Reminder: New Laws Affecting Opioid Prescriptions in California Now in Effect
Last fall, Gov. Brown signed two bills that as of 1/1/19 impose new requirements affecting opioid prescriptions.
- AB 1753 (Low) amended Health & Safety Code §§11161.5, 11162.1, and 11165 to authorize the Dept of Justice (DOJ) to limit the number of approved printers of controlled substance prescription forms to three specified security printers; require the forms to have a uniquely serialized number; and require the printers to submit specified information to the DOJ for all prescription forms delivered. The bill also required that information on controlled substances submitted to DOJ by a pharmacy, clinic, or other dispenser include the serial number for the corresponding prescription form.
The California Medical Board issued a memo on 12/28/18 to alert physician prescribers of the need to use the new prescription forms beginning on 1/1/19 as AB 1753 allowed no grace period for implementation. The memo noted that the California Board of Pharmacy enforcement committee has said it will “not make any action or investigation a priority” against a pharmacist who believes it’s in the best interest of public health to fill a prescription with the old form and does so, and that pharmacists also could ask for an electronic prescription or seek an oral prescription if laws allow that for the specified drug. However, the Fresno Bee reports that the Medical Board has received a number of inquiries from providers complaining that their opioid prescriptions – including some prescribed to post-surgical patients – have been rejected because they were not submitted on the new form.
To avoid any confusion or delays in filling prescriptions for controlled substances, you may want to confirm that your MPNs are aware of the new requirements and that more information on the security printers and the new serialized number format for opioid prescriptions is available from DOJ at (916) 210-3216 or online at securityprinter@doj.gov. The 12/27/18 memo from the Board of Pharmacy to pharmacists and pharmacies is at https://www.pharmacy.ca.gov/licensees/unique_serial.pdf.
- AB 2760 (Wood) added Article 10.7 (commencing with §740) to Ch. 1 of Div. 2 of the Business & Professions Code, relating to healing arts to require that opioid prescribers offer a prescription for the overdose-reversing drug naloxone concurrently with an opioid prescription if:
- The dosage on the opioid prescription is 90 MMEs or more per day;
- The opioid is prescribed concurrently with a benzodiazepine; or
- The patient presents with an increased risk for overdose, including a history of overdose, ahistory of substance use disorder, or is at risk for returning to a high dose of opioid medication to which they are no longer tolerant.
The bill also requires that the prescriber educate the patient, parent/guardian, or person designated by the patient on “overdose prevention and the use of naloxone or another drug approved by the FDA for the complete or partial reversal of opioid depression.”
Physician organizations opposed AB 2760 because naloxone is available over the counter so it does not require a prescription, and because the author would not amend the bill to:
- change the requirement to offer a prescription with language to inform patients about the availability of naloxone;
- allow whoever dispenses the naloxone (e., a pharmacist) to provide the patient education; or
- delete language stating that noncompliance with any provision shall lead to the prescriber beingreferred to their licensing board for administrative sanctions.
Despite this opposition, AB 2760 was enacted and took effect 1/1/19, so you may want to alert your claims staff, MPNs, and UROs of the new requirements, make sure they are aware of the criteria that now trigger the obligation to offer a naloxone prescription, and remind them to document the offer of a naloxone prescription and the provision of patient education in the injured worker’s medical file. Naloxone is available in brand and generic forms, with prices ranging from $20 to $40 per dose for generic versions, while brand-name Narcan can cost $130 to $140 for a kit that includes two doses; however, naloxone is in the Medi-Cal fee schedule, so workers’ compensation reimbursements for this drug are subject to the maximum allowable amount in the OMFS.