State Member Board Briefs

Kansas Legislature Revises State's Pharmacy Act and Controlled Substances Act

The Kansas State Legislature has amended several provisions of the state's rules regarding pharmacy and controlled substances. Among the updates passed in 2012:

A prescription for a Schedule III, IV, or V controlled substance may authorize no more than five refills within six months following the date on which the prescription is issued.

The state's Board of Pharmacy is now authorized to provide data from the state's K-TRACS Prescription Drug Monitoring Program to medical examiners, coroners, or other persons authorized under law to investigate or determine causes of death.

The state's K-TRACS Advisory Committee is now authorized to review and analyze data from K-TRACS for purposes of identifying patterns and activities of concern. If a review of the information appears to indicate that a patient may be obtaining prescriptions in a manner that represents misuse or abuse of controlled substances or drugs of concern, the advisory committee may notify the prescribers and dispensers. If there is reasonable suspicion of criminal activity the committee may notify the appropriate law enforcement agency.

Kansas legislators also made changes to statutory definitions related to electronic prescriptions. A “valid prescription order” has been defined to mean a prescription that is issued for a legitimate medical purpose by an individual prescriber licensed by law to administer and prescribe drugs and acting in the usual course of such prescriber's professional practice.

A prescription issued solely on the basis of an Internet-based questionnaire or without an appropriate prescriber-patient relationship is not a valid prescription.

Legislators also amended the Pharmacy Practice Act so that there are definitions that relate to both written, oral, faxed, or electronically prepared and transmitted prescription orders. A major change is that prescriptions that are oral, faxed, or transmitted by the prescriber's agent must now include both the first and last names of the transmitting agent. If the prescription is for a controlled substance and is written or printed from an electronic prescription application, the prescription must be manually signed by the prescriber prior to delivery of the prescription to the patient or prior to facsimile transmission of the prescription to the pharmacy.

If the refill order or renewal order differs in any manner from the original order, such as a change of the drug strength, dosage form, or directions for use, the prescriber must now sign the order.

Source: Kansas State Board of Healing Arts Guidewire, Vol 4, Issue 1

Michigan Physician Notification Initiative Seeks to Curb Prescription Abuse

The Michigan Department of Licensing and Regulatory Affairs (DLRA) recently released information and statistics about its new Physician Notification initiative, designed to keep physicians apprised of potential controlled substance abuse or diversion.

The initiative provides alerts to physicians based on information from the Michigan Automated Prescription System (MAPS), the state's prescription drug monitoring program. In Michigan, all pharmacies, dispensing practitioners and veterinarians who dispense controlled substances in Schedules 2–5 are required to electronically report this prescription data through MAPS on the first and fifteenth day of every month. Beginning in 2013, the electronic reporting of prescription data will be required on a daily basis.

Michigan's MAPS data shows that 19.4 million controlled substance prescriptions were dispensed in 2011, with a significant increase in oxycodone immediate-release 30 mg and marked decreases in controlled-release OxyContin strengths. There has been a continued increase in the use of hydrocodone, accounting for 33 percent of all controlled substances dispensed, according to DLRA.

The state's Physician Notification initiative provides letters to physicians when MAPS information indicates their patient is seeking treatment from multiple practitioners and obtaining controlled substance prescriptions from those practitioners. Physicians are asked to confirm whether the patient is under active care and then request a MAPS report on the patient to review prescribing information. If they see indications of “doctor-shopping” they are asked to contact pharmacies and any other physicians listed to determine legitimacy of the prescriptions and address concerns of possible abuse.

Source: Michigan Department of Licensing and Regulatory Affairs Healthlink, Fall 2012

Nevada Issues Annual Report Highlighting Trends and Actions

The Nevada State Board of Medical Examiners has issued its Annual Report of its activities in 2011, highlighting trends and tallying actions taken by regulators during the year.

In 2011, Nevada issued licenses for 477 new physicians, 79 physician assistants, 172 respiratory therapists and three perfusionists. During the year, the ratio of physicians to 100,000 population increased slightly over 2010, growing from 170 per 100,000 to 171 per 100,000. In 2008, the ratio was 164 to 100,000.

The number of physician assistants grew by 2.5 percent in 2011, with the number of respiratory therapists up by 4.6 percent and the number of perfusionists up by 3.8 percent.

The recent upward trend in complaints in Nevada continued in 2011. During the year, the Board opened 828 investigations, closed 687 investigations (many of which originated in preceding years) and imposed 46 disciplinary actions in 45 matters. The number of disciplinary matters coming before the Board has continued to increase steadily since 2004. The rate of disciplinary actions taken by the Board per 1,000 active-status licensed physicians was 7.2 in 2011 — a number that has gradually risen since 2004, when it was 1.6 actions per 1,000 active-status licensed physicians. Actions taken against in-state, active-status physicians was slightly higher, at 9.9 per 1,000.

Statistics for investigations per specialty show the highest number of investigations in Internal Medicine (145), followed by Family Practice (82), Obstetrics/Gynecology (78), General Surgery (57), Orthopedic Surgery (52), and Emergency Medicine (45).

Source: Nevada State Board of Medical Examiners Newsletter, November 2012

Oregon Expands Drug Dispensing Authority for Physician Assistants

Dispensing authority for physician assistants (PAs) has previously been available in Oregon for PAs working in medically disadvantaged areas, but starting in 2012 dispensing authority has been expanded to all areas of the state. Supervising physicians throughout Oregon may apply for dispensing authority for a PA under the new statute.

Oregon state legislators passed a bill creating two different types of dispensing authority for PAs.

Under the new legislation, PAs are eligible for dispensing authority regardless of practice location. However, an applicant for dispensing authority under the new laws must fulfill additional requirements. To apply, the qualified physician assistant must complete a Drug Dispensing Training Program jointly developed by the Oregon Medical Board and the Board of Pharmacy, and the supervising physician must:

• Submit a list of drugs or classes of drugs to the Board

• Submit a drug delivery and control plan

• Submit an annual report to the Board on the physician assistant's dispensing

• Register the practice location(s) as a drug outlet with the Board of Pharmacy

A physician assistant with this type of dispensing authority may not dispense Schedule II–IV controlled substances.

Qualified PAs who service an underserved area or population group are exempt from the new requirements but must provide a statement regarding the medical necessity for dispensing, the practice location, and the distance to the nearest pharmacy. These requirements are unchanged by the new legislation.

For more information on applying for drug dispensing authority for a physician assistant and for access to the PA Drug Dispensing Training Program, please visit www.oregon.gov/omb/pages/umbrellapa.aspx.

Source: Oregon Medical Board Report, Vol. 124, No. 3

Pill Mill Raids Result in Loss of Dozens of Medical Licenses

In a large-scale pill-mill sweep by federal authorities in Houston recently, several physicians and physician assistants, five pharmacies and more than a dozen advanced nurse practitioners were forced to surrender their federal licenses for dispensing controlled substances.

The U.S. Drug Enforcement Administration, assisted by 14 local and state agencies, led the eight-month probe into Houston-area pill mills — clinics and pharmacies illegally dispensing addictive prescription drugs. According to the Houston Chronicle, the complex project culminated in raids involving 150 investigators in October. The Chronicle reported that the operation, called “Operation King of the Pill,” was the largest of its kind ever taken in the Houston area, yielding 3,500 boxes of evidence.

Source: Houston Chronicle, November 4, 2012

New Rules for West Virginia Prescribers of Controlled Substances Take Effect

Landmark legislation passed by the West Virginia Legislature early in 2012, tightening requirements for prescribers of controlled substances in the state, is now gone into effect, impacting West Virginia physicians and pharmacies.

The legislation, SB 437, has been called the most comprehensive approach taken in recent history in West Virginia in response to the growing issue of prescription drug diversion and substance abuse.

Among its key components, the legislation:

• Implements additional regulation of opioid treatment centers (methadone clinics)

• Establishes licensing and regulation of chronic pain clinics

• Establishes review capabilities of the state's Controlled Substances Database under the Board of Pharmacy to flag abnormal or unusual usage patterns of controlled substances by patients and unusual prescribing or dispensing patterns by licensed practitioners

• Implements a requirement for Continuing Medical Education (CME) for physicians and continued education for all other prescribers, dispensers and persons who administer controlled substances

• Establishes a requirement for pharmacies to utilize a Multi-State Real-Time Tracking System to track sales of pseudoephedrine and limits the amount allowed to be legally purchased daily, monthly and annually

Physicians in the state who prescribe, dispense or administer controlled substances have new requirements for CME, replacing the former requirement that they take two hours of CME in “end of life care and pain management.” The new legislation stipulates that “drug diversion training” and “best practices for prescribing of controlled substances training” be completed every licensure cycle.

Pharmacists are prohibited from dispensing prescriptions if they know that the prescription was issued without a valid practitioner-patient relationship. Online or telephonic evaluation by questionnaire or consultation is clarified as inadequate to establish such a relationship.

The definition of “pain management clinics” in West Virginia has been updated, including the requirement that all clinics must be licensed by the state and must submit to new regulations in order to be established.

The legislation also tightens up reporting requirements to the state's Controlled Substances Database, and grants civil, criminal and administrative immunity for any practitioner or dispenser who reports suspected “doctor shoppers”—those who fraudulently obtain prescriptions from multiple physicians.

The new bill also establishes a “Fight Substance Abuse Fund” in the state, aimed at substance abuse prevention.

Source: West Virginia Medical Association website, December 2012