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28	28	STATE OF OKLAHOMA
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30	30	1st Session of the 58th Legislature (2021)
31	31
32	32	HOUSE BILL 1013 By: Talley
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38	38	AS INTRODUCED
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40	40	An Act relating to public health; amending Section 5,
41	41	Chapter 175, O.S.L. 2018, as last amended by Section
42	42	19, Chapter 428, O.S.L. 2019 ( 63 O.S. Supp. 2020,
43	43	Section 2-309I), which relates to prescription limits
44	44	and rules for opioid drugs; clarifying construction
45	45	of the Anti-Drug Diversion Act; defining the standard
46	46	of care; protecting practitioners who prescribe in
47	47	good faith; and declaring an emergency.
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54	54	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
55	55	SECTION 1. AMENDATORY Section 5, Chapter 175, O.S.L.
56	56	2018, as last amended by Section 19, Chapter 428, O.S.L. 2019 (63
57	57	O.S. Supp. 2020, Section 2 -309I), is amended to read as follows:
58	58	Section 2-309I. A. A practitioner shall not issue an initial
59	59	prescription for an opioid drug in a quantity exceeding a seven -day
60	60	supply for treatment of acute pain. Any opioid prescription for
61	61	acute pain shall be for the lowest effective dose of an immediate -
62	62	release drug.
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89	89	B. Prior to issuing an initial prescription for an opioid drug
90	90	in a course of treatment for acute or chronic pain, a practitioner
91	91	shall:
92	92	1. Take and document the results of a thorough medical histor y,
93	93	including the experience of the patient with nonopioid medication
94	94	and nonpharmacological pain -management approaches and substance
95	95	abuse history;
96	96	2. Conduct, as appropriate, and document the results of a
97	97	physical examination;
98	98	3. Develop a treatment pla n with particular attention focused
99	99	on determining the cause of pain of the patient;
100	100	4. Access relevant prescription monitoring information from the
101	101	central repository pursuant to Section 2 -309D of this title;
102	102	5. Limit the supply of any opioid drug presc ribed for acute
103	103	pain to a duration of no more than seven (7) days as determined by
104	104	the directed dosage and frequency of dosage; provided, however, upon
105	105	issuing an initial prescription for acute pain pursuant to this
106	106	section, the practitioner may issue one (1) subsequent prescription
107	107	for an opioid drug in a quantity not to exceed seven (7) days if:
108	108	a. the subsequent prescription is due to a major surgical
109	109	procedure or "confined to home" status as defined in
110	110	42 U.S.C., Section 1395n(a),
111	111	b. the practitioner provides the subsequent prescription
112	112	on the same day as the initial prescription,
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139	139	c. the practitioner provides written instructions on the
140	140	subsequent prescription indicating the earliest date
141	141	on which the prescription may be filled, otherwise
142	142	known as a "do not fill until" date, and
143	143	d. the subsequent prescription is dispensed no more than
144	144	five (5) days after the "do not fill until" date
145	145	indicated on the prescription;
146	146	6. In the case of a patient under the age of eighteen (18)
147	147	years old, enter into a patient -provider agreement with a parent or
148	148	guardian of the patient; and
149	149	7. In the case of a patient who is a pregnant woman, enter into
150	150	a patient-provider agreement with the patient.
151	151	C. No less than seven (7) days after issuing the initial
152	152	prescription pursuant to subsection A of this section, the
153	153	practitioner, after consultation with the patient, may issue a
154	154	subsequent prescription for the drug to the patient in a quantity
155	155	not to exceed seven (7) days, provided that:
156	156	1. The subsequent prescription would not be deemed an initial
157	157	prescription under this section;
158	158	2. The practitioner determines the prescription is necessary
159	159	and appropriate to the treatment needs of the patient and documents
160	160	the rationale for the issuance of the subsequent prescription; and
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187	187	3. The practitioner determines that issuance of the subsequent
188	188	prescription does not present an undue risk of abuse, addiction or
189	189	diversion and documents that determination.
190	190	D. Prior to issuing the initial prescription of an opioid drug
191	191	in a course of treatment for acute or chronic pain and again prior
192	192	to issuing the third prescription of the course of treatment, a
193	193	practitioner shall discuss with the patient or the parent or
194	194	guardian of the patient if the patient is under eighteen (18) years
195	195	of age and is not an emancipated minor, the risks associated with
196	196	the drugs being prescribed, including but not limited to:
197	197	1. The risks of addiction and overdose associated with opioid
198	198	drugs and the dangers of taking opioid drugs with alcohol,
199	199	benzodiazepines and other centr al nervous system depressants;
200	200	2. The reasons why the prescription is necessary;
201	201	3. Alternative treatments that may be available; and
202	202	4. Risks associated with the use of the drugs being prescribed,
203	203	specifically that opioids are highly addictive, even wh en taken as
204	204	prescribed, that there is a risk of developing a physical or
205	205	psychological dependence on the controlled dangerous substance, and
206	206	that the risks of taking more opioids than prescribed or mixing
207	207	sedatives, benzodiazepines or alcohol with opioids can result in
208	208	fatal respiratory depression.
209	209	The practitioner shall include a note in the medical record of
210	210	the patient that the patient or the parent or guardian of the
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237	237	patient, as applicable, has discussed with the practitioner the
238	238	risks of developing a p hysical or psychological dependence on the
239	239	controlled dangerous substance and alternative treatments that may
240	240	be available. The applicable state licensing board of the
241	241	practitioner shall develop and make available to practitioners
242	242	guidelines for the discu ssion required pursuant to this subsection.
243	243	E. At the time of the issuance of the third prescription for an
244	244	opioid drug, the practitioner shall enter into a patient -provider
245	245	agreement with the patient.
246	246	F. When an opioid drug is continuously prescribed fo r three (3)
247	247	months or more for chronic pain, the practitioner shall:
248	248	1. Review, at a minimum of every three (3) months, the course
249	249	of treatment, any new information about the etiology of the pain,
250	250	and the progress of the patient toward treatment objective s and
251	251	document the results of that review;
252	252	2. In the first year of the patient -provider agreement, assess
253	253	the patient prior to every renewal to determine whether the patient
254	254	is experiencing problems associated with an opioid use disorder and
255	255	document the results of that assessment. Following one (1) year of
256	256	compliance with the patient -provider agreement, the practitioner
257	257	shall assess the patient at a minimum of every six (6) months;
258	258	3. Periodically make reasonable efforts, unless clinically
259	259	contraindicated, to either stop the use of the controlled substance,
260	260	decrease the dosage, try other drugs or treatment modalities in an
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287	287	effort to reduce the potential for abuse or the development of an
288	288	opioid use disorder as defined by the American Psychiatric
289	289	Association and document with specificity the efforts undertaken;
290	290	4. Review the central repository information in accordance with
291	291	Section 2-309D of this title; and
292	292	5. Monitor compliance with the patient -provider agreement and
293	293	any recommendations that the patient seek a referral.
294	294	G. 1. Any prescription for acute pain pursuant to this section
295	295	shall have the words "acute pain" notated on the face of the
296	296	prescription by the practitioner.
297	297	2. Any prescription for chronic pain pursuant to this section
298	298	shall have the words "chronic pain" notated on the face of the
299	299	prescription by the practitioner.
300	300	H. This section shall not apply to a prescription for a patient
301	301	who is currently in active treatment for cancer, receiving hospice
302	302	care from a licensed hospice or palliative care, or is a resident of
303	303	a long-term care facility, or to any medications that are being
304	304	prescribed for use in the treatment of substance abuse or opioid
305	305	dependence.
306	306	I. Every policy, contract or plan delivered, issued, executed
307	307	or renewed in this state, or approved for issuance or renewal in
308	308	this state by the Insurance Commissioner, and every contract
309	309	purchased by the Employees Group Insurance Division of the Office of
310	310	Management and Enterprise Services, on or after November 1, 2018,
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337	337	that provides covera ge for prescription drugs subject to a
338	338	copayment, coinsurance or deductible shall charge a copayment,
339	339	coinsurance or deductible for an initial prescription of an opioid
340	340	drug prescribed pursuant to this section that is either:
341	341	1. Proportional between the c ost sharing for a thirty -day
342	342	supply and the amount of drugs the patient was prescribed; or
343	343	2. Equivalent to the cost sharing for a full thirty -day supply
344	344	of the drug, provided that no additional cost sharing may be charged
345	345	for any additional prescriptions for the remainder of the thirty -day
346	346	supply.
347	347	J. Any practitioner authorized to prescribe an opioid drug
348	348	shall adopt and maintain a written policy or policies that include
349	349	execution of a written agreement to engage in an informed consent
350	350	process between the prescribing practitioner and qualifying opioid
351	351	therapy patient. For the purposes of this section, "qualifying
352	352	opioid therapy patient " means:
353	353	1. A patient requiring opioid treatment for more than three (3)
354	354	months;
355	355	2. A patient who is prescribed benzodi azepines and opioids
356	356	together for more than one twenty -four-hour period; or
357	357	3. A patient who is prescribed a dose of opioids that exceeds
358	358	one hundred (100) morphine equivalent doses.
359	359	K. Nothing in the Anti-Drug Diversion Act shall be construed to
360	360	require a practitioner to limit or forcibly taper a stable long -term
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387	387	opioid therapy patient. The standard of care requires effective and
388	388	individualized treatment for each patient without limits or
389	389	thresholds on dose or quantity.
390	390	L. When a practitioner thoroughl y assesses and documents his or
391	391	her findings as required by this section and prescribes in good
392	392	faith using his or her clinical expertise, neither an individual
393	393	patient's nor practitioner's practice's average prescribed doses or
394	394	quantities alone shall be u sed as the basis to initiate an
395	395	investigation or disciplinary action, or to pursue civil liability
396	396	or criminal penalties .
397	397	SECTION 2. It being immediately necessary for the preservation
398	398	of the public peace, health or safety, an emergency is hereby
399	399	declared to exist, by reason whereof this act shall take effect and
400	400	be in full force from and after its passage and approval.
401	401
402	402	58-1-6540 AB 12/11/20

Oklahoma 2022 Regular Session

Oklahoma House Bill HB1013 Compare Versions