Bill Text: NY S07999 | 2017-2018 | General Assembly | Introduced
Bill Title: Enacts the "alternative to opioids (ALTO) prescribing act"; limits the initial prescription of a controlled substance for the alleviation of acute pain; requires the commissioner of health to develop guidelines for the prescribing of opioid antagonists; limits medical assistance and insurance coverage for opioids; and establishes an opioid alternative pilot project.
Spectrum: Partisan Bill (Republican 5-0)
Status: (Introduced - Dead) 2018-03-16 - REFERRED TO HEALTH [S07999 Detail]
Download: New_York-2017-S07999-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7999 IN SENATE March 16, 2018 ___________ Introduced by Sens. HANNON, AKSHAR, AMEDORE, JACOBS -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the public health law, in relation to limiting the initial prescription of a controlled substance for the alleviation of acute pain from a seven-day supply to a three-day supply and requiring the commissioner of health to develop guidelines for the prescribing of opioid antagonists; to amend the social services law, in relation to limiting medical assistance coverage for opioids; to amend the insurance law, in relation to limiting coverage for opioids; and to amend the public health law, in relation to establishing an opioid alternative pilot project The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act shall be known and may be cited as the "alterna- 2 tives to opioids (ALTO) prescribing act". 3 § 2. Paragraph (b) of subdivision 5 of section 3331 of the public 4 health law, as added by section 1 of part C of chapter 71 of the laws of 5 2016, is amended and a new paragraph (d) is added to read as follows: 6 (b) Notwithstanding the provisions of paragraph (a) of this subdivi- 7 sion, a practitioner, within the scope of his or her professional opin- 8 ion or discretion, may not prescribe more than a [seven-day] three-day 9 supply of any schedule II, III, or IV opioid to an ultimate user upon 10 the initial consultation or treatment of such user for acute pain. Upon 11 any subsequent consultations for the same pain, the practitioner may 12 issue, in accordance with paragraph (a) of this subdivision, any appro- 13 priate renewal, refill, or new prescription for the opioid or any other 14 drug. 15 (d) Prior to issuing a prescription for any schedule II, III or IV 16 opioid to an ultimate user upon the initial consultation or treatment of 17 such user for chronic pain, the practitioner shall consider the recom- 18 mendations of the federal centers for disease control and prevention 19 including but not limited to the recommendation that nonpharmacologic 20 therapy and nonopioids pharmacologic therapies are preferred for chronic EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD15063-02-8S. 7999 2 1 pain, and that an initial opioid prescription should be immediate 2 release opioids not exceeding fifty morphine milligram equivalents. 3 § 3. The public health law is amended by adding a new section 3346 to 4 read as follows: 5 § 3346. Guidelines for prescribing of opioid antagonists. 1. The 6 commissioner shall adopt guidelines for the prescribing of opioid antag- 7 onists which shall include, but not be limited to: 8 (a) when opioid antagonists should be prescribed to individuals to 9 whom an opioid medication is also prescribed, which shall at a minimum 10 provide for the prescribing of an opioid antagonist to any individual 11 with a treatment plan that consists of opioid use for more than one 12 month; 13 (b) identifying patients at risk of any opioid overdose and when 14 prescribing an opioid antagonist to that patient or a person in a posi- 15 tion to administer the opioid antagonists is appropriate; and 16 (c) information on how consumers can access opioid antagonists with or 17 without a prescription. 18 2. In adopting these guidelines the commissioner shall consult with 19 the state board of pharmacy as well as materials published by the 20 substance abuse and mental health services administration of the United 21 States department of health and human services, and other appropriate 22 materials including medical journals subject to peer review and publica- 23 tions by medical associations. 24 § 4. Subdivision 4 of section 365-a of the social services law is 25 amended by adding a new paragraph (h) to read as follows: 26 (h) opioids prescribed to a patient initiating or being maintained on 27 opioid treatment for pain which has lasted more than one month or past 28 the time of normal tissue healing, unless the medical record contains a 29 written treatment plan that includes: goals for pain management and 30 functional improvement based on diagnosis; information on whether non-o- 31 pioid therapies have been tried and optimized or are contraindicated; a 32 statement that the prescriber has explained to the patient the risks of 33 and alternatives to opioid treatment; an evaluation of the patient for 34 risk factors of harm and misuse of opioids; an assessment of the 35 patient's adherence to treatment with respect to other conditions treat- 36 ed by the same provider; the signature of the patient and/or an attesta- 37 tion by the prescriber that the patient verbally agreed to the treatment 38 plan; and any other information required by the department. Such treat- 39 ment plan shall also include a prescription for an opioid antagonist and 40 information on the administration and use of such opioid antagonists. 41 The treatment plan shall be updated twice within the year immediately 42 following its initiation and annually thereafter. The requirements of 43 this paragraph shall not apply in the case of patients who are being 44 treated for cancer that is not in remission, who are in hospice or other 45 end-of-life care, or whose pain is being treated as part of palliative 46 care practices. 47 § 5. Section 4303 of the insurance law is amended by adding a new 48 subsection (rr) to read as follows: 49 (rr) Every contract issued by a corporation subject to the provisions 50 of this article which provides medical, major medical or similar compre- 51 hensive-type coverage shall not be required to cover opioids prescribed 52 to a patient initiating or being maintained on opioid treatment for pain 53 which has lasted more than one month or past the time of normal tissue 54 healing, unless the medical record contains a written treatment plan 55 that includes: goals for pain management and functional improvement 56 based on diagnosis; information on whether non-opioid therapies haveS. 7999 3 1 been tried and optimized or are contraindicated; a statement that the 2 prescriber has explained to the patient the risks of and alternatives to 3 opioid treatment; an evaluation of the patient for risk factors of harm 4 and misuse of opioids; an assessment of the patient's adherence to 5 treatment with respect to other conditions treated by the same provider; 6 the signature of the patient and/or attestation by the prescriber that 7 the patient verbally agreed to the treatment plan; and any other infor- 8 mation required by the department. Such treatment plan shall also 9 include a prescription for an opioid antagonist and information on the 10 administration and use of such opioid antagonists. The treatment plan 11 shall be updated twice within the year immediately following its initi- 12 ation and annually thereafter. The requirements of this subsection shall 13 not apply in the case of patients who are being treated for cancer that 14 is not in remission, who are in hospice or other end-of-life care, or 15 whose pain is being treated as part of palliative care practices. 16 § 6. Section 3216 of the insurance law is amended by adding a new 17 subsection (n) to read as follows: 18 (n) No policy of accident and health insurance delivered or issued for 19 delivery in this state shall provide for reimbursement or coverage of 20 opioids prescribed to a patient initiating or being maintained on opioid 21 treatment for pain which has lasted more than one month or past the time 22 of normal tissue healing, unless the medical record contains a written 23 treatment plan that includes: goals for pain management and functional 24 improvement based on diagnosis; information on whether non-opioid thera- 25 pies have been tried and optimized or are contraindicated; a statement 26 that the prescriber has explained to the patient the risks of and alter- 27 natives to opioid treatment; an evaluation of the patient for risk 28 factors of harm and misuse of opioids; an assessment of the patient's 29 adherence to treatment with respect to other conditions treated by the 30 same provider; the signature of the patient and/or attestation by the 31 prescriber that the patient verbally agreed to the treatment plan; and 32 any other information required by the department. Such treatment plan 33 shall also include a prescription for an opioid antagonist and informa- 34 tion on the administration and use of such opioid antagonists. The 35 treatment plan shall be updated twice within the year immediately 36 following its initiation and annually thereafter. The requirements of 37 this subsection shall not apply in the case of patients who are being 38 treated for cancer that is not in remission, who are in hospice or other 39 end-of-life care, or whose pain is being treated as part of palliative 40 care practices. 41 § 7. Section 3221 of the insurance law is amended by adding a new 42 subsection (j-1) to read as follows: 43 (j-1) No policy of group or blanket accident and health insurance 44 delivered or issued for delivery in this state shall provide for 45 reimbursement or coverage of opioids prescribed to a patient initiating 46 or being maintained on opioid treatment for pain which has lasted more 47 than one month or past the time of normal tissue healing, unless the 48 medical record contains a written treatment plan that includes: goals 49 for pain management and functional improvement based on diagnosis; 50 information on whether non-opioid therapies have been tried and opti- 51 mized or are contraindicated; a statement that the prescriber has 52 explained to the patient the risks of and alternatives to opioid treat- 53 ment; an evaluation of the patient for risk factors of harm and misuse 54 of opioids; an assessment of the patient's adherence to treatment with 55 respect to other conditions treated by the same provider; the signature 56 of the patient and/or attestation by the prescriber that the patientS. 7999 4 1 verbally agreed to the treatment plan; and any other information 2 required by the department. Such treatment plan shall also include a 3 prescription for an opioid antagonist and information on the adminis- 4 tration and use of such opioid antagonists. The treatment plan shall be 5 updated twice within the year immediately following its initiation and 6 annually thereafter. The requirements of this subsection shall not apply 7 in the case of patients who are being treated for cancer that is not in 8 remission, who are in hospice or other end-of-life care, or whose pain 9 is being treated as part of palliative care practices. 10 § 8. Subparagraph (v) of paragraph (a) of subdivision 2 of section 11 3343-a of the public health law, as added by section 2 of part A of 12 chapter 447 of the laws of 2012, is amended to read as follows: 13 (v) a practitioner prescribing a controlled substance in the emergency 14 department of a general hospital, provided that the quantity of 15 controlled substance prescribed does not exceed a [five] three day 16 supply if the controlled substance were used in accordance with the 17 directions for use; 18 § 9. The public health law is amended by adding a new section 2827 to 19 read as follows: 20 § 2827. Opioid alternative pilot project. There shall be established 21 an opioid alternative pilot project whereby the commissioner, in consul- 22 tation with the commissioner of alcoholism and substance abuse services, 23 shall identify at least five acute care emergency departments in the 24 state to participate in the opioid alternative pilot project. While 25 traditionally opioids have been the primary treatment for acute pain in 26 emergency departments, they are not always necessary or the most effec- 27 tive treatment and the side effects of misuse and addiction can be dead- 28 ly. The opioid alternative pilot project shall be designed to reduce the 29 use of opioids in emergency departments by using a multimodal treatment 30 approach to pain including coordination across providers, pharmacies, 31 clinical staff and administrators, as well as looking at new procedures, 32 methods of treatment and less addictive alternatives. Within one year of 33 the effective date of this section the participants in the project shall 34 report to the commissioner, the speaker of the assembly and the tempo- 35 rary president of the senate on the effectiveness of the opioid alterna- 36 tive pilot project in reducing opioid use and any recommendations for 37 expansions of or alterations to the project. 38 § 10. This act shall take effect on the ninetieth day after it shall 39 have become a law; provided, however, that sections five, six and seven 40 of this act shall take effect on the first of January next succeeding 41 the date on which this act shall have become a law and shall apply to 42 all policies issued, modified or renewed on and after such date.
