Arizona Joins States Enacting Opioid Prescribing Restrictions

by
Optum Workers' Comp
| Feb 22, 2018

Arizona’s Governor recently signed into law Senate Bill 1001 which, among other changes, establishes several new requirements for prescribing and dispensing opioids. Most notably, Arizona has gone the route of several other states over the last couple of years by enacting days’ supply and morphine milligram equivalent (MME) limits on prescriptions for these medications.

The legislation limits the initial prescription of a Schedule II opioid for a patient to not more than a 5-day supply, except for an initial prescription following a surgical procedure which is limited to not more than a 14-day supply. There are several exceptions to these limits, including if the patient has an active oncology diagnosis, has a traumatic injury, or is receiving medication-assisted treatment for a substance abuse disorder (among other listed exemptions). “Initial prescription” is defined as a prescription for a Schedule II opioid that has not covered any portion of the past 60 days before the date the pharmacy dispenses the current prescription as evidenced by data in the state’s prescription drug monitoring program (PDMP).

Additionally, a prescriber may not issue a new prescription for a Schedule II opioid which exceeds 90 MMEs per day. Similar to the initial days’ supply limit, exceptions also apply to this MME limit. Also exempted are prescriptions which are a continuation of a prior prescription order issued within the previous 60 days, or an opioid with a maximum approved total daily dose in the labeling as approved by the FDA. Prescribers believing the patient (if not already exempted under these provisions) requires more than this 90 MME daily dosage are to first consult with a physician who is licensed in pain treatment.  If the consulting physician is not available to consult within 48 hours after the request by the prescriber, the prescriber may prescribe the amount they believe the patient requires and subsequently have the consultation. If a patient is prescribed more than 90 MMEs per day, the prescriber is also to prescribe naloxone or another FDA approved opioid antagonist for the patient.

The bill also includes provisions requiring a minimum of three hours of opioid-related, substance abuse disorder-related, or addiction-related continuing education for prescribers each license renewal cycle; requiring electronic prescribing of Schedule II opioids by 2019; and requiring dispensers to obtain a patient utilization report from the state PDMP prior to dispensing a Schedule II controlled substance.

Most of these requirements are effective as of April 26, 2018 and apply to all prescribing treatment in Arizona, regardless of payment or insurance coverage type. Coupled with much more legally actionable provisions afforded to payers under Arizona’s workers’ compensation statutes and regulations, these new prescribing practice requirements position Arizona in a more advantageous position to continue tackling the effects of the opioid epidemic within the state and its workers’ compensation system. Claims administrators with business in Arizona should take note of the new provisions to monitor the prescribing and treatment patterns of physicians treating claimants in the state.

The full text of SB 1001 can be viewed here. Should you have questions about this topic, please contact Kevin Tribout, Executive Director of Government Affairs, at 813-627-2445 or our Government Affairs team at AskGovtAffairs@optum.com. For assistance in evaluating a claimant’s medication therapy or to ask a question of a clinical nature, please use our Ask-A-Pharmacist resource or contact your clinical services team at 1-877-275-7674 ext. 8612.

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