STRENGTHEN OPIOID MISUSE PREVENTION (STOP)ACT.

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View NCGA Bill Details2017-2018 Session
Senate Bill 175 (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 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.
Intro. by J. Davis, McInnis, Rabon.

Status: Re-ref to Health Care. If fav, re-ref to Judiciary. If fav, re-ref to Appropriations/Base Budget. If fav, re-ref to Rules and Operations of the Senate (Senate Action) (Mar 7 2017)

SOG comments (1):

Identical bill

Identical to H 243, filed 3/2/17.

S 175

Bill Summaries:

  • Summary date: Mar 2 2017 - View Summary

    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 90­12.7. 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 90­18.1(b) and GS 90­18.2(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 90­106 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 five­day 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 medication­assisted treatment for substance use disorder), unless for immediate post­operative pain relief, which many not exceed a seven­day supply. Practitioners may issue any appropriate renewal, refill, or new prescription, upon subsequent consultation. Effective July 1, 2018.

    Section 6 enacts new GS 90­106.3 (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 58­51­56 (Limitation on co­payments for limited, initial opioid prescriptions). Directs health benefit plans to charge a co­payment for a limited, initial prescription of a Schedule II through V controlled substance in an amount that is either proportional between the co­payment charged for a 30­day supply of the controlled substance and the amount prescribed to the beneficiary, or equal to the co­payment charged for a 30­day supply, provided that the beneficiary will not be charged any additional co­payments for subsequent prescriptions for the remainder of the 30­day supply. Effective July 1, 2018.

    Section 8 amends GS 90­113.27(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 90­113.72. 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 90­113.73. 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 90­113.74(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 90­113.74(c). Authorizes DHHS to release Controlled Substances Reporting System (CSRS) data to third­party 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 90­113.74A through GS 90­113.75C, as described below, effective September 1, 2017.

    New GS 90­113.74A (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 90­113.74B (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 three­month 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 90­113.74C (Dispenser use of CSRS) directs dispensers to review patients’ information in the CSRS for the preceding 12­month 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 90­113.75A (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 90­113.75B, 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 90­113.75B (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 90­113.75C (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 2017­18 and 2018­19 from the General Fund to DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, to be used for increasing the availability of community­based 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 2016­94, 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.