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.

Has the Pendulum Swung Too Far? Chronic Pain vs. Opioid Addiction

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Video courtesy of CBS Los Angeles

It’s estimated that 100 million Americans struggle with chronic pain, yet most are facing a barrage of obstacles while seeking treatment in order to appropriately manage their pain. With the current opioid epidemic sweeping the nation, people want the number of opioid overdoses to fall, but patients don’t want to be made to suffer, and rightfully so.

Has the opioid crisis and its implications prevented legitimate chronic pain sufferers from receiving the treatment and associated services they require to productively function in life?

As of recently, more than half of prescribers across America are cutting back on opioid prescriptions, and nearly 1 in 10 have stopped prescribing them altogether. They’re ultimately struggling to find a balance about the merits of using opioids to treat pain, especially in the absence of effective and affordable alternatives.

With this reality, it appears that the chronic pain population is facing an uphill battle, especially with the justified fear of prescribers pulling back in such a chaotic way that could be harmful to patients. Opioid drugs affect the body in an extreme manner and are not something a patient should stop abruptly or without appropriate medical oversight. It needs to be a monitored process, especially for those who have been on long term treatment.

In fairness to the other component of the chronic pain equation, are those patients that truly suffer from opioid addiction. As noted in a recent Boston Globe article, physicians face myriad pressure as they struggle to treat addiction and chronic pain, two conditions in which most physicians receive little training and often intertwine with one another.

Addiction is a complex disease that requires multifaceted solutions and a team approach. No single physician can provide the breadth of treatment required, nor are the necessary payment mechanisms in place to facilitate the “entirety” approach to treating addiction. That and the lack of physician education in addiction further fuels the long battle chronic pain patients are currently experiencing. Without proper knowledge of the physician, is every chronic pain patient now being viewed as an addict? Is that a realistic prejudice they’re being faced with?

In many cases, physicians are walking away completely – they don’t even want to see patients in chronic pain, but others urge to partner with patients and stay with them to help find other options. Such alternatives include The Spaulding Program, a program aimed at developing and teaching coping mechanisms, strategies, and “tricks” to manage and get through the pain. Although the program experiences great success, it had to limit its operation 20 years ago due to insurers ceasing payment for their comprehensive form of care.

It’s hopeful that the concern over opioids will lead to improved care, by deepening the doctor-patient relationship and opening the door for conversation to talk about managing pain, thus pointing to the desperate need for alternative treatments. For now, what is a chronic pain sufferer to do?

Author: Mark H.

Sources: Health.com; The Hill; American Academy of Pain Medicine; Boston Globe; Kevin MD Blog; CBS Los Angeles

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.