Kentucky Governor Matt Bevin recently signed HB342 into law. This Act mandates Kentucky healthcare providers to electronically prescribe all controlled substances with an effective date of January 1^st, 2021

Other subsections of this Act include:

• The act contains provisions for a waiver to delay the mandate for a specified time period for e-prescribing in the event of economic hardship, technological limitations, or exceptional circumstances, these are to be determined.
• Pharmacies are not required to verify if a controlled substance prescription received via written, oral, or fax falls within the state and federal laws.

Kentucky has remained above the national average for opioid-related overdose deaths since 2001, several years were double the national rate.  In 2000, only nine counties in the U.S. had overdose death rates of more than 20 per 100,000 people, and four of these were located in Kentucky.  By 2014, more than half of Kentucky counties had overdose rates that high.  This represents a quadrupling of deaths due to drug overdose, from less than 250 in 2000 to more than 1,000 each year since 2010.  According to the Kentucky Justice and Public Safety Cabinet, drug overdose deaths reached 1,248 in 2015. [1]

Over the past two decades, the Commonwealth has taken efforts to curb problems related to substance use. In 1998, Kentucky became one of the first states to launch a prescription drug monitoring program—the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to monitor medical use of controlled substances, such as prescription opioid painkillers. KASPER has since been enhanced and now offers health care providers and pharmacies real-time 24-hour access to prescription information that can be used to monitor and prevent overuse of prescription medications.  Policymakers have also adopted policies aimed at reducing the impact of illegal drugs, such as passing the 2015 Senate Bill 192, which authorized expanded use of naloxone, a drug that treats opioid overdoses, and funded substance use treatment programs.[2]

Kentucky currently has only 18.9% provider enablement for electronic prescribing of controlled substances, which is below the national average of 33.4%.  Pharmacy enablement for EPCS is 98.1% which makes Kentucky one of the states with highest percentage of pharmacies ready to receive electronic prescriptions.  The current nation average for pharmacies is 95.2%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Kentucky now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Kentucky to ease the transition and help provide tools and resources in combating the opioid epidemic.  With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start your free 30 day free trial.

[1]https://www.healthy-ky.org/res/images/resources/Full-Substance-Use-Brief-Final_12_16-002-.pdf

[2]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

Wyoming Governor Mark Gordon recently signed Enrolled Act No 66/SF0047 into law. This Act mandates Wyoming providers to electronically prescribe all controlled substances with an effective date of January 1^st, 2021.  The Act has provisions for the state board to provide some exemptions to the requirement for emergencies and has the power to grant an extension to a dispenser or practitioner; however, being granted an extension is not guaranteed.

Other subsections of this Act include:

• Prior to writing a prescription for a controlled substance, providers are required to search the state PMP database, as well as every 3 months thereafter for as long as the patient remains on a controlled substance.
• Pharmacies must submit their dispense data on controlled substances to the state daily.
• All prescribing providers are required to take 3 hours of continuing education every two years related to the responsible prescribing of controlled substances when they renew their license.
• All Schedule II prescriptions require either written or electronic prescription until the 1/1/21 mandate, oral orders will not be accepted.
• All Schedule III and IV prescriptions shall not be refilled more than six months after the prescribed date, and not refilled more than five times unless renewed. 

In recent years, Wyoming has fallen below the national average for opioid-related overdose deaths.  However, prior to 2015 Wyoming was above the national average for 5 consecutive years[1].  The state trends continue to rise along with the national average of opiate-related deaths.  Wyoming currently has only 17.5% provider enablement for electronic prescribing of controlled substances[2], well below the national average.  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Wyoming now aligns with several other states mandating electronic prescribing. MDToolbox looks forward to working with providers throughout Wyoming to ease the transition and help provide tools and resources in combating the opioid epidemic. With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start your free 30 day free trial.

[1]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/wyoming-opioid-summary

[2]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

This week President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act¹. The legislation is aimed at combating the opioid epidemic by focusing on several information technology tools that help prevent prescription fraud and abuse.

One of those tools is e-Prescribing. One of the more than 60 policies included is the Every Prescription Conveyed Securely Act. Beginning in January 2021, prescribers will be required to electronically prescribe controlled substances for Schedule II-V drugs covered under a Medicare Part D or Medicare Advantage prescription drug plan. While many states have enacted their own laws requiring e-Prescribing, this is the first federal mandate.

Another tool included in the law is electronic prior authorization. Also by January 2021, electronic prior authorization will be required for Medicare Part D covered drugs. Electronic prescription programs will be required to securely transmit the requests. A facsimile, proprietary payer portal, or an electronic form that does not meet the standards will not be counted as an electronic submission.

The legislation also contains provisions to enhance states’ Prescription Drug Monitoring Programs (PDMPs). The goal is to ensure each state has a PDMP, improve their functionality, make sure all prescribers are utilizing the systems, and foster data sharing between states. Beginning October 1, 2021 States must require health care providers to check their PDMP for a Medicaid enrollee's prescription drug history before prescribing controlled substances to the enrollee.

MDToolbox applauds this bipartisan legislation. We are continually encouraging providers to take advantage of the technologies we provide including Electronic Prescribing of Controlled Substances (EPCS) and Electronic Prior Authorization (e-PA) as they are important tools to use in fighting the devastating opioid epidemic. Putting these federal mandates in place is an important step towards fully utilizing the available technology to save lives. 

1. H.R.6 - SUPPORT for Patients and Communities Act https://www.congress.gov/bill/115th-congress/house-bill/6

Starting October 2, 2018, prescribers in California will be required to check the state’s prescription monitoring database, Controlled Substance Utilization Review and Evaluation System (CURES), before prescribing Schedule II, III, or IV drugs. California is one of 39 states that mandate prescribers to check prescription monitoring databases in an effort to combat the opioid epidemic. By checking a database before prescribing, prescribers can identify “doctor shoppers” who go from doctor to doctor to obtain multiple prescriptions.

Prescribers will now be required to check CURES if it is the first time prescribing the scheduled drug for the patient or if it has been four months since the last time they checked the database for the patient. The check must be completed no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

All prescribers who were authorized to prescribe or dispense Schedule II-IV controlled substances were originally required to just register to use CURES by July 1, 2016. The requirement to check the database was to start six months after the state certified the database was ready. The California Department of Justice (DOJ) certified CURES was ready for statewide use on April 2, 2018.

If prescribers do not comply, it could result in disciplinary proceedings against a practitioner’s license. The Medical Board of California states in their CURES Mandatory Use FAQs¹, “Failing to consult CURES is a violation of the law and it could result in the issuance of a citation and fine, or could be a cause of action In an accusation that leads to disciplinary action. Disciplinary action could be a public reprimand, suspension, probation, or revocation. Each violation of the law is reviewed on a case-by-case basis.”

The Medical Board of California also recommends that prescribers either note in the patient’s chart that they checked the CURES database or print the report and put it in the patient’s file to document that the check was completed.

MDToolbox makes it convenient for prescribers to check CURES by providing a link directly to the database from within the prescription writer. The system also automatically makes note that the database was checked for the prescriber. For more information and to request a free trial, see California E-Prescribing or contact us at info@mdtoolbox.com.

1. Medical Board of California CURES Mandatory Use FAQs http://www.mbc.ca.gov/Licensees/Prescribing/CURES/CURES_FAQ.pdf?utm_source=link&utm_medium=email&utm_campaign=CURES&utm_content=faq

In a draft report, the Commission on Combating Drug Addiction and the Opioid Crisis proposed that state and federal prescription drug monitoring programs (PDMPs) should be completely interoperable by July 1, 2018¹. The White House-appointed commission is led by New Jersey Governor Chris Christie and is tasked with addressing the national opioid crisis.

The commission proposed several recommendations to President Trump in the report including declaring the opioid epidemic a national emergency. Specifically relating to the PDMPs it states, “Provide federal funding and technical support to states to enhance interstate data sharing among state-based prescription drug monitoring programs (PDMPs) to better track patient-specific prescription data and support regional law enforcement in cases of controlled substance diversion. Ensure federal health care systems, including Veteran’s Hospitals, participate in state-based data sharing.”

The report states that currently 49 states have PDMPs but many do not share data. As we wrote about earlier, 37 states are connected to NABP PMP InterConnect which is run by the National Association of Boards of Pharmacy. The commission urged that the VA and HHS should lead the effort to have all state and federal PDMP systems share information.

The report went on to state that PDMPs need to be easy to use and include other data to assist prescribing doctors. Interestingly, the commission said that “ideally, clinician should check their state PDMP before making the decision to prescribe either an opioid or benzodiazepine” but there was no recommendation to make it mandatory for prescribers to check.

The commission’s final report is due in just a couple weeks on October 1^st and it’s expected to include several other recommendations related to health IT.

1.  https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf

Missouri Governor Eric Greitens recently signed Executive Order (EO) 17-18¹ directing the Missouri Department of Health and Senior Services (DHSS) to create a statewide Prescription Drug Monitoring Program (PDMP). Despite legislative efforts for more than a decade, Missouri is currently the only state lacking such a program.

The governor’s announcement of the statewide PDMP said that it will utilize de-identified data from private sector partners to target “pill mills” that pump out prescription drugs at dangerous and unlawful levels. It will monitor both prescribers and dispensers of Schedule II through Schedule IV controlled substances in an effort to go directly to the source of drug shoppers. Opioids are the main focus as the national plague is hitting hard in Missouri with over 900 deaths in 2016 being due to opioid overdoses.

The executive order received national praise. Richard Baum, Acting Director of National Drug Control Policy stated, “In the context of both the ongoing opioid epidemic and the health of Missourians, it’s vital to have safeguards in place to make sure that doctors aren’t overprescribing opioids that can be misused and patients aren’t doctor-shopping for multiple prescriptions that could be misused or diverted.” Secretary Tom Price of the U.S. Department of Health and Human Services also praised the Governor stating, “I commend Missouri Governor Eric Greitens for taking a strong step in fighting the opioid epidemic by joining other states in establishing a Prescription Drug Monitoring Program (PDMP). I commend Governor Greitens for his leadership in Missouri as we all work to detect and deter the abuse of prescription drugs.”

State statute prevents Missouri from identifying patients, so they will be focusing on the prescribers and the dispensers with data from pharmacy benefit management organizations. They plan to be live with data from Express Scripts Holding Co. later this summer and hope to contract with two additional pharmacy benefit management organizations as well.

Due to the lack of a statewide program, local counties, led by St. Louis County, took it upon themselves earlier this year to create a prescription monitoring program. The St. Louis County PDMP focuses at the patient level instead of on prescribers and dispensers. The county program has three goals listed on its website²:

   1) Improve controlled substance prescribing by providing critical information regarding a patient’s controlled substance prescription history
   2) Inform clinical practice by identifying patients at high-risk who would benefit from early interventions
   3) Reduce the number of people who misuse, abuse, or overdose while making sure patients have access to safe, effective treatment

The new statewide PDMP is hoped to be a companion to the county program which covers the majority of the state, not a replacement, as the two systems take different approaches to combating the opioid epidemic.

1.https://governor.mo.gov/news/archive/governor-eric-greitens-announces-statewide-prescription-drug-monitoring-program

2. http://www.stlouisco.com/HealthandWellness/PDMP