Amd §§3309-a, 3331 & 3381, Pub Health L; amd §§3216, 3221 & 4303, Ins L; amd §367-a, Soc Serv L; amd §19.09,
Ment Hyg L
Relates to providing training in pain management for certain individuals; relates to providing coverage for medically necessary inpatient services for the diagnosis and treatment of substance abuse disorder; directs the commissioner to create educational materials regarding the dangers of addiction to prescription controlled substances, treatment resources available and the proper way to dispose of unused prescription controlled substances; allows a pharmacy to offer counseling and referral services to customers purchasing hypodermic syringes.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A10727
SPONSOR: Rules (Rosenthal) TITLE OF BILL:
An act to amend the public health law, in relation to providing training
in pain management for certain individuals (Part A); to amend the insur-
ance law, in relation to providing coverage for medically necessary
inpatient services for the diagnosis and treatment of substance abuse
disorder (Part B); to amend the public health law, the social services
law, and the insurance law, in relation to limiting initial
prescriptions for opioids to a seven-day supply (Part C); and to amend
the mental hygiene law and the public health law, in relation to the
dissemination of information by pharmacists to customers regarding
controlled substances and counseling for individuals purchasing syringes
(Part D)
PURPOSE OF THE BILL:
The purpose of this bill is to require continuing medical education on
pain management by physicians and other healthcare providers, to mandate
insurance coverage for needed inpatient treatment services, to limit
opioid prescriptions from 30-day supplies to 7-day supplies, and to
require pharmacists to provide additional education and counseling to
those receiving opioids.
SUMMARY OF PROVISIONS:
PART A
Section 1 of this bill would require physicians and other individuals
authorized to prescribe opioids by the U.S. Drug Enforcement Adminis-
tration to complete mandatory three hours of coursework on pain manage-
ment, palliative care, and addiction every three years by amending Pub.
Health L. § 3309-a. Certain exemptions would apply.
Section 2 would make the bill effective immediately.
PART B
Sections 1, 2, and 3 of this bill would break down barriers to inpatient
opioid treatment by requiring insurance companies to: (i) provide insur-
ance coverage, without prior authorization, for inpatient services for
the diagnosis and treatment of a substance use disorder as long as need-
ed; and (ii) only conduct a utilization review, including retrospective
review, commencing on or after the fifteenth day by amending Ins. L. §§
3216(i)(30), 3221(1)(6), and 4303(k). Patients would also be held harm-
less for any costs, other than copayments or coinsurances, for the
provision of these services.
Section 4 would set forth the effective date of the bill.
PART C
Section 1 of this bill would prohibit doctors from prescribing schedule
II, III, or IV opioids in an amount greater than a seven-day supply
(from the current law of 30-days) by amending Pub. Health L. § 3331(5).
Sections 2, 3, and 4 of this bill would amend the insurance law to
provide that consumers shall remain eligible for coverage up to a 30-day
supply but only pay a single copayment for this amount of medication or
instead a copayment proportionate to the amount of medication received
at a given time.
Section 5 of this bill would amend Soc. Serv. L. § 367-a(6) to provide
that customers of managed care organizations only be required to pay a
copayment that is in proportion to the amount of medication that they
received.
Section 6 would make the bill effective on the 30th day after enactment.
PART D
Section 1 of this bill would amend Men. Hyg. L. § 19.09 to require the
commissioner of the office of alcoholism and substance abuse services to
create educational materials that would be disseminated by a pharmacist
to a consumer at the time the consumer receives his or her prescription
of controlled substances (OASAS). This section would also allow that
such materials be disseminated electronically at the request of the
consumer, and would require OASAS to post the information on its
website.
Section 2 of this bill would amend Pub. Health L. § 3381(5) to authorize
pharmacists to offer counseling and referral services to individuals
purchasing hypodermic needles.
Section 3 would make the bill effective immediately.
STATEMENT IN SUPPORT:
This bill would enact a number of initiatives to address the State's
current heroin and opioid crisis, including requiring prescriber educa-
tion and providing insurance coverage for necessary inpatient services
for the diagnosis and treatment of substance use disorder.
PART A
While legally prescribed medications play an important role in the
treatment and management of pain, it is critical that prescribers
receive updated education on these medications, their use, and potential
associated risks for patients. This bill would require certain prescri-
bers to complete three hours of coursework on pain management, pallia-
tive care, and addiction every three years. Since many types of health
care professionals have the ability to prescribe opioids, this require-
ment would apply to physicians, nurse practitioners, physician assist-
ants, podiatrists, dentists, and midwives.
PART B
Any person who needs inpatient medical services at a detoxification or
treatment facility must first receive prior approval from their insur-
ance company before they can be admitted. This process can take several
days and prevents individuals from getting timely access to treatment.
Further, even after admission to a facility, insurers can immediately
conduct clinical reviews to determine if inpatient treatment remains
necessary. These processes take valuable time away from clinical staff
and serve as a barrier for people trying to access inpatient treatment.
This bill would eliminate prior authorization for necessary inpatient
treatment services to get patients in the door of a treatment facility
and would only allow insurers to commence utilization review after four-
teen days.
PART C
While New York has made strides towards reducing "doctor shopping"
through I-STOP and the prescription monitoring program, overprescribing
continues, and admissions to OASAS certified treatment programs for
opioids increased 20 percent from 2011 to 2015. The federal Centers for
Disease Control and Prevention recently issued its "Guideline for
Prescribing Opioids for Chronic Pain" recommending that "when opioids
are used for acute pain, clinicians should prescribe the lowest effec-
tive dose of immediate-release opioids and should prescribe no greater
quantity than needed for the expected duration of pain severe enough to
require opioids. Three days or less will often be sufficient; more than
seven days will rarely be needed."
To limit access to unused medication and reduce the likelihood that a
patient with a prescription may become addicted to opioids, this bill
would limit the initial prescription of an opioid to no more than a
7-day supply, with exceptions for chronic pain, cancer, and palliative
care.
PART D
Pharmacists play a critical role in educating consumers about
prescription pain medications before a consumer becomes addicted. This
bill would require pharmacists to educate consumers about the risk of
addiction and available treatment resources for substance use disorder.
Further, a pharmacist should be able to counsel individuals seeking to
purchase hypodermic needles. This bill would authorize a pharmacist to
counsel a person purchasing hypodermic needles on preventing drug abuse,
the availability of drug abuse treatment services, preventing and treat-
ing Hepatitis C, and testing for the human immunodeficiency virus.
BUDGET IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect immediately provided, however, that the
applicable effective date of Parts A through D of this act shall be as
specifically set forth in the last section of such Parts.
