FRAMINGHAM -- When Tufts Health Plan engrave a patient's instruction for the sleep aid Lunesta from 30 pills to 10 pills a month, her physician, Dr. Stephen A. Hoffmann, determined to circumvent state regulations by writing a second prescription in the name of her husband so she could get 10 more pills per month.

Hoffmann is conscious that by publicly acknowledging the prescription trick, he might be subject to disciplinary action and even criminal charges. But he judge himself a "medical conscientious objector," and says a patient's welfare comes before what he believes are difficult insurance restrictions.

"I'm willing to do something that may put me at risk," he said. "I feel I have no alternative."

Hoffmann, 51, has been practicing since 1982, and has run a busy solo practice in Framingham since 2003. He said he has broken prescribing regulations about 11 times in the last six or seven years to avoid insurance company restrictions on various drugs.

His actions are a great example of widespread dissatisfaction among primary - care physicians, who say they are aggravated by increasingly restrictive rules compulsory by health insurance companies in an attempt to reduce healthcare costs.