Reference is to Printer's Date 3/29/18-H.
Amend the bill, as and if amended, by striking all after the enacting words and inserting:
/ SECTION 1. Section 44-53-360 of the 1976 Code is amended by adding an appropriately lettered subsection at the end to read:
"( )(1) Initial
opioid prescriptions for acute pain management or postoperative
pain management must not exceed a seven-day supply, except when
clinically indicated for cancer pain, chronic pain, hospice
care, palliative care, major trauma, major surgery, treatment of
sickle cell disease, treatment of neonatal abstinence syndrome,
or medication-assisted treatment for substance use disorder.
Upon any subsequent consultation for the same pain, the
practitioner may issue any appropriate renewal, refill, or new
opioid prescription.
(2)
This subsection does not apply to opioid prescriptions
issued by a practitioner who orders an opioid prescription to be
wholly administered in a hospital, nursing home, hospice
facility, or residential care facility.
(3)
A practitioner who acts in accordance with the limitation
on prescriptions as set forth in this subsection is immune from
any civil liability or disciplinary action from the
practitioner's professional licensing board.
(4)
As used in this subsection:
(A)
'Acute pain' means pain that a practitioner reasonably
expects to last for three months or less, whether resulting from
disease, accident, intentional trauma, or other cause. The term
does not include 'chronic pain' or pain being treated as part of
cancer care, chronic care, hospice care, palliative care, major
trauma, major surgery, treatment of sickle cell disease,
treatment of neonatal abstinence syndrome, or
medication-assisted treatment for substance use disorder.
(B)
'Chronic pain' means pain that typically lasts for longer
than three months or that lasts beyond the time of normal tissue
healing.
(C)
'Postoperative pain' means acute pain experienced
immediately after a surgical procedure.
(D)
'Surgical procedure' means a procedure performed for the
purpose of altering the human body by incision or destruction of
tissues as part of the practice of medicine such as diagnostic
or therapeutic treatment of conditions or disease processes by
use of instruments and includes lasers, ultrasound, ionizing,
radiation, scalpels, probes, or needles that cause localized
alteration or transportation of live human tissue by cutting,
burning, vaporizing, freezing, suturing, probing, or
manipulating by closed reduction for major dislocations and
fractures, or otherwise altering by any mechanical, thermal,
light-based, electromagnetic, or chemical means."
SECTION 2. Article 15, Chapter 53, Title 44 of the 1976 Code is amended by adding:
"Section 44-53-1655.
(A) The department shall develop and
maintain as part of the prescription monitoring program a system
to provide prescription report cards to practitioners to inform
the practitioner about certain prescribing trends. The report
card must provide, at a minimum:
(1)
a comparison of the practitioner's number of prescriptions
issued per month by therapeutic class code or by specific
substances to peer averages by specialty throughout the
State;
(2)
a comparison of the practitioner's number of milligrams
prescribed per month by therapeutic class code over by specific
substances to peer averages by specialty throughout the State;
(3)
the total number of patients receiving ninety morphine
milligram equivalents (MMEs) or more a day;
(4)
the total number of patients receiving opioid medications
for thirty days or more;
(5)
the total number of patients receiving opioids and
benzodiazepines medications at the same time;
(6)
the total number of patients issued prescriptions from
three or more practitioners;
(7)
the total number of patients filling prescriptions at
three or more pharmacies;
(8)
the total number of patients with controlled substance
prescriptions whose dispensing dates overlap;
(9)
the total number of patients obtaining refills on their
prescriptions more than one week early; and
(10)
the total number of prescription drug monitoring program
queries made by the practitioner and a ratio of the queries to
the number of patients or prescriptions issued.
The report card also must provide data on
the number of practitioners registered against which the
comparisons of items (1) and (2) are being made and any other
demographic data relating to the pool of practitioners and may
include regional or nationwide prescribing comparison data that
would be useful to the practitioner. Prescription report cards,
data, documents, records, and any other information accessed or
compiled in preparing prescription report cards, are
confidential and not subject to discovery, subpoena, or
introduction into evidence in any civil action, unless
confidentiality is waived by the practitioner.
(B) The department
shall coordinate with the Board of Medical Examiners and any
other appropriate professional boards as part of the development
and implementation of a prescription report card program. The
department may contract with another agency of the State or with
a private vendor, as necessary, to ensure effective operation of
the report card program, as provided in Section 44-53-1660, and
may apply for public or private grants or other funding to
develop, implement, and maintain the program."
SECTION 3. Section 44-53-1650(D) of the 1976 Code is amended by an appropriately numbered item at the end to read:
"( ) a practitioner in a prescription report card provided to practitioners in accordance with Section 44-53-1655."
SECTION 4. Section 44-53-1640 of the 1976 Code is amended to read:
"Section 44-53-1640.
(A) The Department of Health and
Environmental Control, Bureau of Drug Control shall establish
and maintain a program to monitor the prescribing and dispensing
of all Schedule II, III, and IV controlled substances by
professionals licensed to prescribe or dispense these substances
in this State and the administering of opioid antidotes by
first responders in accordance with Section 44-130-60 and in
hospital emergency departments or other health care facilities
when a supervising physician diagnoses a patient as having
experienced an opioid overdose.
(B)(1) A dispenser
shall submit to drug control, by electronic means, information
regarding each prescription dispensed for a controlled
substance. The following information must be submitted for each
prescription:
(a)
dispenser DEA registration number;
(b)
date drug was dispensed;
(c)
prescription number;
(d)
whether prescription is new or a refill;
(e)
NDC code for drug dispensed;
(f)
quantity dispensed;
(g)
approximate number of days supplied;
(h)
patient name;
(i)
patient address;
(j)
patient date of birth;
(k)
prescriber DEA registration number;
(l)
date prescription issued by prescriber.
(2)
A dispenser shall submit daily to the department the
information required pursuant to subsection (B)(1) in accordance
with transmission methods and protocols provided in the latest
edition of the 'ASAP Telecommunications Format for Controlled
Substances', developed by the American Society for Automation in
Pharmacy.
(3)
Drug control may issue a waiver to a dispenser who is
unable to submit prescription information by electronic means.
The waiver may permit the dispenser to submit prescription
information by paper form or other means if all information
required pursuant to subsection (B)(1) is submitted in this
alternative format.
(C)(1) If a
person is administered an opioid antidote in a hospital
emergency department or other health care facility and the
supervising physician diagnoses the patient as having
experienced an opioid overdose, the supervising physician, the
supervising physician's authorized delegate, or the
institutional pharmacy's pharmacist-in-charge shall report to
the department's Bureau of Drug Control, within three business
days after a discharge diagnosis of an opioid overdose and
administration of an opioid antidote, information regarding the
opioid antidote administered for inclusion in the prescription
monitoring program. The information submitted must include:
(a)
date the opioid antidote was administered;
(b)
dosage of opioid antidote administered and route
of administration; and
(c)
name, address, and date of birth of the person
to whom the opioid antidote was administered, if available.
(2)(a)
After a supervising physician, the
supervising physician's authorized delegate, or the
institutional pharmacy's pharmacist-in-charge submits the name,
address, and date of birth of a person to whom an opioid
antidote was administered as required by subsection (A), Drug
Control shall verify whether any prescription history of the
person appears in the prescription monitoring program and, if
prescription history exists, shall document for review by a
practitioner or an authorized delegate the date on which the
opioid antidote was administered to the person.
(b)
Drug Control also shall maintain data on the
administering of opioid antidotes as required by this section
including, but not limited to, the frequency with which opioid
antidotes are administered in hospital emergency departments as
required pursuant to subsection (A) and other health care
facilities by geographic location.
(D)(1) A
first responder who administers an opioid antidote in accordance
with Section 44-130-60 shall report to the department's Bureau
of Drug Control information regarding the opioid antidote
administered for inclusion in the prescription monitoring
program. The information submitted must include:
(a)
date the opioid antidote was administered;
(b)
dosage of opioid antidote administered and route
of administration;
(c)
name, address, and date of birth of the person
to whom the opioid antidote was administered, if available;
and
(d)
dispenser from which the opioid antidote was
obtained.
(2)
A first responder shall submit the information
required pursuant to item (1) electronically to Drug Control
within seventy-two hours of administration.
(3)(a)
If a first responder submits the name,
address, and date of birth of a person to whom an opioid
antidote was administered, Drug Control shall verify whether any
prescription history of the person appears in the prescription
monitoring program and, if prescription history exists, shall
document for review by a practitioner or an authorized delegate
the date on which the opioid antidote was administered to the
person.
(b)
Drug Control also shall maintain data on the
administering of opioid antidotes by first responders including,
but not limited to, the frequency with which first responders
administer opioid antidotes by geographic location, first
responder, and dispenser."
SECTION 5. Section 44-53-1645(A) of the 1976 Code is amended to read:
"(A) A practitioner, or the practitioner's authorized delegate, shall review a patient's controlled substance prescription history and history of the administering of an opioid antidote to the patient pursuant to Section 44-53-1640(C) or (D), as maintained in the prescription monitoring program, before the practitioner issues a prescription for a Schedule II controlled substance. If an authorized delegate reviews a patient's controlled substance prescription history and history of the administering of an opioid antidote to the patient as provided in this subsection, the practitioner must consult with the authorized delegate regarding the prescription and opioid antidote administering history before issuing a prescription for a Schedule II controlled substance. The consultation must be documented in the patient's medical record."
SECTION 6. SECTION 2 is effective six months after the effective date of this act. SECTIONS 4 and 5 are effective one year after the effective date of this act. All other SECTIONS are effective upon approval by the Governor. /
Renumber sections to conform.
Amend title to conform.