STRENGTHEN OPIOID MISUSE PREVENTION (STOP)ACT.

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View NCGA Bill Details2017-2018 Session
House Bill 243 (Public) Filed Thursday, March 2, 2017
AN ACT STRENGTHENING OPIOID MISUSE PREVENTION BY EXTENDING STANDING ORDERS FOR OPIOID ANTAGONIST TO COMMUNITY HEALTH GROUPS; REQUIRING SUPERVISING PHYSICIANS TO PERSONALLY CONSULT WITH PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS WHO PRESCRIBE CERTAIN SCHEDULE II OR III CONTROLLED SUBSTANCES FOR LONG-TERM USE; REQUIRING ELECTRONIC PRESCRIBING OF CERTAIN SCHEDULE II AND III CONTROLLED SUBSTANCES; ESTABLISHING MAXIMUM LIMITS FOR INITIAL PRESCRIPTIONS OF SCHEDULE II AND III CONTROLLED SUBSTANCES; REQUIRING HOSPICE AND PALLIATIVE CARE PROVIDERS TO PROVIDE EDUCATION REGARDING PROPER DISPOSAL OF CERTAIN UNUSED CONTROLLED SUBSTANCES; CLARIFYING ALLOWABLE FUNDS FOR SYRINGE EXCHANGE PROGRAMS; REQUIRING VETERINARIAN PARTICIPATION IN THE CONTROLLED SUBSTANCES REPORTING SYSTEM; ESTABLISHING CIVIL PENALTIES FOR PHARMACIES THAT EMPLOY DISPENSERS WHO IMPROPERLY REPORT INFORMATION TO THE CONTROLLED SUBSTANCES REPORTING SYSTEM (CSRS); EXPANDING THE ROLE OF THE DEPARTMENTS OF HEALTH AND HUMAN SERVICES (DHHS) IN USING CSRS DATA TO DETECT AND PREVENT FRAUD AND MISUSE; MANDATING DISPENSER REGISTRATION FOR ACCESS TO THE CSRS; MANDATING DISPENSER AND PRACTITIONER USE OF THE CSRS; REQUIRING DHHS TO REPORT PRACTITIONERS WHO FAIL TO PROPERLY USE THE CSRS; CREATING A SPECIAL REVENUE FUND TO SUPPORT THE CSRS; AND REQUIRING AN ANNUAL REPORT FROM DHHS ON THE CSRS.
Intro. by Murphy, Davis, Malone, Horn.

Status: Ch. SL 2017-74 (House Action) (Jun 29 2017)

SOG comments (1):

Long Title Change

House committee substitute to the 1st edition made changes to the long title. The original title is as follows:

AN ACT STRENGTHENING OPIOID MISUSE PREVENTION BY EXTENDING STANDING ORDERS FOR OPIOID ANTAGONIST TO COMMUNITY HEALTH GROUPS; REQUIRING SUPERVISING PHYSICIANS TO PERSONALLY CONSULT WITH PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS WHO PRESCRIBE SCHEDULE II THROUGH V CONTROLLED SUBSTANCES FOR LONG-TERM USE; REQUIRING ELECTRONIC PRESCRIBING OF SCHEDULE II THROUGH V CONTROLLED SUBSTANCES; ESTABLISHING MAXIMUM LIMITS FOR INITIAL PRESCRIPTIONS OF SCHEDULE II THROUGH V CONTROLLED SUBSTANCES; CLARIFYING ALLOWABLE FUNDS FOR SYRINGE EXCHANGE PROGRAMS; REQUIRING VETERINARIAN PARTICIPATION IN THE CONTROLLED SUBSTANCES REPORTING SYSTEM; ESTABLISHING CIVIL PENALTIES FOR PHARMACIES THAT EMPLOY DISPENSERS WHO IMPROPERLY REPORT INFORMATION TO THE CONTROLLED SUBSTANCES REPORTING SYSTEM (CSRS); EXPANDING THE ROLE OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) IN USING CSRS DATA TO DETECT AND PREVENT FRAUD AND MISUSE; MANDATING DISPENSER REGISTRATION FOR ACCESS TO THE CSRS; MANDATING DISPENSER AND PRACTITIONER USE OF THE CSRS; REQUIRING DHHS TO REPORT PRACTITIONERS WHO FAIL TO PROPERLY USE THE CSRS; CREATING A SPECIAL REVENUE FUND TO SUPPORT THE CSRS; IMPOSING AN ANNUAL FEE ON PRACTITIONERS TO BE DEPOSITED INTO THE CSRS SPECIAL REVENUE FUND; REQUIRING AN ANNUAL REPORT FROM DHHS ON THE CSRS; AND APPROPRIATING FUNDS FOR COMMUNITY-BASED SUBSTANCE USE DISORDER TREATMENT AND RECOVERY SERVICES.

Bill History:

H 243/S.L. 2017-74

Bill Summaries:

  • Summary date: Jun 30 2017 - View Summary

    AN ACT STRENGTHENING OPIOID MISUSE PREVENTION BY EXTENDING STANDING ORDERS FOR OPIOID ANTAGONIST TO COMMUNITY HEALTH GROUPS; REQUIRING SUPERVISING PHYSICIANS TO PERSONALLY CONSULT WITH PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS WHO PRESCRIBE CERTAIN SCHEDULE II OR III CONTROLLED SUBSTANCES FOR LONG-TERM USE; REQUIRING ELECTRONIC PRESCRIBING OF CERTAIN SCHEDULE II AND III CONTROLLED SUBSTANCES; ESTABLISHING MAXIMUM LIMITS FOR INITIAL PRESCRIPTIONS OF SCHEDULE II AND III CONTROLLED SUBSTANCES; REQUIRING HOSPICE AND PALLIATIVE CARE PROVIDERS TO PROVIDE EDUCATION REGARDING PROPER DISPOSAL OF CERTAIN UNUSED CONTROLLED SUBSTANCES; CLARIFYING ALLOWABLE FUNDS FOR SYRINGE EXCHANGE PROGRAMS; REQUIRING VETERINARIAN PARTICIPATION IN THE CONTROLLED SUBSTANCES REPORTING SYSTEM; ESTABLISHING CIVIL PENALTIES FOR PHARMACIES THAT EMPLOY DISPENSERS WHO IMPROPERLY REPORT INFORMATION TO THE CONTROLLED SUBSTANCES REPORTING SYSTEM (CSRS); EXPANDING THE ROLE OF THE DEPARTMENTS OF HEALTH AND HUMAN SERVICES (DHHS) IN USING CSRS DATA TO DETECT AND PREVENT FRAUD AND MISUSE; MANDATING DISPENSER REGISTRATION FOR ACCESS TO THE CSRS; MANDATING DISPENSER AND PRACTITIONER USE OF THE CSRS; REQUIRING DHHS TO REPORT PRACTITIONERS WHO FAIL TO PROPERLY USE THE CSRS; CREATING A SPECIAL REVENUE FUND TO SUPPORT THE CSRS; AND REQUIRING AN ANNUAL REPORT FROM DHHS ON THE CSRS. Enacted June 29, 2017. Sections 1, 2, 3, 4, 5, 7, 8, 11, and 13 are effective July 1, 2017. Subsections (a), (a1), and (a2) of GS 90-106, as amended by Section 6 of this act, are effective January 1, 2020. Subsections (a3) and (a4) of GS 90-106, as amended by Section 6 of this act, are effective January 1, 2018. Section 10 of this act and GS 90-113.75A and GS 90-11375B, as enacted by Section 12 of this act, are effective September 1, 2017. The remainder of the act is effective June 29, 2017, and applies to acts committed 30 days after the date the State CIO notifies the Revisor of Statutes that (i) the upgrades to the CSRS database described in subdivisions (1) and (2) of subsection (a) of Section 12F.7 of SL 2016-94 have been completed and (ii) the upgraded CSRS database is fully operational within the Department of Information Technology and connected to the statewide health information exchange.


  • Summary date: Jun 21 2017 - View Summary

    Senate amendment makes the following changes to the 4th edition.

    Makes amendments to GS 90-113.73 (regarding requirements for the controlled substances reporting system) effective September 1, 2017 (4th edition made part of the amendments effective when the act became law, and other parts 30 days after the date the Chief Information Officer notified the Revisor of Statutes of the fulfillment of a certain condition). Makes conforming changes.


  • Summary date: Jun 15 2017 - View Summary

    Senate committee substitute makes the following changes to the 3rd edition.

    Adds whereas clauses concerning the impact of the opioid epidemic in North Carolina.

    Part III

    Deletes the previous language of proposed GS 90-18.1(b) and now provides the following. Requires a physician assistant to personally consult with the supervising physician before prescribing a targeted controlled substance as defined in Article 5 of GS Chapter 90 when: (1) the patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises in any medium for any type of pain management services and (2) the therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days. Requires the physician assistant to consult with the supervising physician at least once every 90 days when a targeted controlled substance prescribed in accordance with this subdivision is continuously prescribed to the same patient in order to verify that the prescription remains medically appropriate for the patient. Deletes the previous language of proposed GS 90-18.2(b), concerning nurse practitioners, and instead provides identical language as just described for proposed GS 90-18.1(b) concerning physician assistants, making the same requirements applicable for nurse practitioners. 

    Amends the proposed new language in GS 90-106 concerning prescriptions and labeling. Adds two new exemptions to those set out in new subsection (a1), exempting a practitioner who orders a controlled substance to be administered in an outpatient dialysis facility as well as a person licensed to practice veterinary medicine pursuant to Article 11 of GS Chapter 90 from the requirement that practitioners electronically prescribe all targeted controlled substances. Adds to new subsection (a3), establishing immunity for a practitioner who acts in accordance with the limitation on prescriptions set forth in the subsection for acting in accordance with the subsection. Deletes proposed subsection (a4), concerning pain management agreement plans for extended therapeutic use of a targeted controlled substance. Makes conforming changes to the effective date provisions in Part VI.

    Part V

    Deletes the proposed changes to GS 90-113.73(b)(2), which make the required patient information that a dispenser must report for whom a controlled substance is dispensed also applicable to the owner of an animal to whom the controlled substance for the animal is dispensed. Also deletes proposed subdivision (b)(12), requiring the dispenser to report the name of a prescribing physician assistant or nurse practitioner's supervising physician. Adds to proposed subsection (e), prohibiting the assessment of any civil penalty upon a pharmacy acting in good faith that attempts to report the information required by the statute as amended. 

    Provides that the effective date for the proposed changes to GS 90-113.73(e) (concerning penalties for failure to report)  are effective when the act becomes law (previously included in the provisions that become effective 30 days after the date the Chief Information Officer notifies the Revisor of Statutes that the CSRS database has the capability to record the described information).

    Further amends GS 90-113.74, now amending subsection (c). Requires the administrator of a hospital emergency department or hospital acute care facility to provide the Department of Health and Human Services (Department) with a list of prescribers who are authorized to prescribe controlled substances for the purpose of providing medical care for patients of the hospital emergency department or hospital acute care facility and a list of delegates who are authorized to receive data on behalf of the providers listed. Requires the administrator to submit the lists to the Department by December 1 of the calendar year preceding the year during which the delegates are to receive data. Permits the administrator to provide updated lists at any time during the course of the year. Directs the Department to establish, within one week of receiving the initial or updated lists, all of the delegate accounts necessary to enable each delegate listed by the administrator of the hospital emergency department or hospital acute care facility to receive data on behalf of the listed prescribers. Adds that delegations made pursuant to this provision are valid during the calendar year for which submitted by the administrator. 

    Modifies proposed GS 90-113.75B, concerning the annual report by the Department of Health and Human Services to the General Assembly and licensing boards. Amends the required content of the report to also include any other data deemed appropriate and requested by the North Carolina Board of Podiatry Examiners. 

    Modifies the proposed changes to Section 12F.16(h) of SL 2015-241, deleting the requirement that the Department of Health and Human Services apply for grant funding from the National Association of Boards of Pharmacy to establish interstate connectivity for the Controlled Substances Reporting System (CSRS) as specified.

    Modifies the proposed changes to Section 12F.16(i)(3) of SL 2015-241, deleting the requirement that the specified funds be used to establish interstate connectivity for the CSRS for the 2015-16 fiscal year. 

    Directs the Department to conduct a study in consultation with the Office of the Attorney General and the NC Veterinary Medical Board on how to implement the provisions of the act pertaining to electronic prescriptions and the submission of data to the CSRS as they relate to the practice of veterinary medicine. Directs the Department to report to the Joint Legislative Oversight Committee on Health and Human Services no later than February 1, 2018.


  • Summary date: Apr 10 2017 - View Summary

    House amendments make the following changes to the 2nd edition.

    House amendment #1 amends proposed GS 90-87(26a), defining targeted controlled substance to mean any controlled substance included in GS 90-90(1) or (2), or GS 90-91(d) (previous edition also included GS 90-90(3)).

    House amendment #2 further amends GS 90-106 by adding a new subsection. Requires that if a prescription is for a targeted controlled substance and therapeutic use of the targeted controlled substance will or is expected to exceed a period of 60 days, the practitioner prescribing the targeted controlled substance must execute a pain management agreement with the patient that includes eleven specified elements, including the agreement date; the patient name and practitioner name; the name of the targeted drug(s), dosage amount, and frequency of administration; refill policy; random drug testing; and policy for agreement termination. Effective January 1, 2018. Makes technical and conforming changes.


  • Summary date: Mar 30 2017 - View Summary

    House committee substitute makes the following changes to the 1st edition.

    Changes the act's long title.

    Adds the term targeted controlled substance to GS 90-87, defining the term to mean any controlled substance included in GS 90-90(1), (2), or (3), or GS 90-91(d). Effective July 1, 2017. Makes changes to refer to targeted controlled substance instead of controlled substance throughout the proposed language of GS 90-18.1(b), GS 90-18.2(j), GS 90-106, and proposed GS 90-106.3. Makes conforming changes.

    Adds descriptors to each new subsection of GS 90-106, concerning prescriptions and labeling. Changes the effective date of the proposed changes, providing subsections (a), (a1), and (a2) become effective January 1, 2020, and subsections (a3) and (a4) become effective January 1, 2018 (previously, provided an effective date of July 1, 2018, to the entire statute).

    Amends proposed subsection (a1), requiring a practitioner to electronically prescribe all targeted controlled substances. Provides that a practitioner who experiences temporary technological or electric failure or other extenuating circumstances (currently does not include other extenuating circumstances) that prevent the prescription from being transmitted electronically is exempt from the requirement.

    Amends proposed subsection (a3), concerning limitations on prescriptions upon initial consultation for acute pain. Prohibits a practitioner from prescribing more than a five-day supply of any targeted controlled substance upon the initial consultation and treatment of a patient for acute pain, unless the prescription is for post-operative acute pain relief (previously not clarified) for use immediately following a surgical procedure. Adds provision prohibiting a practitioner from prescribing more than a seven-day supply of any targeted controlled substance for post-operative acute pain relief immediately following a surgical procedure. Further, adds that subsection (a3) does not apply to prescriptions for controlled substances issued by a practitioner who orders a controlled substance to be wholly administered in a hospital, nursing home licensed under GS Chapter 131E, hospice facility, or residential care facility as defined in GS 14-32.2(c1).

    Adds surgical procedure to the defined terms in proposed subsection (a4).

    Adds new subsection (a5) to grant a dispenser immunity from any civil or criminal liability or disciplinary action from the Board of Pharmacy for dispensing a prescription written by a prescriber in violation of GS 90-106, as amended.

    Deletes and replaces the previous language of proposed GS 90-106.3. Now directs any hospice or palliative care provider who prescribes a targeted controlled substance to be administered to a patient in his or her home for the treatment of pain as part of in-home hospice or palliative care to, at the commencement of treatment, provide oral and written information to the patient and his or her family regarding the proper disposal of the targeted controlled substances. Requires the information to include the availability of permanent drop-boxes or periodic drug take-back events that allow for the safe disposal of controlled substances such as those permanent drop boxes and events that may be identified through NC Operation Medicine Drop. 

    Deletes proposed GS 58-51-56, which directs health benefit plans to charge a co-payment for a limited, initial prescription of a Schedule II through V controlled substance in an amount that is either proportional between the co-payment charged for a 30-day supply of the controlled substance and the amount prescribed to the beneficiary, or equal to the co-payment charged for a 30-day supply, provided that the beneficiary will not be charged any additional co-payments for subsequent prescriptions for the remainder of the 30-day supply.

    Amends the proposed changes to GS 90-113.73. Amends the Schedule II through V prescription reporting deadline for dispensers to require a report no later than the close of the next business day after the prescription is delivered, but encourages dispensers to report the information no later than 24 hours after the prescription is delivered (previously, proposed no later than 24 hours after a prescription is delivered; currently required at close of business three days after the date of delivery). Further, adds new provision providing that, in the event the dispenser is unable to report the information within the time frame required by the statute because the system is not operational or there is some other temporary electrical or technological failure, the inability must be documented in the dispenser's records, and the dispenser must promptly report the information once the electrical or technological failure has been resolved. Amends the information a dispenser is required to report, as specified in subsection (b), to now include (1) if the controlled substance is dispensed for an animal, the name of the owner of the animal and the specified contact information and date of birth of the owner and (2) if the prescriber is a physician assistant or a nurse practitioner, the name of that individual's supervising physician. Amends the directive in proposed subsection (e) to require the Department of Health and Human Services (DHHS) to assess a civil penalty of up to $100 for a first violation and up to $250 for a second violation, and up to $500 for each subsequent violation (currently up to $250 for a first violation and up to $500 for subsequent violations) against a pharmacy that employs a dispenser who fails to comply with the reporting requirements within a reasonable period of time after being informed by DHHS that required information is missing or incomplete for a first violation, up to a maximum of $5,000 (previously, $10,000) per pharmacy per calendar year.

    Provides that the proposed changes to GS 90-113.73, except for subsection (b), which is effective when the act becomes law, are effective 30 days after the date the Chief Information Officer notifies the Revisor of Statutes that the Controlled Substance Reporting System database has the capability to record the information described in the statute as amended. Directs the Chief Information Officer to notify the Revisor of Statutes once the CSRS database has the capability to record the information described in the statute as amended.

    Amends proposed GS 90-113.74(b1)(1a) to authorize DHHS to notify practitioners and their respective licensing boards (previously only practitioners) of prescribing behavior that increases risk of diversion of controlled substances, increases risk of patient harm, or is an outlier among other practitioner behavior. Adds an effective date of July 1, 2017.

    Deletes proposed GS 90-113.74(c)(11), which authorizes DHHS to release Controlled Substances Reporting System (CSRS) data to third-party payers and their agents, for the purposes of claimant case management, detection of inappropriate prescriptions of controlled substances to a claimant, or detection of misuse or diversion of a controlled substance by a claimant.

    Enacts proposed GS 90-113.74A as GS 90-113.74B. Makes organizational changes and adds new subsection providing that the statute does not apply to a licensee employed in a pharmacy practice setting where a Schedule II, III, or IV controlled substance will not be dispensed. Makes conforming changes to the statute's proposed title.

    Enacts proposed GS 90-113.74B as GS 90-113.74C. Adds clarification that in the event the practitioner is unable to review the information in the controlled substances reporting system pertaining to the patient because the system is not operational or there is some other temporary electrical or technological failure (previously temporary nature was not specified), this inability must be documented in the patient's medical record. Makes conforming changes to refer to targeted controlled substance. Deletes the provision in subsection (b), subdivision (4), allowing a practitioner to review the information in the controlled substances reporting system pertaining to a patient prior to prescribing a targeted controlled substance to the patient when the controlled substance is prescribed in an amount indicated for a period not to exceed five days and does not allow a refill, or for a period not to exceed seven days if the prescription indicates the controlled substance is for immediate post-operative pain relief. 

    Enacts proposed GS 90-113.74C as GS 90-113.74D. Makes clarifying change. Makes conforming changes to refer to targeted controlled substance. Adds new provision to subsection (b) establishing that failure to review the controlled substance reporting system in accordance with subsection (a) of the statute does not constitute medical negligence. 

    Makes technical changes to proposed GS 90-113.75A, establishing the Controlled Substances Reporting System Fund.

    Deletes proposed GS 90-113.75B, which directs practitioners, prior to prescribing Schedule II through V controlled substances, to review information in CSRS regarding the patient for the 12 months preceding the initial prescription; to consult CSRS information for the 12 months preceding each subsequent three-month period that the substance remains part of the patient’s medical care; and to document each instance of review in the patient’s medical record, as well as instances in which review is not possible due to the unavailability of CSRS due to some technological failure. Directs the practitioner to review the information when the CSRS becomes available again, and to document that review in the patient’s medical record. 

    Enacts proposed GS 90-113.75C as GS 90-113.75B, directing the annual report by DHHS be submitted by February 1, beginning February 1, 2019 (previously annually on November 1, beginning November 1, 2019). Adds the NC Board of Podiatry Examiners to the entities to which the report must be submitted. Makes conforming change to refer to "targeted controlled substances." Changes the requirements of the report, requiring the specified practitioners be treated as distinct categories of practitioners for categorizing the practitioners prescribing controlled substances and the number of prescriptions authorized by each category of practitioners. Deletes the requirement that the report include the prescribing behavior of practitioners that increases the risk of diversion of controlled substances, increases the risk of harm to the patient, or is an outlier among other practitioner behavior.

    Adds new section to amend SL 2015-241, Section 12F.16(h), to direct DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, to continue to work toward establishing interstate connectivity for the Controlled Substances Reporting System established under GS 90-113.73. Makes conforming changes to replace references to the PMP InterConnect with references to the Controlled Substances Reporting System (CSRS). Further, amends Section 12F.16(i)(3), providing that the $40,035 appropriation is to be used to establish interstate connectivity for CSRS. Directs DHHS, upon receipt of any grant funding for that purpose or upon identification of other allowable receipts for that purpose, to reimburse the General Fund for the costs associated with establishing interstate connectivity for the CSRS. Limits the reimbursement amount to the amount of any grant funding received by DHHS for the purpose plus the amount of any allowable receipts used by DHHS for the purpose, not to exceed the amount of the nonrecurring funds appropriated in Section 12F.16(i)(3). Effective July 1, 2017.

    Deletes the previous appropriation provision, which appropriated $10 million each for 2017-18 and 2018-19 from the General Fund to DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, to be used for increasing the availability of community-based treatment and recovery services for substance use disorders. 


  • Summary date: Mar 2 2017 - View Summary

    Identical to S 175, filed 3/2/17.

    Section 1 refers to the bill as the “Strengthen Opioid Misuse Prevention Act of 2017” or the “STOP Act.” Effective July 1, 2017.

    Section 2 amends GS 90-12.7. Authorizes a practitioner acting in good faith and exercising reasonable care to prescribe opioid antagonists to any governmental or nongovernmental organization, either directly or by standing order, for the purpose of distributing the opioid antagonist to persons at risk of experiencing an opioid overdose, or persons in a position to assist a person at risk of experiencing an opioid overdose. Authorizes governmental or nongovernmental organizations to distribute opioid antagonists obtained pursuant to an authorized prescription to persons at risk of experiencing an opioid overdose, or to persons in a position to assist a person at risk of experiencing an opioid overdose. Adds organizations and agents of organizations that distribute opioid antagonist as described above to the list of individuals immune from civil or criminal liability for actions authorized by this statute. Makes conforming changes. Authorizes the State Health Director's designee to prescribe an opiod antagonist by a statewide standing order. Effective July 1, 2017.

    Sections 3 and 4 amend GS 90-18.1(b) and GS 90-18.2(b). Directs physicians assistants and nurse practitioners, when prescribing a controlled substance included in Schedule II through V of GS Chapter 90, Article 5 (all subsequent references to Schedule [x] Substances refer to GS Chapter 90, Article 5, schedules), and the use of the substance is expected to exceed a period of 30 days, to consult with the supervising physician prior to prescription to verify that the prescription is medically appropriate, and to consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate. Effective July 1, 2017.

    Section 5 amends GS 90-106 to authorize the dispensation of Schedule II substances pursuant to an electronic prescription (previously only authorized written prescriptions), and prohibits dispensation after six months from the date of prescription. Directs practitioners to electronically prescribe all controlled substances included in Schedule II through V. Exempts (1) non-pharmacist practitioners who dispense directly to an ultimate user; (2) practitioners who order a controlled substance to be administered in a hospital, nursing home, hospice facility, or residential care facility; (3) practitioners experiencing temporary technological or electrical failures that prevent transmitting electronic prescriptions, provided that the reason for the exception is documented in the patient’s medical record; and (4) practitioners who write prescriptions to be dispensed by a pharmacy on federal property, provided that the reason for this exception is documented in the patient’s medical record. Dispensers are not required to verify that a practitioner falls under one of the exceptions prior to dispensation, and may continue to dispense controlled substances from valid written, oral, or facsimile prescriptions. Prohibits practitioners from prescribing more than a five-day supply of controlled substances on Schedule II through V upon initial consultation and treatment for acute pain (defined as pain that the practitioner reasonably expects to last for three months or less, not including chronic pain or pain being treated as part of cancer care, hospice care, palliative care, or medication-assisted treatment for substance use disorder), unless for immediate post-operative pain relief, which many not exceed a seven-day supply. Practitioners may issue any appropriate renewal, refill, or new prescription, upon subsequent consultation. Effective July 1, 2018.

    Section 6 enacts new GS 90-106.3 (Disposal of residual pain prescriptions following death of hospice or palliative care patient). Directs hospice or palliative care providers who prescribe Schedule II through V controlled substances to patients in their home to make diligent efforts to ensure that residual portions of the substance are safely disposed of following the death of the patient. Effective July 1, 2017.

    Section 7 enacts new GS 58-51-56 (Limitation on co-payments for limited, initial opioid prescriptions). Directs health benefit plans to charge a co-payment for a limited, initial prescription of a Schedule II through V controlled substance in an amount that is either proportional between the co-payment charged for a 30-day supply of the controlled substance and the amount prescribed to the beneficiary, or equal to the co-payment charged for a 30-day supply, provided that the beneficiary will not be charged any additional co-payments for subsequent prescriptions for the remainder of the 30-day supply. Effective July 1, 2018.

    Section 8 amends GS 90-113.27(b)(2). Clarifies that State funds may not be used to purchase needles, hypodermic syringes, or other injection supplies in syringe exchange programs (currently prohibits use of public funds). Effective July 1, 2017.

    Section 9 amends GS 90-113.72. Amends the definition of dispenser to no longer exclude persons licensed to practice veterinary medicine. Defines pharmacy as a person or entity holding a valid pharmacy permit. Makes technical changes.

    Section 10 amends GS 90-113.73. Amends the Schedule II through V prescription reporting deadline for dispensers to require a report no later than 24 hours after a prescription is delivered (currently required at close of business three days after the date of delivery). Directs the Department of Health and Human Services (DHHS) to assess a civil penalty up to $250 against a pharmacy that employs a dispenser who fails to comply with the reporting requirements within a reasonable period of time after being informed by DHHS that required information is missing or incomplete for a first, and a civil penalty up to $500 for each subsequent violation, up to a maximum of $10,000 per pharmacy per calendar year. Each day of a continuing violation constitutes a separate violation. Proceeds of the penalty must be deposited to the Civil Penalty and Forfeiture Fund. Directs the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services to adopt rules to implement the penalty requirements, including factors to be considered in determining the amount of the penalty. Makes a conforming change to the statute's caption.

    Section 11 amends GS 90-113.74(b1). Authorizes DHHS to notify practitioners of prescribing behavior that increases risk of diversion of controlled substances, increases risk of patient harm, or is an outlier among other practitioner behavior.

    Section 12 amends GS 90-113.74(c). Authorizes DHHS to release Controlled Substances Reporting System (CSRS) data to third-party payers and their agents, for the purposes of claimant case management, detection of inappropriate prescriptions of controlled substances to a claimant, or detection of misuse or diversion of a controlled substance by a claimant.

    Section 13 enacts new GS 90-113.74A through GS 90-113.75C, as described below, effective September 1, 2017.

    New GS 90-113.74A (Mandatory dispenser registration for access to CSRS) directs pharmacy licensees to demonstrate to the North Carolina Board of Pharmacy that he or she is registered for access to CSRS within 30 days of obtaining an initial or renewal license. Violation of this requirement may be cause for the Board of Pharmacy to suspend or revoke the license.

    New GS 90-113.74B (Practitioner use CSRS; mandatory reporting of violations) directs practitioners, prior to prescribing Schedule II through V controlled substances, to review information in CSRS regarding the patient for the 12 months preceding the initial prescription, and to consult CSRS information for the 12 months preceding each subsequent three-month period that the substance remains part of the patient’s medical care, and to document each instance of review in the patient’s medical record, as well as instances in which review is not possible due to the unavailability of CSRS due to some technological failure, and directs the practitioner to review the information when the CSRS becomes available again, and to document that review in the patient’s medical record. Authorizes, but does not direct, practitioners to review information in the CSRS before prescribing a Schedule II through V controlled substance in other circumstances. Directs DHHS to conduct periodic audits of prescribers’ compliance with this section, and to report violations to the appropriate licensing board. Violations may constitute cause for suspension or revocation of a prescriber’s license.

    New GS 90-113.74C (Dispenser use of CSRS) directs dispensers to review patients’ information in the CSRS for the preceding 12-month period prior to dispensation in several circumstances, including whenever the dispenser has a reasonable belief that the ultimate user may be seeking a Schedule II through V controlled substance for any reason other than treatment of the ultimate user’s existing medical condition. Directs a dispenser to withhold delivery of prescribed Schedule II through V substances whenever the dispenser has reason to believe the prescription is fraudulent or duplicative, until the dispenser is able to contact the prescriber and determine that the prescription is medically appropriate. Protects dispensers from civil or criminal liability for actions authorized by this subsection.

    New GS 90-113.75A (Creation of CSRS Fund) creates the fund as indicated in the caption as a special revenue fund. Directs DHHS to administer the fund and use it only for the operation of the reporting system and to carry out the provisions of GS Chapter 90, Article 5E. The fund consists of moneys transmitted to the fund pursuant to new GS 90-113.75B, appropriated by the General Assembly, or received for deposit into the fund. Interest that accrues to the fund shall be credited to the Fund, and remaining balances at the end of any fiscal year remain in the fund.

    New GS 90-113.75B (CSRS fee) directs, beginning January 1, 2018, each licensing board that issues licenses authorizing prescription of controlled substances for medical care to impose an annual CSRS fee of $20 upon the licensee, at the same time as the initial or renewal license fee imposed on the licensee, and to retain 10% of the total fee to cover the costs of collecting and providing an accounting of all moneys received as payment of this fee. Directs the licensing boards to transmit the remaining 90% of the moneys collected by this fee to the CSRS Fund on the first day of each calendar quarter. Does not apply to individuals licensed to practice veterinary medicine.

    New GS 90-113.75C (annual report to General Assembly and licensing boards) directs DHHS to report annually, on November 1, beginning on November 1, 2018, to the Joint Legislative Oversight Committee on Health and Human Services, the North Carolina Medical Board, the North Carolina Board of Nursing, the North Carolina Dental Board, the North Carolina Veterinary Medical Board, and the North Carolina Board of Pharmacy on data reported to the CSRS. The report must include eight types of information on Schedule II through V substances reported during the preceding calendar year, including the total number of prescriptions dispensed, broken down by Schedule, and the demographics about the ultimate users to whom prescriptions were dispensed.

    Section 14 appropriates $10 million each for 2017-18 and 2018-19 from the General Fund to DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, to be used for increasing the availability of community-based treatment and recovery services for substance use disorders. These funds do not supplant existing funds for this purpose. Effective July 1, 2017.

    Except as otherwise indicated, the bill is effective when it becomes law and applies to acts committed on or after the date the State Chief Information Officer notifies the Revisor of Statutes that (1) the upgrades to the CSRS database described in SL 2016-94, section 12F.7(a)(1 & 2) have been completed and (2) the upgraded CSRS database is fully operational within the Department of Information Technology and connected to the statewide health information exchange.