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Tennessee enacts enhanced opioid prescribing controls

by
Optum Workers' Comp
| Jun 01, 2018

House Bill 1831 was recently signed by Tennessee’s Governor, which enacts prescribing restrictions on opioid analgesics; sets dose caps on morphine milligram equivalent (MME); and defines enhanced prescription drug monitoring program (PDMP) requirements.  Effective July 1, 2018, the bill bases prescribing restrictions on various treatment timeframes and requires the prescriber to properly examine, justify and document the need for additional opioid treatment.

Per the requirements set in the bill, unless specifically exempted by law, a healthcare practitioner shall not treat a patient with:

  • More than a three-day supply of an opioid (unless they meet the requirements as stated below)
  • A dosage that exceeds a total of 180 MME

 A provider may treat a patient with more than a three-day supply of an opioid if the provider treats the patient with no more than one prescription for an opioid per encounter, and:

  • Conducts a thorough evaluation of the patient
  • Documents consideration of non-opioid and non-pharmacologic pain management strategies and why the strategies failed
  • Includes the ICD-10 code for the primary disease in the medical chart and on the prescription
  • Obtains informed consent and documents the reason for treating with an opioid in the medical record

 If a provider treats a patient with more than a three-day supply of an opioid, it may not exceed a 10-day supply or a total dosage greater than 500 MME. Exemptions are included in the legislation for certain situations (e.g., end-of-life care) including days-supply limitations and MME dose caps for continual opioid use to treat pain with greater than a 10-day supply.  We suggest reviewing the legislation for more detailed information on the various requirements. 

 The bill also includes enhancements to existing PDMP requirements. When prescribing a controlled substance, all healthcare practitioners (unless otherwise exempted) are required to check the state PMDP:

  • Prior to prescribing one of the controlled substances identified by law at the beginning of each new episode of treatment
  • Prior to the issuance of each new prescription for the controlled substance for the first 90 days of a new episode of treatment
  • At least every six months when that controlled substance remains part of the treatment

 Additional PDMP consultation requirements are outlined when dispensing a controlled substance.

 Text of the bill can be found here.

Should you have any questions on this or other legislative or regulatory topics, please contact our Government Affairs Team at AskGovtAffairs@optum.com.



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