Mandate Madness – 3 States Propose e-Prescribing Legislature in the First Two Months of 2017

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New York will soon be celebrating their one year e-Prescribing mandate anniversary at the end of March and on the heels of this inaugural, impactful mandate, it’s exciting to see other states hopping on the e-Prescribing bandwagon. Not only did Maine announce its own e-Prescribing legislation that’s effective in just four months, but since the start of 2017, three additional states have introduced similar mandates. One common denominator most prevalent to note, however, is the overwhelming commitment by each state to combat the opioid crisis in order to decrease overdose death rates and improve patient safety overall.

Let’s review the three states that have recently proposed e-Prescribing legislation.

Pennsylvania

Pennsylvania experienced an astounding 3,264 opioid overdose deaths in 2015, a 20.1% increase from 2014. With the rising, devastating numbers in tow, Pennsylvania has decided to take further action and follow suit with New York and Maine.

On February 6, 2017, Pennsylvania State Senator Richard Alloway and Pennsylvania State Representative Tedd Nesbit announced the introduction of legislation that will require all opioid prescriptions such as OxyContin®, Percocet®, and Norco® to be e-Prescribed in Pennsylvania. The proposed bill will not only require controlled substances to be sent electronically, but will also enforce Schedule II medications not to be refilled by the pharmacy. For Schedules III and IV prescriptions, the bill requires that such prescriptions, “shall not be filled or refilled more than six months after the date thereof or be refilled more than five times after the date of the prescription unless renewed by the practitioner.”

The state is committed to a fast turnaround on implementing this legislation and as a result, especially for the protection of patients, the General Assembly is being urged to pass this vital legislation before June 30, 2017.

Connecticut

Yet another state devastated by the increasing drug overdose deaths from opioids, Connecticut Governor Dannel Malloy recently announced an increase in state funding to address opioid addiction and also introduced a series of legislative proposals, including one that will require all opioid prescriptions to be electronically prescribed. Governor Malloy not only highlighted the reduction in fraud that e-Prescribing can accomplish relative to curbing drug diversion, but also specifically noted the benefits of being able to track prescription data as a means to document both prescriber and patient information for electronic transactions.

“A pad of paper doesn’t come from a particular site. It is hard to trace,” Malloy said. “If you do it electronically, you can instantaneously trace, and it’s easier for us to document who is getting the drug, and who is prescribing the drug.”

As part of Governor Malloy’s proposal, a bill that outlines giving patients the ability to include a form in their medical file that indicates that they do not want opioid treatment has also been included. With value based care underway, this serves as another way to encourage patients to make their own health care and treatment decisions for what they deem works best for them.

Like Pennsylvania, the protection of patients across Connecticut is of utmost importance to the state, therefore Governor Malloy is pushing for this imperative legislation to be effective as of January 1, 2018.

Virginia

In Virginia, it has been estimated that 1,000 people died from overdose in 2016, a 33% increase from the prior year. Moving quickly, the General Assembly of Virginia unanimously approved legislature on January 26, 2017 requiring any prescription containing an opiate to be issued as an electronic prescription and will also prohibit any pharmacist from dispensing a controlled substance that contains an opiate unless the prescription is issued electronically.

On February 23rd, Virginia Governor Terry McAuliffe signed five bills to address the opioid epidemic, including the mandate for all opioid prescriptions to be prescribed electronically by July 1, 2020. It will also create a working group to study how best to implement this change.

What’s unique about this legislature, however, is that it all began with a practicing dentist who happens to be a state delegate for Virginia.

“We have all seen the tragic headlines that highlight the devastating impact that opioid addiction has had – and continues to have – on families and communities throughout the Commonwealth and the Nation,” said Delegate Todd Pillion. “This is an issue that I see not only as a legislator, but as a prescriber myself.”

As such, Delegate Pillion decided to utilize his profound, and heartfelt, voice to address the opioid epidemic that is sweeping our nation at alarming rates. Having personal experience under his belt, he was responsible for the original proposed e-Prescribing mandate in Virginia.

Where do other states stand?

With 3 states proposing legislature in the first 60 days of 2017, we anticipate more states to follow. As many individuals involved in the aforementioned state legislations have mentioned, it just makes plain sense to prescribe the most addictive, but necessary, medication through e-Prescribing. It is finally, and rightfully, being viewed as an optimal tool to overcome this drug crisis.

Electronically prescribing opioids will not only decrease drug overdose deaths and increase patient safety, but it will also:

• Combat the rising issue of prescription fraud within a dental practice, including misuse of a dentist’s DEA number, forged signatures, and stolen prescription pads by patients or an Insider Threat.
• Allow a prescriber to query a patient’s medication history at point of care in order to determine if they are “doctor shopping”, or visiting multiple prescribers strictly to receive opioid prescriptions.
• Add to patient convenience by reducing wait times in pharmacies.
• Increase patient medication pick-up adherence. Between 28% and 31% of all paper prescriptions either never make it to the pharmacy or are not picked up at all.

Stay tuned for more states that will undoubtedly be proposing similar legislature in order to work together toward a common goal for the safety of patients overall.

Sources: Virginia Gazette; Bearing Drift; Centers for Disease Control and Prevention; CBS Local; WNPOR

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Opioid Road Map: How the Government Plans to Battle the Opioid Epidemic by Utilizing PDMPs

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The opioid crisis has taken our nation by storm, claiming an average of 78 victims a day, all of whom lost a vicious battle with opioid addiction. According to the National Governors Association, the current epidemic is being fueled by inappropriate opioid prescribing, as 4 out of 5 heroin users reported misusing prescription opioids before switching to heroin. Now, governors across the United States are taking action against the epidemic with a range of public health and safety strategies that address everything from prevention to treatment to recovery. In order to successfully attack the opioid crisis head on, they’ve decided to create an Opioid Road Map which will act as a tool to outline these strategies for states nationwide.

A Road Map Was Born

The Road Map was developed by the National Governors Association (NGA) to help states respond to the growing crisis of opioid abuse and overdose, as well as strengthen law enforcement efforts and abilities to address illegal activity. The individual state can either follow the road map step-by-step or they can pick and choose which pieces to utilize based on their needs.

The Opioid Road Map is a three-part process as outlined by the NGA:

Step 1 – Assess the Situation

Step 2 – Develop and Select Policies

Step 3 – Finalize Policies, Implement, and Evaluate Results

To develop the Road Map, the NGA worked with 13 states between 2012 and 2015 to create effective statewide programs to battle the opioid epidemic. Input was received from multiple stakeholders including pain specialists, law enforcement officials, health care payers, substance use disorder treatment professionals, and more. Numerous resources were shared in order to build this Road Map and having the ability to optimize and utilize the data collected from state Prescription Drug Monitoring Programs (PDMPs) was key to the Road Map’s creation.

The Role of PDMPs

The PDMPs of individual states is a database that contains controlled substance prescribing and dispensing data submitted by pharmacies and prescribers. This information is used to monitor and analyze all prescribing activity for use in abuse prevention, research and law enforcement. In regards to the Opioid Road Map specifically, the NGA is encouraging states to use their PDMPs as a tool for prescribers to gather real-time information on prescription opioids, and to analyze trends and outcomes associated with policies and programs.

According to the NGA, in order to maximize the use and effectiveness of state PDMPs, the following should be required:

• Prescribers should be querying PDMPs before prescribing Schedule II, III, IV controlled substances
• Pharmacists must report to the state’s PDMP within 24 hours of dispensing
• PDMP data must be used to provide proactive analyses and reporting to professional licensing boards and law enforcement
• PDMPs must be easy to use and PDMP data should be integrated into the Electronic Health Record (EHR)
• PDMPs should be interoperable with other states

Since these Prescription Drug Monitoring Programs already exist within forty nine states, it would be beneficial to utilize this data not only for preventing occurrences such as “doctor shopping” (people seeking multiple pain prescriptions from multiple prescribers) and identifying at risk patients, but also for achieving goals put forth by the Road Map in relation to research, law enforcement, and policy reform.

Road Map Expectations

By utilizing the Road Map, states will find background information on the current issue of opioid abuse and which factors are involved with prescription opioid misuse and addiction. They will also have access to the different steps outlined which act as a how-to guide for assessing the situation, selecting policies, and evaluating initiatives. Another item of value they could get from using the road map is a summary of evidence-based health care and public safety strategies to reduce opioid abuse.

By utilizing the Road Map, states will be able to work together to not only brainstorm about how to prevent and respond to the opioid epidemic, but more importantly, they will be able to put a plan into action which will achieve those defined objectives, with the ultimate goal of saving more lives in the process.

Author: Shannon K.

Sources: National Governors Association; NGA Road Map Outline; GCN Magazine

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Maine’s New Mandate and What It Means for Opioid Prescribers

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Maine is well known for its rocky coastline, iconic lighthouses, sandy beaches, and lobster shacks. However, past the classic scenery is where you’ll find the state dealing with a crisis that others across the United States are also experiencing: the opioid epidemic.

In 2015, Maine suffered an astounding 272 drug overdose deaths, following 208 deaths of the same cause in 2014. Sadly, there is no end in sight. Maine’s Attorney General Janet Mills declared that drug overdose deaths are up 50% in 2016, with the first 6 months of the year experiencing 189 drug overdose deaths alone. What’s worse, the number of overdose-related deaths in 2016 is expected to reach a new record, surpassing those numbers of 2014 and 2015.

“Heroin addiction is devastating our communities,” Maine Governor Paul LePage said in a statement. “For many, it all started with the overprescribing of opioid pain medication.”

As a state with the largest number of patients per capita on prescription for long-acting opioids, the news that prescribed pain medication is further fueling opioid addiction is unsettling.

This is why Maine has decided to take action.

Maine’s new statue, “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” entails a number of rules and regulations designed to reduce the harm of over-prescribing opioids relative to the abuse and misuse of such substances. This bill, signed into law by Governor LePage, mandates a number of changes for doctors and dentists who prescribe controlled substances in Maine.

[Read: The Maine Mandate – Confronting Controlled Substances Head-On]

What changes will be implemented?

Dosing and Duration of Schedule II Medications

First, this law imposes limitations on the medication dosage, as well as the duration of a prescription, that can be prescribed to a patient. According to Gordon Smith, JD, Executive Vice President of Maine Medical Association (MMA), the original bill limited opioid prescriptions to three days for acute pain and fifteen days for chronic pain. However, this legislation will now mandate a limit of seven days for acute pain and thirty days for chronic pain on opioid prescriptions. This law goes in to effect January 1, 2017.

In terms of dosing, prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 100 Morphine Milligram Equivalents (MMEs) per day to new opioid patients (after July 29, 2016). Existing opioid patients with active prescriptions in excess of 100 MMEs per day are referred to as “Legacy Patients” and prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day from July 29, 2016 to July 1, 2017.

Prescription Monitoring Program

Maine prescribers are required to query the Prescription Monitoring Program (PMP) database prior to prescribing opiates. Although this requirement has been in place since 2005, surveys indicate that only 7-20% of Maine prescribers currently utilize the state’s PMP.

The purpose of checking this central state database is to identify patients who may be doctor shopping and minimize multiple controlled substance prescriptions for one patient. This aligns with the state’s hope of empowering healthcare providers to recognize potential substance abuse and treat patients accordingly.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

[Read: The Link Between PDMP’s and e-Prescribing]

Continuing Education

Via this statute, prescribers must complete three hours of continuing education every two years as a condition of prescribing opioid medications. This specific addiction training is only required if a prescriber wishes to continue prescribing opioids.

Electronic Prescribing

All opioid prescriptions must be sent electronically as of July 1, 2017.

What exceptions are part of this mandate?

The Maine Medical Association (MMA) confirms that exceptions from the law’s provisions may be granted for the following:

• Cancer Patients
• Hospice Care
• End-of-Life Care
• Palliative Care
• Patients on Medication-Assisted Therapy (MAT)
• Patients receiving medication in hospitals and nursing homes

The MMA is currently seeking an exception for burn victims as well.

Due to the supremacy clause of the U.S. Constitution, federal law takes priority over state law, therefore prescribers within the Department of Veterans Affairs (the VA) cannot be regulated by this type of legislation so long as the medication is dispensed at a VA pharmacy. Furthermore, dosage and duration limits would not apply to a prescription written for a veteran by a prescriber outside of the VA system if the prescription were filled in a VA pharmacy.

How does this bill measure up?

With this bill, Maine becomes the third state behind Minnesota and New York to require e-Prescribing and the second to require the electronic sending of a controlled substance after New York imposed a similar mandate in March of 2016. Since the implementation of New York’s mandate, total numbers of opioid analgesics prescribed fell by 78% within the first four months.

Important dates to remember:

Lastly, as part of the state’s strategy, Maine has launched Dose of Reality, a website to help educate and inform their citizens of the dangers of painkillers and where to turn for help.

Author: Lindsey W.

Sources: Maine Medical Association; Maine.gov; Medscape; WCSH6; Bangor Daily News

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.