May 2018

Florida HB 21 Prescription Law

 

Important Notice to All Medical Offices That Prescribe Schedule 2 Prescriptions

Effective July 1, 2018 all prescription pads and laser prescription paper will have to be reprinted to reflect the new changes Florida HB 21 requires.  EHR systems using electronic prescriptions and print on Laser Security Rx paper will have to make adjustments as well. Any schedule 2 drug written on a non-complaint prescription will not be filled by a pharmacist and will leave a patient unable to get the necessary medication prescribed.   

In addition to how schedule 2 drugs are written there will be new required Continuing Education Courses for all medical professionals that prescribe them and the pharmacists that fill them.

What the new law requires for
prescription pads and Laser paper
(source Florida Department of Health)…

HB 21 imposes a number of requirements on health care practitioners who prescribe or dispense controlled substances. Effective July 1, 2018, section 456.44, Florida Statutes, will be amended to require health care practitioners who prescribe controlled substance to indicate directly on the prescription if the prescription is for the treatment of pain other than acute pain. The bill specifically states the prescriber must indicate “NONACUTE PAIN” on a prescription for an opioid drug listed as a Schedule II controlled substance.

To assist in the implementation of this bill, the Department has modified a sample prescription pad to include a place for health care practitioners to indicate “NONACUTE PAIN” when appropriate. The check box must be preprinted and not hand written.

 

What you should do immediately…

1.            Use a Florida State approved prescription printer to get your new Security Counterfeit-Proof Prescription Paper ready before supply and demand costs may create hardships before the July 1st deadline.  Any existing paper you may have can still be used for non-controlled substances.

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2.       Immediately notify your EHR software company that your system has to be updated to accommodate the new law. If there is a cost associated with this or they cannot accommodate you in time you can have the appropriate information added by your approved printer to the blank security laser paper.

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3.       Check with the State of Florida Health Department to see what the requirements are for your doctors and staff to get the necessary Continuing Education Credits.  Make sure you know the deadlines and get something in writing from them if possible as there can be confusion with the new law and the requirements of different modalities. See below for CME Links

 

All MOROF Medical Office Members can get 25% off* the new style prescription paper from our approved Counterfeit-Proof Prescription Pad Vendor TWIhealthcare.com - Non MOROF members get 15% off*.

CLICK HERE For a Prescription order Form and Pricing

*All orders eligible for discounts must be placed by June 15, 2018.
For more information on this offer please call 407-260-0565 or email info@twiservices.com.

CLICK HERE for Florida Prescription Frequently Asked Questions - FAQ?

 

The new law, which will take effect July 1, will limit prescriptions for acute pain and hold those prescribing opioids more accountable.

Anyone who is prescribed a schedule II opioid, which includes Vicodin, Dilaudid, Demerol, OxyContin and fentanyl, for acute pain will only be prescribed a three-day supply, once the new law takes effect. If the prescriber feels more than a three-day supply is medically necessary, a seven-day supply can be prescribed. The prescription will need to say "acute pain exception" and the patient's record will need to include documentation of the acute condition and a lack of alternative treatment that justifies the seven-day supply.

HB 21 continues Florida’s fight against opioids by:

• Placing a three-day limit on prescribed opioids for acute pain, unless strict conditions are met for a seven-day supply. Physicians could prescribe up to seven-day supplies of controlled substances if deemed medically necessary. Cancer patients, people who are terminally ill, palliative care patients and those who suffer from major trauma would be exempt from the limits.


• Requiring healthcare prescribers or dispensers of opioids to consult the Florida Prescription Drug Monitoring Program, a statewide database that monitors controlled substance prescriptions, to review a patient’s medication history prior to prescribing or dispensing a controlled substance. The goal is for the database, known as the prescription drug monitoring program, to interface with physicians’ offices and electronic health records used by doctors. To help make that a reality, lawmakers agreed to spend $991,000 for improvements.


• Requiring continuing education courses for healthcare practitioners on responsibly prescribing opioids;
• Increasing penalties for healthcare practitioners that provide medically unnecessary controlled substance to a patient by fraud, misrepresentation, or other deception; and
• Implementing additional reforms to fight unlicensed pain management clinics.

CS/CS/HB 21 amends various sections of law to increase the regulation, training, and reporting required when controlled substances are prescribed and dispensed. The bill:

  • Requires all prescribing practitioners who are authorized to prescribe controlled substances to complete a two-hour training course prior to biennial licensure renewal on the safe and effective prescribing of controlled substances, unless such practitioner is already required to take such a course by his or her practice act.
  • Defines “acute pain” as the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness. The term specifically does not include pain related to:
    • Cancer;
    • A terminal condition;
    • Palliative care to provide relief of symptoms related to an incurable, progressive illness or injury; or
    • A serious traumatic injury with an Injury Severity Score of 9 or greater.
  • Provides restrictions on certain prescriptions written to treat acute pain by:
    • Requiring applicable health care regulatory boards to create guidelines for prescribing controlled substances for the treatment of acute pain.
    • Limiting a prescription for an opioid listed in Schedule II to no more than three days if prescribed to treat acute pain as defined. This limit is increased to seven days if determined to be medically necessary by the prescribing practitioner and with proper documentation.
    • Requiring a prescriber to co-prescribe an opioid antagonist when prescribing controlled substances for serious traumatic injury.
  • Requires clinics that are exempt from the requirement to register as a pain management clinic to obtain and maintain a certificate of exemption from the Department of Health (DOH). These provisions take effect January 1, 2019.
  • Requires pharmacists and dispensing practitioners to verify a patient’s identity prior to dispensing controlled substances.
  • Conforms an exemption allowing health care practitioners to dispense controlled substances in connection with a surgical procedure to the limits on prescribing established for Schedule II opioid medications.
  • Creates an exemption to allow a physician to dispense Schedule II and III controlled substances approved by the United States Food and Drug Administration (FDA) for the medication-assisted treatment (MAT) of his or her own patients.
  • Explicitly authorizes electronic prescriptions for controlled substances.
  • Adds and reschedules substances to the various schedules of controlled substances.
  • Substantially rewords the Prescription Drug Monitoring Program (PDMP) with changes including, but not limited to:
    • Including Schedule V controlled substances in the list of drugs that must be reported to the PDMP;
    • Requiring prescribing practitioners to consult the PDMP before prescribing controlled substances with certain exceptions;
    • Allowing the DOH to coordinate and share Florida’s PDMP data with other states’ PDMPs and to enter into contracts to establish secure connections between the PDMP and prescribing or dispensing health care practitioner’s electronic health records; and
    • Allowing prescribers and dispensers with Veterans’ Affairs, the military, and the Indian Health Services, and Florida medical examiners access to data in the PDMP.
  • Increases the penalty from a 3rd degree felony to a 2nd degree felony for a patient or health care practitioner who knowingly obtains or provides a controlled substance that is not medically necessary.
  • Creates a new 3rd degree felony for unlawfully possessing and using tableting or encapsulation machines.
 

Resource Links

State Opioid Prescribing Policy:  http://fapmmed.net/state_opioid_prescribing_policy.pdf

CME Courses through the state (many can be done on a computer) http://www.ceatrenewal.com/

2018 FMA Orlando Opioid CME: Friday June 1, 2018 Orlando FL
- Responsible Prescribing -
 https://www.flmedical.org/florida/Florida_Public/Docs/Ins-Registration-agenda-live.pdf

Florida Society of Health-System Pharmacists (FSHP)
Continuing Education Resources

http://www.fshp.org/?page=CEresources