Prescription drug requirements may be scaled back

Complaints from physicians, patients prompt proposed regulation changes

By Kevin Wheatley Published:

Mandatory urine screens would be less frequent under proposed prescription regulations to alleviate some “unintended consequences” of legislation fighting drug abuse, says the chairman of the Kentucky Board of Medical Licensure.

Dr. Preston Nunnelley presented the proposed changes to the regulations, which could take effect in January, to the House Bill 1 Implementation and Oversight Committee on Wednesday.

The changes come after complaints from physicians and patients about certain regulations, such as required drug screens before and during long-term treatment for not only pain, but also attention deficit hyperactivity disorder, insomnia, anxiety and testosterone replacement. Those tests generally cost about $100 each and initially weren’t covered by insurers or Medicaid.

Drugs like the sleep aid Ambien and ADHD medications would not be included if the new regulations are approved, but physicians or designees in their office must still get a patient’s Kentucky All Schedule Prescription Electronic Reporting record over the last year and perform a physical before prescribing them.

“I think what this is going to do is this is going to take away a lot of complaints that we had about ADHD, sleep disorders, anxiety, depression, low testosterone,” Nunnelley said.

“… Those are basically covering most of the prescribing and taking care of most of the unintended consequences that we could.”

Patients younger than 16 would also be excluded from the prescription regulations, Nunnelley said, and physicians can document occasions when KASPER reports are unavailable.

The state licensure board made long-term pain treatment the primary focus of its proposed changes, he said. Patients would be required to take a drug screen before getting a prescription for long-term pain medication, which is at least a 90-day supply. KASPER reports from the past year would be required at the initial prescription, and physicians or designees would be required to query KASPER every three months.

Over the course of long-term treatment, doctors would see the patient each month initially, but those visits can be less frequent with sufficient monitoring in place, according to the proposed regulations. Random drug screens on patients suspected of abusing prescription drugs would also be required at appropriate times.

“We’re not mandating beyond the initial screen,” Nunnelley told legislators, noting doctors can also request pill counts or hair samples for testing from patients.

“… You do need to see them periodically. You need to do KASPERs periodically, but you don’t have to do the urine screens unless you suspect something.”

The new law, which went into effect in July, has already made an impact, officials say. Ten pain management facilities have closed their doors since HB1 became law, and participation in KASPER has more than tripled, said Mary Begley, inspector general with the state Cabinet for Health and Family Services.

More than 17,000 KASPER reports are examined each day compared to the 3,290 daily average before HB1, she said.

Plans for KASPER include searching for doctor shoppers and reviewing prescribing patterns by profession, Begley said.

Rep. John Tilley, D-Hopkinsville and co-chair of the oversight committee, called the proposed regulation changes “a step in the right direction.” HB1 authorizes KBML to regulate prescribing practices, but those regulations can’t be more lenient than the law.

There are still some technical matters with HB1 that may need to be amended legislatively, such as provisions concerning emergency care, he said.

“I still stand by, and I think the committee would as well; those who have worked on it stand by the proposition that the vast majority of concerns can be handled in the regulatory process, and that’s what you saw today,” Tilley told reporters after the meeting.

“…(The Kentucky Board of Medical Licensure) addressed a number of concerns – I would say the vast majority of concerns.”

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