Thursday, May 25, 2017

Utah Makes Extensive Opioid-Related Policy Changes

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During what can only be described as a whirlwind of a legislative session, Utah’s legislature adjourned earlier this month after passing more than half a dozen bills addressing opioid medications, many of which will directly affect the way that health care providers may provide care to people living with pain.

Please note: New laws in Utah become effective 60 days after adjournment, unless specifically noted in the bill (full text links have been provided for all bills). Utah’s legislature adjourned on March 9th, 2017.

Prescribing Requirements for Schedule II and III Opioids Have Changed

A prescription for a Schedule II or III opioid that is issued for an acute condition shall be completely or partially filled for no more than a 7-day supply as directed on the daily dosage rate of the prescription. This rule does not apply to prescriptions issued for complex or chronic conditions which are documented as being complex or chronic in the medical record. A pharmacist is not required to verify that a prescription is in compliance with this rule. (HB 50)

Physician assistants no longer need to obtain a co-signature on a chart medical record of a prescription from the supervising physician to prescribe Schedule II and Schedule III controlled substances. (SB 162)

Rules will be developed to establish scientifically based guidelines for controlled substance prescribers to co-prescribe an opiate antagonist to a patient. (SB 258)

Prescription Monitoring Program (PMP) Requirements Have Changed

A prescriber shall check the PMP for information about a patient before the first time the prescriber gives a prescription to a patient for a Schedule II or III opioid. However, this rule does not apply if: the prescription is for 3 days or fewer; the prescriber has prior knowledge of the patient’s prescription history based on the prescriber’s review of the patient’s health record; or, the prescription is a post-surgical prescription written for 30 days or fewer.

If a prescriber is repeatedly prescribing a Schedule II or III opioid to a patient, the prescriber shall periodically review either PMP information or other similar records of controlled substances the patient has filled.

Action shall not be taken against the license of a prescriber for failure to follow these PMP rules if the prescriber demonstrates substantial compliance with the rules, generally.

The PMP must review and adjust the database programming which automatically logs off an individual accessing the database to maximize the following objectives:

  1. Reduce patient privacy;
  2. Reduce inappropriate access; and
  3. Make the database more useful and helpful to prescribers of controlled substances and their delegates authorized to access the system, especially in high usage locations such as the emergency department.  (HB 50)

Partial Filling of Schedule II Controlled Substances is Permitted

This bill relates to partial filling of a Schedule II controlled substance prescription. As passed, the bill allows a prescription for a Schedule II controlled substance to be partially filled in accordance with federal law for a patient in a long-term care facility or a patient with a terminal illness. However, in the case of all other patients, a prescription for a Schedule II controlled substance may only be partially filled if in accordance with federal law and in accordance with state rules (yet to be drafted) that will specify how to record the date, quantity supplied, and quantity remaining of a partially filled prescription, as well as anything else “otherwise necessary for the implementation” of this newly-passed statute. (HB 146)

To learn more about partial fills of Schedule II controlled substances, which is a rapidly evolving area of law at both the state and federal levels, we urge you to review our Issue Brief: Partial Fills, updated March 2017.

Prescribers Must Receive Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training

Controlled substance prescribers must receive training in a nationally recognized opioid abuse screening method, SBIRT.  The bill permits controlled substance prescribers to fulfill continuing education requirements through training in the screening method and permits controlled substance prescribers who receive a DATA 2000 waiver to use the waiver to fulfill certain continuing education requirements.

The bill also requires Medicaid reimbursement to health care providers for screening services and requires the Public Employees’ Benefit and Insurance Program to reimburse health care providers for screening services. (HB 175)

Insurers May Enact Prescribing Policies to Minimize Opioid Addiction and Overdose

Commercial insurers, the state Medicaid program, workers’ compensation insurers, and public employee insurers may implement prescribing policies to minimize the risk of opioid addiction and overdose.

Health insurer that provides prescription drug coverage may enact a policy to minimize the risk of opioid addiction and overdose from:

  1. Chronic co-prescription of opioids with benzodiazepines and other sedating substances;
  2. Prescription of very high dose opioids in the primary care setting; and
  3. The inadvertent transition of short-term opioids for an acute injury into long-term opioid dependence.

A health insurer that provides prescription drug coverage may enact policies to facilitate:

  1. Non-narcotic treatment alternatives for patients who have chronic pain; and
  2. Medication-assisted treatment for patients who have opioid dependence disorder.

Health insurers must annually submit a written report to the Utah Insurance Department regarding whether the insurer has adopted a policy and a general description of the policy. The Utah Insurance Department must annually submit a written summary of the information submitted by health insurers to the Health and Human Services Interim Committee. (HB 90)

Feel free to contact me if you have any questions about these or any other pain-related policies.

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About Katie Duensing, JD, Asst. Director, Legislative & Regulatory Affairs