $283.00/month

- Four Consultations

- Three Pellet Insertions

- Two Comprehensive Lab Panels

- One Basic Lab Panel

- Six Monthly Check-Ins

- (Weight loss medication cost not included; prices vary)

- **Male/Female BHRT - Compound Therapy with Medical Weight Loss:** $200.00/month

- Four Consultations

- Four Comprehensive Lab Panels

- Six Monthly Check-Ins

- (Medication cost not included; prices vary)

- **Medical Weight Loss:** $100.00/month

- Four Consultations

- Four Comprehensive Lab Panels

- Six Monthly Check-Ins

- (Medication cost not included; prices vary)

- **Primary Care:** $120.00/month

- Unlimited Consultations

- Four Comprehensive Lab Panels

- Trigger Point Injections

- Joint Injections

**Annual Packages (20% off)**

- **Male BHRT - Pellet Therapy:** $2365.00/year

- Two Consultations

- Three Pellet Insertions

- Two Comprehensive Lab Panels

- One Basic Lab Panel

- **Female BHRT - Pellet Therapy:** $1757.00/year

- Two Consultations

- Four Pellet Insertions

- Two Comprehensive Lab Panels

- One Basic Lab Panel

- **Male/Female BHRT - Compound Therapy:** $960.00/year

- Four Consultations

- Four Comprehensive Lab Panels

- (Medication cost not included; prices vary)

- **Male BHRT - Pellet Therapy and Medical Weight Loss:** $3332.00/year

- Four Consultations

- Four Comprehensive Lab Panels

- Three Pellet Insertions

- Six Monthly Check-Ins

- (Weight loss medication cost not included; prices vary)

- **Female BHRT - Pellet Therapy and Medical Weight Loss:** $2717.00/year

- Four Consultations

- Four Comprehensive Lab Panels

- Four Pellet Insertions

- Six Monthly Check-Ins

- (Weight loss medication cost not included; prices vary)

- **Male/Female BHRT - Compound Therapy with Medical Weight Loss:** $1920.00/year

- Four Consultations

- Four Comprehensive Lab Panels

- Six Monthly Check-Ins

- (Medication cost not included; prices vary)

- **Medical Weight Loss:** $960.00/year

- Four Consultations

- Four Comprehensive Lab Panels

- Three Pellet Insertions

- Six Monthly Check-Ins

- (Medication cost not included; prices vary)

- **Primary Care:** $1152.00/year

- Unlimited Consultations

- Trigger Point Injections

- Joint Injections

- Four Comprehensive Lab Panels

I understand this is an abundance of information, and the past two months have been tumultuous. I am grateful for your patience as we navigate these changes.

With heartfelt gratitude,

Landon Pettit, APRN, AGNP-C