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/

Pennsylvania Governor Tom Wolf recently signed Act 96 into law. This mandates Pennsylvania providers to electronically prescribe controlled substances II-V within a year of the bill passing.

The goal is to eliminate fraud associated with written prescriptions. Per the National Institute on Drug Abuse (NIDA), in 2016, there were 2,235 opioid-related overdose deaths in Pennsylvania. Prescription opioid overdoses alone increased from 411 to 729 deaths since 2010 [1].  The bill focuses on illegal drug diversion and combating the opioid epidemic. Between June 2017 and June 2018, eight drug gang arrests for illegal paper prescriptions were made in Pennsylvania, totaling more than 60,000 illegally diverted opioid prescriptions[2].

Providers who do not follow suit with the new law can face charges of $100 up to $5,000 per year. However, there are some exceptions which include:

• When electronic prescribing is unavailable due to temporary technological or electrical failure
• Prescriptions issued by a practitioner and dispensed by a pharmacy located outside the Commonwealth
• Prescriptions issued by a practitioner in an emergency department or health care facility when an electronic prescription would be impractical or would cause undue delay
• For a patient in a hospice, nursing home or residential health care facility
• For controlled substance compounded prescriptions and prescriptions containing elements that are not able to be accomplished with electronic prescribing
• For a prescription issued pursuant to a valid collaborative practice agreement, a standing order or a drug research protocol
• For a prescription issued in an emergency situation
• The pharmacy receiving the prescription is not set up to process electronic prescriptions; and
• For controlled substances that are not required to be reported to the prescription monitoring program system.

If providers do not meet an exception, they do have the option to apply for an exemption based upon economic hardship, technical limitations, or exceptional circumstances.

Pennsylvania now aligns with many other states headed towards mandating electronic prescribing. MDToolbox looks forward to working with providers throughout Pennsylvania 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.

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

Oklahoma recently became the latest state to enact an e-prescribing law in order to prevent opioid abuse. Governor Mary Fallin signed into law House Bill 2931¹ which will require prescribers in Oklahoma to electronically prescribe Schedule II through V controlled substances starting January 1, 2020.

The bill allows for a few exemptions in certain circumstances such as for veterinarians or prescriptions that are administered through an on-site pharmacy at facilities like nursing homes. It also states that waivers or extensions can be granted through the licensing board. There aren’t any details on what will constitute a waiver or extension at this time though. Other states who offer waivers and extensions will grant them for reasons like a lack of proper technology such as internet or computers.

If a prescriber is granted an e-prescribing waiver, they will be required to use official prescription forms provided by the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control. Pharmacists will not be required to verify that a prescription falls under an exception.

Currently, only 12% of prescribers in Oklahoma are enabled for EPCS. However, 96% of pharmacies are able to receive electronic controlled substance prescriptions.

Attorney General Mike Hunter is convinced requiring e-Prescribing “will have a material impact on this leakage of opioids into the hands of addicts.” E-prescribing can help put a stop to prescriptions being forged which an opioid task force found out could easily be done. During their research, a real prescription was scanned, altered, and printed on security paper. Almost all experts, including pharmacists and DEA agents, were fooled by the fake prescription. Tulsa County Director of Governmental Affairs Terry Simonson said, “It was so easy. It was just kind of mind-boggling that that's all it took.”

E-Prescribing offers many benefits in addition to preventing forged prescriptions. MDToolbox can help prescribers in Oklahoma, as well as nationwide, start utilizing all of those benefits. See Oklahoma E-Prescribing for more information or to request a free trial to start e-Prescribing today.

   1. http://webserver1.lsb.state.ok.us/cf_pdf/2017-18%20ENR/hB/HB2931%20ENR.PDF

Earlier this week, a bipartisan group of U.S. Senators introduced the Every Prescription Conveyed Securely (EPCS) Act. Under the act, all controlled substance prescriptions under Medicare would have to be sent electronically. The aim of the bill is to combat the opioid epidemic by preventing fraudulent prescriptions and doctor shopping.

The legislation was introduced by four senators: Elizabeth Warren, D-Massachusetts; Michael Bennet, D-Colorado; Dean Heller, R-Nevada, and Pat Toomey, R-Pennsylvania.

As we wrote about previously, companion legislation was introduced in the House of Representatives in July by Congressman Markwayne Mullin (R-OK) and Congresswoman Katherine Clark (D-MA). House bill 3528¹ has a lot of bipartisan support with 21 cosponsoring representatives including 11 Republicans and 10 Democrats.

“We need to be using every tool at our disposal to fight the opioid epidemic,” Warren said in a statement². “I’m glad to partner with Senator Bennet on a bipartisan bill that will help gather better data on the opioid epidemic while also helping health care providers make the best decisions for their patients.”

A Department of Justice report recently released found that misused prescription opioids are often obtained illegally using forged or altered prescriptions and by consulting multiple doctors. It was also found that most prescription fraud remains undetected.

“An epidemic of this magnitude requires us to address all aspects of the problem, starting with how providers prescribe opioids,” Bennet said in the statement. "This bipartisan legislation would expand a critical tool to track the use of opioids, ultimately reducing overdoses and saving lives."

Toomey added to the statement, “This commonsense measure will help improve tracking of opioid prescribing and reduce diversion due to forged prescriptions. This is a simple but important step in the direction of curbing opioid abuse.” Heller further added by stating, “This bipartisan legislation takes a critical step toward eliminating doctor shopping and duplicative or fraudulent prescriptions.”

The bill is proposed to go into effect in 2020 and does allow for some exceptions. These include prescriptions generated and dispensed by the same entity, economic hardship, technological limitations and other exceptional circumstances.

At MDToolbox, we strongly encourage all providers to not wait for legislation and to take advantage of the benefits of e-Prescribing controlled substances as soon as possible. It not only prevents fraud but makes things easier for prescribers as well. We are happy to answer any questions you may have about getting started with EPCS and offer a free 30 day trial so that you can see how quick and easy it is.

1.       H.R.3528 - Every Prescription Conveyed Securely Act https://www.congress.gov/bill/115th-congress/house-bill/3528
2.       Warren, Bennet, Heller, Toomey Introduce Bill to Combat Opioid Crisis with E-Prescriptions https://www.warren.senate.gov/newsroom/press-releases/warren-bennet-heller-toomey-introduce-bill-to-combat-opioid-crisis-with-e-prescriptions

Iowa is the latest state to consider legislation that would require electronic prescribing. The Iowa Board of Pharmacy suggested Senate Study Bill 3074¹ which would require all prescriptions to be sent electronically. Like several other states with similar enacted and proposed legislation, lawmakers in Iowa hope to curb the opioid epidemic with this bill.

Executive director of the Iowa Board of Pharmacy, Andrew Funk, informed senators that currently 65% of Iowa prescriptions for non-addictive drugs are sent electronically, but only 9% of prescriptions for addictive drugs are electronic. This leaves a lot of room for fraudulent prescriptions.

Iowa Senator Tom Greene, a former pharmacist, is all too familiar with forged paper prescriptions. "A patient presented me with a prescription for sleeping medication-a controlled substance," said Greene. "And the doctor had ordered ten tablets. Well, the patient changed the one-zero to a four-zero. There are cases like that out there, and again electronic prescribing and the electronic transmission of that information is very accurate." Lawmakers hope that in addition to preventing phony prescriptions, it would also help with mistakes caused by handwritten prescriptions. Prescriptions sent electronically eliminate the possibilities for patients to alter them, as well as remove the potential for pharmacists to misinterpret illegible prescriptions.

The bill allows for providers to ask for temporary exemptions if they aren’t able to meet the requirements in time, but any prescriber without an exemption would be subject to $250 fines per violation of the law, up to $5,000 per year. There are also exemptions for prescriptions for patients in nursing homes, long-term care facilities, or jail, as well as veterinary prescriptions. In addition, the bill states the requirements do not apply to compound prescriptions containing two or more components and prescriptions requiring “information that makes electronic submission impractical, such as complicated or lengthy directions for use or attachments.”

As the bill is written now, it would begin July 1, 2019. Some lobbyists, however, feel that this is too soon especially for rural hospitals and physicians. They are pushing for the date to moved to July 1, 2020. Senator Greene and two other senators on the subcommittee were said to informally agree to a compromise of January 1, 2020.

One of the great things about our stand-alone web-based e-Prescribing products is that there is not a lot of setup needed. As long as a prescriber has a device that can access the internet (computer, tablet, or phone), they can send their prescriptions electronically. While sending controlled substances electronically does require a 2^nd device to electronically sign the prescription, it is as simple as using a phone or key fob.  Most prescribers can get setup and start e-Prescribing with MDToolbox in just a matter of minutes. There is no need to stress about putting complex systems in place or wait until the deadline. To see how quick and easy it is, sign up for a free trial or request a demo here.

1.  https://www.legis.iowa.gov/legislation/BillBook?ba=SSB3074

Last week, Arizona Governor Doug Ducey called a special legislative session to pass the Arizona Opioid Epidemic Act¹. In record speed, the Arizona Legislature voted unanimously to approve it and Ducey signed it into law on Friday.

The act is aimed at combating the opioid epidemic in Arizona, where in just the last 6 months there have been more than 800 opioid-related deaths. The focus of the act is to reduce opioid misuse, promote safe prescribing and dispensing, and improve access to treatment.

As stated in the Governor’s news release outlining the act, the policy includes:

• Identifying gaps in and improving access to treatment, including for uninsured or underinsured Arizonans, with a new $10 million investment;
• Expanding access to the overdose reversal drug Naloxone for law enforcement or corrections officers currently not authorized to administer it;
• Holding bad actors accountable by ending pill mills, increasing oversight mechanisms, and enacting criminal penalties for manufacturers who defraud the public about their products;
• Enhancing continuing medical education for all professions that prescribe or dispense opioids;
• Enacting a Good Samaritan law to allow people to call 911 for a potential opioid overdose;
• Cracking down on forged prescriptions by requiring e-prescribing;
• Requiring all pharmacists to check the Controlled Substances Prescription Monitoring Program prior to dispensing an opioid or benzodiazepine;
• And limiting the first-fill of an opioid prescription to five days for all opioid naïve patients and limiting dosage levels to align with federal prescribing guidelines. These proposals contain important exemptions to protect chronic pain suffers, cancer, trauma or burn patients, hospice or end-of-life patients, and those receiving medication assisted treatment for substance use disorder.

The e-Prescribing requirement will begin January 1, 2019 and mandates schedule II controlled substances must be sent electronically. There is some concern that those in rural areas do not have the necessary technology for e-Prescribing. Therefore, the act gives those providers additional time and outlines that e-Prescribing will not be mandated until July 1, 2019 for counties with less than 150,000. It also allows for the Board of Pharmacy to grant waivers to prescribers with a lack of broadband Internet access or other hardships.

At MDToolbox, we urge providers not to wait until the mandate and to e-Prescribe all prescriptions. In addition to preventing forged prescriptions and helping combat opioid abuse, e-Prescribing provides many other benefits for providers and patients. Contact us to get started with a free trial today.

1.       Arizona Opioid Epidemic Act Policy Primer https://azgovernor.gov/sites/default/files/related-docs/arizona_opioid_epidemic_act_policy_primer.pdf

President Donald Trump declared the opioid epidemic a national public health emergency on October 26, 2017. In his address, Trump called opioids the “worst drug crisis in American history.”

After the President’s declaration, the President’s Commission on Combating Drug Addiction and the Opioid Crisis issued its final report¹. In the Chairman’s letter written by Governor Chris Christie, he points out that 175 Americans are dying a day from this epidemic. The 131-page report goes on to include more than 50 recommendations.

One of the most prudent recommendations is that the Office of National Drug Control Policy (ONDCP) and the DEA increase electronic prescribing to prevent diversion and forgery. They also recommend that the DEA revise the Interim Final Rule which lays out the requirements for electronically prescribing controlled substances in order to make registration and using EPCS easier.

Other recommendations include mandatory PDMP checks, the creation of a Department of Justice-led data-sharing hub, and integrated PDMP data in EHRs. The report suggests passing the Prescription Drug Monitoring (PDMP) Act of 2017 which mandates using PDMPs in states that receive federal funding. This Act also directs the Department of Justice (DOJ) to fund the establishment and maintenance of a data-sharing hub so information could be shared across states. The Commission points out that many providers resist using PDMPs because they don’t integrate well into EHRs, so they believe improving these integrations is necessary to increase effectiveness.

While these are great strides in the right direction, there is still a huge issue at hand. Trump did not mention any specific actions the administration will take or how they will be funded. With only declaring it a national public health emergency as opposed to a national emergency, there is not much more funding available. The commission’s report urges Congress and the Administration to block grant federal funding for opioid-related and SUD-related activities to the states. However, the report does not address the amount of funding needed for their recommendations.

1. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf

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