Prescribing the Fisher Wallace Stimulator®

Step 1: Obtain a Free Sample Device

MaineCare requires that prescribers (or nursing staff under the physician’s supervision) trial the device with patients in an initial office visit to demonstrate usage and ensure that the patient experiences no immediate adverse event (headache). Fisher Wallace Laboratories (the manufacturer of the device) has agreed to supply one sample device per prescribing physician at no cost. Physicians may obtain a sample device by emailing a request and proof of license to info@fisherwallace.com.

Step 2: Fax the Following Three Documents to Coastal Med Tech For Each Patient

Please complete and fax these forms to Coastal Med Tech, Inc (the DME supplier for the device) to meet MaineCare requirements for prescribing the device:

MaineCare Authorization Form (Doctor Signs and Date inside Red Box)

Trial Verification Form (Doctor and Patient Signatures)

Assignment vs Non-Assignment of Benefits (Doctor Input and Patient Signature)

Coastal Med Tech Fax Number: 207-848-7767

Local offices of Coastal Med Tech include:

Ellsworth 207-667-2508

Waterville 207-872-7321

Auburn 207-782-0660

Bangor 207-907-4506

Wilton 207-645-3343

Step 3: Patient Follow-Up Visits

MaineCare stipulates that the patient should schedule regular follow-up visits with the physician to ensure proper use of the device and monitor compliance and treatment effectiveness.

Contraindication and Side Effect Information

Patients who are NOT qualified to use a CES device are those with implanted medical devices, such as an implanted nerve stimulator or pacemaker, as the CES device may interfere with the functioning of such devices. CES devices cause side effects (headache, dizziness, skin irritation) in less than 1% of patients and pose no contraindications with medication. As a result, CES is considered a low-risk intervention and is often prescribed in conjunction with antidepressants and other medications.

Patients should be instructed to use the device twice a day for 20 minutes per treatment session.

How To Use the Device

About the Fisher Wallace Stimulator

The Fisher Wallace Stimulator® is a wearable Cranial Electrotherapy Stimulation (CES) medical device indicated for the treatment of depression, anxiety and insomnia that is now covered by MaineCare. The device has been cleared by the FDA and approved in Europe (CE-ISO), Canada, Mexico and Brazil. The safety and effectiveness of CES devices has been demonstrated in multiple published studies, including two randomized controlled trials on the treatment of depression and anxiety that have been published since 2014. In published biomarker studies, CES devices have been shown to stimulate the production of serotonin and other neurotransmitters while modulating the default mode network. Since 2009, 7,000 healthcare providers have prescribed the The Fisher Wallace Stimulator® to 30,000 patients.

MaineCare has authorized Fisher Wallace Laboratories to provide doctors with a free sample device to use with patients in a medical office. Please contact Fisher Wallace Laboratories if you are a licensed MaineCare doctor and wish to obtain a sample device: info@fisherwallace.com.

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