WEST virginia legislature
2019 regular session
Committee Substitute
for
House Bill 2768
By Delegate Rohrbach
[Originating in the Committee on Health and Human Resources; Report of February 12, 2019]
A BILL to amend and reenact §16-54-1, §16-54-3, §16-54-4, §16-54-5, §16-54-6, §16-54-7, and §16-54-8, of the Code of West Virginia, 1931, as amended, all relating to reducing the use of certain prescription drugs; defining terms; clarifying types of examinations; requiring certain information in a narcotics contract; clarifying that the drug being regulated is a Schedule II opioid drug; providing exceptions; and requiring coverage for certain procedures to treat chronic pain.
Be it enacted by the Legislature of West Virginia:
ARTICLE 54. Opioid reduction Act.
As used in this section:
“Acute pain” means a time limited pain caused by a specific disease or injury.
“Chronic pain” means a noncancer, nonend of life pain lasting more than three months or longer than the duration of normal tissue healing.
“Health care practitioner” or “practitioner” means:
(1) A physician licensed authorized
pursuant to the provisions of §30-3-1 et seq. and §30-14-1 et seq.
of this code;
(2) A podiatrist licensed pursuant to the provisions of §30-3-1 et seq. of this code;
(3) A physician assistant with prescriptive authority as set forth in §30-3E-3 of this code;
(4) An advanced practice registered nurse with prescriptive authority as set forth in §30-7-15a of this code;
(5) A dentist licensed pursuant to the provisions of §30-4-1 et seq. of this code; and
(6) An optometrist licensed pursuant to the provisions of §30-8-1 et seq. of this code;
“Insurance provider” means an entity that is regulated under the provisions of §33-6-1 et seq., §33-15-1 et seq., §33-16-1 et seq., and §33-25A-1 et seq. of this code.
“Office” means the Office of Drug Control Policy.
“Pain clinic” means the same as that term is defined in §16-5H-2 of this code.
“Pain specialist” means a practitioner who is board certified in pain management or a related field.
“Schedule II opioid drug” means an opioid drug contained in §60A-2-206 of this code.
“Surgical procedure” means a medical procedure involving an incision with instruments performed to repair damage or arrest disease in a living body.
Prior to issuing a
prescription for an opioid a Schedule II opioid drug, a
practitioner shall:
(1) Advise the patient
regarding the quantity of the opioid Schedule II opioid drug and
a patient’s option to fill the prescription in a lesser quantity; and
(2) Inform the patient of
the risks associated with the opioid Schedule II opioid drug
prescribed.
§16-54-4. Opioid prescription limitations.
(a) When issuing a
prescription for an opioid a Schedule II
opioid drug to an adult patient seeking treatment in an emergency room
for outpatient use, a health care practitioner may not issue a prescription for
more than a four-day supply: Provided, That a prescription for
a Schedule II opioid drug issued to an adult patient in an emergency room for
outpatient use is not considered to be an initial Schedule II opioid
prescription.
(b) When issuing a
prescription for an opioid a Schedule II opioid drug to an adult
patient seeking treatment in an urgent care facility setting for outpatient
use, a health care practitioner may not issue a prescription for more than a
four-day supply: Provided, That an additional dosing for up to no more
than a seven-day supply may be permitted, but only if the medical rational for
more than a four-day supply is documented in the medical record.
(c) A health care
practitioner may not issue an opioid an initial Schedule II opioid
drug prescription to a minor for more than a three-day supply and shall
discuss with the parent or guardian of the minor the risks associated with opioid
Schedule II opioid drug use and the reasons why the prescription is
necessary.
(d) A dentist or an
optometrist may not issue an opioid a Schedule II opioid drug
prescription for more than a three-day supply. at any time.
(e) A practitioner, other
than a dentist or an optometrist, may not issue an initial opioid Schedule
II opioid drug prescription for more than a seven-day supply. The
prescription shall be for the lowest effective dose which in the medical
judgement of the practitioner would be the best course of treatment for this
patient and his or her condition.
(f) Prior to issuing an
initial opioid Schedule II opioid drug prescription, a
practitioner shall:
(1) Take and document the results of a thorough medical history, including the patient’s experience with nonopioid medication, nonpharmacological pain management approaches, and substance abuse history;
(2) Conduct, as appropriate, and document the results of a physical examination. The physical exam should be relevant to the specific diagnosis and course of treatment, and should assess whether the course of treatment would be safe and effective for the patient.
(3) Develop a treatment plan, with particular attention focused on determining the cause of the patient’s pain; and
(4) Access relevant prescription monitoring information under the Controlled Substances Monitoring Program Database.
(g) Notwithstanding any
provision of this code or legislative rule to the contrary, no medication
listed as a Schedule II controlled substance opioid drug as set
forth in §60A-2-206 of this code, may be prescribed by a practitioner for
greater than a 30-day supply: Provided, That two additional
prescriptions, each for a 30-day period for a total of a 90-day supply, may be
prescribed if the practitioner accesses the West Virginia Controlled Substances
Monitoring Program Database as set forth in §60A-9-1 et seq. of this
code: Provided, however, That the limitations in this section do
not apply to cancer patients, patients receiving hospice care from a licensed
hospice provider, patients receiving palliative care, a patient who is a
resident of a long-term care facility, or a patient receiving medications that
are being prescribed for use in the treatment of substance abuse or opioid
dependence.
(h) A practitioner is
required to conduct and document the results of a physical examination every 90
days for any patient for whom he or she continues to treat with any Schedule II
controlled substance opioid drug as set forth in §60A-2-206
of this code. The physical exam should be relevant to the specific
diagnosis and course of treatment, and should assess whether continuing the
course of treatment would be safe and effective for the patient.
(i) A veterinarian licensed
pursuant to the provisions of §30-10-1 et seq. of this code may not
issue more than an initial opioid Schedule II opioid drug
prescription for more than a seven-day supply. The prescription shall be for
the lowest effective dose which in the medical judgment of the veterinarian
would be the best course of treatment for this patient and his or her
condition.
(j) A prescription for
any opioid drug listed on In conjunction with the issuance of the third
prescription for a Schedule II opioid drug, as set forth in
§60A-2-206 of this code for greater than a seven-day period shall require
the patient to shall execute a narcotics contract with their
prescribing practitioner. The contract shall be made a part of the patient’s
medical record. The narcotics contract is required to provide at a minimum
that:
(1) The patient agrees only to obtain scheduled medications from this particular prescribing practitioner;
(2) The patient agrees he or she will only fill those prescriptions at a single pharmacy which includes a pharmacy with more than one location;
(3) The patient agrees to
notify the prescribing practitioner within 72 hours of any emergency where he
or she is prescribed scheduled medication; and
(4) If the patient fails to honor the provisions of the narcotics contract, the prescribing practitioner may either terminate the provider-patient relationship or continue to treat the patient without prescribing a Schedule II opioid drug for the patient. Should the practitioner decide to terminate the relationship, he or she is required to do so pursuant to the provisions of this code and any rules promulgated hereunder. Termination of the relationship for the patient’s failure to honor the provisions of the contract is not subject to any disciplinary action by the practitioner’s licensing board; and
(5) If another physician is approved to prescribe to the patient.
(k) A pharmacist is not responsible for enforcing the provisions of this section and the Board of Pharmacy may not discipline a licensee if he or she fills a prescription in violation of the provisions of this section.
§16-54-5. Subsequent prescriptions; limitations.
(a) No fewer than six
days After issuing the initial Schedule II opioid drug prescription
as set forth in §16-54-4 of this code, the practitioner, after consultation
with the patient, may issue a subsequent prescription for an opioid a
Schedule II opioid drug to the patient if:
(1) The subsequent prescription would not be deemed an initial prescription pursuant to §16-54-4 of this code;
(2) The practitioner determines the prescription is necessary and appropriate to the patient’s treatment needs and documents the rationale for the issuance of the subsequent prescription; and
(3) The practitioner determines that issuance of the subsequent prescription does not present an undue risk of abuse, addiction, or diversion and documents that determination.
(b) Prior to issuing the subsequent Schedule II opioid drug prescription of the course of treatment, a practitioner shall discuss with the patient, or the patient’s parent or guardian if the patient is under 18 years of age, the risks associated with the Schedule II opioid drug being prescribed. This discussion shall include:
(1) The risks of addiction and overdose associated with a Schedule II opioid drugs and the dangers of taking Schedule II opioid drugs with alcohol, benzodiazepines, and other central nervous system depressants;
(2) The reasons why the prescription is necessary;
(3) Alternative treatments that may be available; and
(4) Risks associated with
the use of the Schedule II opioid drug being prescribed, specifically
that opioids a Schedule II opioid drug are highly addictive, even
when taken as prescribed, that there is a risk of developing a physical or
psychological dependence on the controlled substance Schedule II
opioid drug, and that the risks of taking more opioids than prescribed, or
mixing sedatives, benzodiazepines, or alcohol with opioids, can result in fatal
respiratory depression.
(c) The discussion as set forth in §16-54-5(b) of this code shall be included in a notation in the patient’s medical record.
§16-54-6. Ongoing treatment; referral to pain clinic or pain specialist.
(a) At the time of the
issuance of the third prescription for a prescription opioid Schedule
II opioid drug the practitioner shall consider referring the patient to a
pain clinic or a pain specialist. The practitioner shall discuss the benefits
of seeking treatment through a pain clinic or a pain specialist and provide him
or her with an understanding of any risks associated by choosing not to pursue
that as an option.
(b) If the patient declines
to seek treatment from a pain clinic or a pain specialist and opts to remain a
patient of the practitioner, and the practitioner continues to prescribe an
opioid for pain a Schedule II opioid drug as provided in this code,
the practitioner shall:
(1) Note in the patient’s medical records that the patient knowingly declined treatment from a pain clinic or pain specialist;
(2) Review, at a minimum of every three months, the course of treatment, any new information about the etiology of the pain, and the patient’s progress toward treatment objectives and document the results of that review;
(3) Assess the patient prior to every renewal to determine whether the patient is experiencing problems associated with physical and psychological dependence and document the results of that assessment; and
(4) Periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence, and document with specificity the efforts undertaken.
§16-54-7. Exceptions.
(a) This article does
not apply to a prescription for a patient who is currently in active treatment for cancer, receiving hospice care from a
licensed hospice provider or palliative care provider, or is a resident of a
long-term care facility.
or to any medications that are being
prescribed for use in the treatment of substance abuse or opioid dependence.
(b) This article does not apply to a patient being prescribed, or ordered, any medication in an inpatient setting at a hospital.
(b)
(c) Notwithstanding the limitations on the prescribing of a Schedule II
opioid drug contained in §16-54-4 of this code, a practitioner may
prescribe an initial seven-day supply of an opioid a Schedule II opioid drug to a post-surgery
patient immediately following a surgical procedure. Based upon the medical
judgment of the practitioner, a subsequent prescription may be prescribed by
the practitioner pursuant to the provisions of this code. Nothing in this
section authorizes a practitioner to prescribe any medication which he or she
is not permitted to prescribe pursuant to their practice act.
(c)
(d) A practitioner who acquires a patient after January 1, 2018, who is
currently being prescribed an opioid a Schedule II opioid drug from another
practitioner shall be is required to access the Controlled
Substances Monitoring Program Database as set forth in §60A-9-1 et seq.
of this code. Any prescription would not be deemed an initial prescription
pursuant to the provisions of this section The practitioner shall
otherwise treat the patient as set forth in this code.
(d)
(e) This article does not apply to an existing practitioner-patient
relationship established before January 1, 2018, where there is an established
and current opioid treatment plan which is reflected in the patient’s medical
records.
§16-54-8. Treatment of pain.
(a) When patients seek
a patient seeks treatment, for any of the myriad conditions that
cause pain, a health care practitioner shall refer or prescribe to a
patient any of the following treatment alternatives, as is appropriate
based on the practitioner’s clinical judgment and the availability of the
treatment, before starting a patient on an opioid: physical therapy,
occupational therapy, acupuncture, massage therapy, osteopathic manipulation,
chronic pain management program, and chiropractic services, as defined in
§30-16-3 of this code.
(b) Nothing in this section should be construed to require that all of the treatment alternatives set forth in §16-54-8(a) of this code are required to be exhausted prior to the patient receiving a prescription for an opioid.
(c) At a minimum, an
insurance provider who offers an insurance product in this state, the Bureau
for Medical Services, and the Public Employees Insurance Agency shall provide
coverage for 20 total visits per event of physical therapy, occupational
therapy, osteopathic manipulation, a chronic pain management program, and
chiropractic services, as defined in §30-16-3 of this code, when ordered or
prescribed by a health care practitioner. to treat conditions that cause
chronic pain.
(d) A patient person
may seek treatment for physical therapy, occupational therapy,
osteopathic manipulation, a chronic pain management program, and chiropractic
services, as defined in §30-16-3 of this code, prior to seeking treatment from
a health care practitioner. and A health care practitioner
referral is not required as a condition of coverage by the Bureau for
Medical Services the Public Employees Insurance Agency, and any insurance
provider who offers an insurance product in this state. Any deductible,
coinsurance, or copay required for any of these services may not be greater than
the deductible, coinsurance, or copay required for a primary care visit.
(e) Nothing in this section precludes a practitioner from simultaneously prescribing an opioid and prescribing or recommending any of the procedures set forth in §16-54-8(a) of this code.
NOTE: The purpose of this bill is to clarify certain provisions within the Opioid Reduction Act 2018.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.