Opioids and Pharmacy: PMP Extension Granted
By Joey Berlin Texas Medicine August 2019


Charting Medicine's Statehouse Progress

When it came to opioids and pharmacy matters, some of the major pieces of medicine’s 2019 agenda came down to something everyone wishes they had more of: time.

Physicians need it to get comfortable with a mandate to check the state’s prescription monitoring program (PMP). Patients need it to make sure the pain medications they’re prescribed do what the drugs are supposed to do.

The legislature listened, and TMA achieved wins on both counts, as well as on increased transparency from pharmacy benefit managers (PBMs).

House Bill 3284 by Rep. J.D. Sheffield, DO (R-Gatesville), helped buy the time physicians needed to comply with lawmakers’ 2017 mandate to check the state’s PMP before issuing any prescription for opioids, benzodiazepines, barbiturates, or carisoprodol.

That mandate was scheduled to go into effect in September. But thanks to HB 3284, it won’t kick in until March 1, 2020. That gives physicians and their electronic health record (EHR) vendors time to properly integrate their systems with the PMP. Plus, lawmakers appropriated an additional $5 million for the Texas State Board of Pharmacy to spend this year to upgrade the PMP to make it easier to integrate, as well as to cover the licensing fees for all state prescribers and pharmacists.

“As it stands now, if I want to check the prescription monitoring program, I have to leave my electronic medical record, log in to a different website, type in the patient’s first and last name and birthdate at a bare minimum, check some boxes, and then click search and then get a printout,” said San Antonio orthopedic surgeon Adam Bruggeman, MD, who’s also board-certified in addiction medicine. “That all takes time to get in and out of the system.

“TMA has worked very hard with the legislators, and they’ve agreed to help pay for physicians to have an integrated prescription monitoring program. We’re not quite there yet, and I think the September date was a little aggressive to get us across the finish line.”

With opioids generating bleak national headlines on a regular basis, lawmakers seemed focused on limiting opioid prescriptions for acute pain to a seven-day supply. But House Bill 2174 by Rep. John Zerwas, MD (R-Richmond) establishes a 10-day limit instead.

“It is somewhat of an arbitrary thing to put a particular maximum amount of time for opioid prescriptions,” said Jason Terk, MD, chair of TMA’s Council on Legislation throughout the session. “We felt like 21 days is probably too long and doesn’t respect the concern about how long it takes for an individual to become dependent on these medications. But the council reasoned that [a limit of] 10 days was reasonable for most post-operative and post-trauma patients.”

HB 2174 also requires electronic prescribing for opioids beginning in 2021 (when a similar requirement from Medicare takes effect) plus two hours of CME for opioid-prescribing, and generally prohibits prior authorization for medication-assisted treatment for opioid use disorder.

Increasing drug-pricing transparency from PBMs was another priority for TMA in this session, and House Bill 2536 by Rep. Tom Oliverson, MD (R-Cypress), made a big dent in that problem. The bill requires PBMs to submit a report each year that includes information on collected and distributed payments. The bill also includes reporting requirements for drug manufacturers and health plans.

Tex Med. 2019;115(8):22 
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Last Updated On

September 16, 2019

Originally Published On

July 23, 2019

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