Advocacy Alert: End of Session Summary

Governor Haslam’s TN Together Opioid Reform – Passed!

Governor Haslam’s TN Together legislation was passed by the House of Representatives and Senate. Thanks to the advocacy efforts of TPA, and especially pharmacist Senators Randy McNally, Ferrell Haile, and Shane Reeves, as well as Representatives Cameron Sexton and Bryan Terry, the ICD-10 requirement for opioid prescriptions was NOT removed from the legislation. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law.

TPA worked extensively with state legislators and Governor Haslam’s administration over the course of this session to improve the original legislation, easing the burden on legitimate patients and minimizing overly cumbersome requirements for practicing pharmacists. While this legislation is well-intended, TPA remains concerned about the unintended consequences of the legislation on patients and the pharmacy profession. Decreasing the overall epidemic of prescription drug abuse and reducing patients’ risk of dependence are commonly shared goals of all pharmacy professionals and Tennesseans. However, the need for patient access to treatment and recovery services has never been greater, and our state must continue to seek solutions which help our patients struggling with dependence and addiction to get the help they desperately need. Reducing the supply of opioids is a step in the right direction, but TPA remains concerned that any further decrease in the prescription drug supply without providing needed access to treatment and recovery services may drive individuals to the streets to obtain illicit heroin and fentanyl, and may also result in individuals committing criminal acts, including pharmacy robberies and pharmacy burglaries, in order to illegally obtain these prescription drugs.

Legislation: Senate Bill 2257 / House Bill 1831
Effective: July 1, 2018 (partial fill requirements effective January 1, 2019)
Senate Sponsor(s): Norris, Haile, Yager, Massey
House Sponsor(s): Hawk, Casada, Kumar, Johnson, Sexton C, Terry, Powers, Coley, Daniel, Eldridge, Holsclaw, Favors, Hardaway

Summary: (Infographic)

• Requires all dispensers (or their delegates) to check the Controlled Substance Monitoring Database (CSMD) prior to dispensing an opioid or a benzodiazepine the first time that human patient is dispensed a controlled substance at that practice site
• Requires all dispensers (or their delegates) to check the CSMD again at least once every six (6) months for that human patient after the initial dispensing, for the duration of time the controlled substance is dispensed to that patient

• Requires prescribers to document specific elements prior to prescribing opioids, including informed consent and reasons for prescribing opioids
• Dispensers (including pharmacists) have been removed from above documentation requirements

• No required CSMD checks for prescribers or dispensers
• No additional documentation requirements or partial fill restrictions
• ICD-10 Codes are not required to be written on prescriptions
• Maximum of 180 cumulative morphine milligram equivalents (MME)

• Must be partially filled with no more than a 5-day supply (for a 10-day prescription), or partially filled with no more than half the prescribed day supply limit (for prescriptions written for more than 10 days)
• ICD-10 Codes (and “medical necessity” or “surgery”, if applicable) must be written on all non-exempt opioid prescriptions
• General script limits: No more than a 10-day supply and a maximum of 500 cumulative MME
• Surgery: No more than a 20-day supply and a maximum of 850 cumulative MME
• Medical necessity: No more than a 30-day supply and a maximum of 1,200 cumulative MME

• Partial fill requirements do not apply
• MME limits do not apply
• ICD-10 Codes and “Exempt” must be written on all Exempt Opioid Prescriptions
• Exempt conditions: active or palliative cancer treatment, hospice care, diagnosis of Sickle Cell Disease, inpatients of a licensed healthcare facility, patients seen by pain management specialists, patients treated with opioids for 90 days or more in the last year OR who are subsequently treated for 90 days or more, patients on methadone, buprenorphine, or naltrexone, or patients with severe burns or major physical trauma

Partial Filling of Controlled Substances – Passed!

Thanks to the advocacy efforts of TPA members, this TPA-backed legislation was passed by the House of Representatives and Senate. TPA worked hard with state legislators and successfully fought to protect pharmacists and pharmacies from adverse financial impact, by including language that authorizes pharmacists and pharmacies to charge dispensing fees for each partial fill of a controlled substance, and by establishing that partial fills may not be used to reduce payments to pharmacists and pharmacies. This legislation will now be transmitted to Governor Haslam’s desk to be signed into law!

Legislation: Senate Bill 2025 / House Bill 2440
Effective: Upon becoming law (dispensing fee authorization and prorating of copay requirements effective January 1, 2019, for opioids and July 1, 2019, for all other controlled substances)
Senate Sponsor(s): Haile
House Sponsor(s): Terry, Sexton C, Ragan, Hardaway, Curcio

Summary:

• Authorizes the partial filling of a controlled substance if the partial fill is requested by the patient or the practitioner who wrote the prescription and the total quantity dispensed through partial fills does not exceed the total quantity prescribed for the original prescription
• Requires the pharmacist to retain the original prescription at the pharmacy where the prescription was first presented and the partial fill dispensed, and any subsequent fill shall occur at the pharmacy that initially dispensed the partial fill within thirty (30) days from issuance of the original prescription.
• Requires the pharmacist to notify the prescriber of the partial fill and of the amount actually dispensed, either through a notation in the interoperable electronic health record of the patient, through submission of information to the controlled substance database, by electronic or facsimile transmission; or through a notation in the patient’s record that is maintained by the pharmacy, and that is accessible to the practitioner upon request.
• Requires any person who presents a prescription for a partial fill to pay the prorated portion of cost sharing and copayments.
• Authorizes a pharmacist or pharmacy to charge a dispensing fee to cover the actual supply and labor costs associated with the dispensing of the original prescription for a controlled substance and each partial fill associated with the original prescription.
• Establishes that any cost sharing, copayment, dispensing fee, or any portion thereof, made to a pharmacist or pharmacy for the dispensing of a partial fill of a controlled substance shall not be considered an overpayment.
• Establishes that a health insurance issuer or pharmacy benefits manager shall not utilize partial fills of a controlled substance to reduce payments to a pharmacist or pharmacy for dispensing multiple partial fills.