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.
LBD15063-02-8
S. 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 have
S. 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 patient
S. 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.