What's happening
This bill limits initial opioid prescriptions for acute pain to three days, adds stricter requirements for ongoing opioid treatments, and establishes an opioid alternative pilot project in emergency departments.
Why it matters
Makes ongoing opioid prescriptions for chronic pain much harder to obtain. by requiring a detailed written treatment plan that demonstrates non-opioid therapies have been considered, documents patient consent, regular treatment plan updates, evaluation of risk factors, and mandates co-prescribing naloxone (an opioid overdose antidote).
Links insurance and Medicaid coverage for opioids to compliance with these stricter standards. , meaning insurers and Medicaid are not required to pay for opioids for chronic pain unless all new documentation and safety requirements are met—potentially reducing unnecessary long-term opioid use.
Expands patient safety and education measures. by requiring prescribers to consider CDC guidelines for chronic pain, and by directing the health department to issue guidelines for when and how to prescribe overdose-reversal drugs, increasing awareness and availability of opioid antagonists.
Launches a pilot project to promote alternatives to opioids in emergency departments. , encouraging hospitals to test and report on strategies for reducing opioid use for acute pain, potentially setting the stage for broader changes in pain management practices statewide.
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Who cares
Headline styles
Limit Opioid Prescriptions, Promote Alternatives
Plain English, a few words. Used as the page title.
Sponsors
History
- Referred to health
Full text
4 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
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 Assembly, do enact as follows:
Section 1. This act shall be known and may be cited as the "alternatives to opioids (ALTO) prescribing act".
§ 2. Paragraph (b) of subdivision 5 of section 3331 of the public health law, as added by section 1 of part C of chapter 71 of the laws of 2016, is amended and a new paragraph (d) is added to read as follows:
(b) Notwithstanding the provisions of paragraph (a) of this subdivision, a practitioner, within the scope of his or her professional opinion or discretion, may not prescribe more than a [seven-day] three-day supply of any schedule II, III, or IV opioid to an ultimate user upon the initial consultation or treatment of such user for acute pain. Upon any subsequent consultations for the same pain, the practitioner may issue, in accordance with paragraph (a) of this subdivision, any appropriate renewal, refill, or new prescription for the opioid or any other drug.
(d) Prior to issuing a prescription for any schedule II, III or IV opioid to an ultimate user upon the initial consultation or treatment of such user for chronic pain, the practitioner shall consider the recommendations of the federal centers for disease control and prevention including but not limited to the recommendation that nonpharmacologic 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
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pain, and that an initial opioid prescription should be immediate release opioids not exceeding fifty morphine milligram equivalents.
§ 3. The public health law is amended by adding a new section 3346 to read as follows:
§ 3346. Guidelines for prescribing of opioid antagonists. 1. The commissioner shall adopt guidelines for the prescribing of opioid antagonists which shall include, but not be limited to:
(a) when opioid antagonists should be prescribed to individuals to whom an opioid medication is also prescribed, which shall at a minimum provide for the prescribing of an opioid antagonist to any individual with a treatment plan that consists of opioid use for more than one month;
(b) identifying patients at risk of any opioid overdose and when prescribing an opioid antagonist to that patient or a person in a position to administer the opioid antagonists is appropriate; and
(c) information on how consumers can access opioid antagonists with or without a prescription.
2. In adopting these guidelines the commissioner shall consult with the state board of pharmacy as well as materials published by the substance abuse and mental health services administration of the United States department of health and human services, and other appropriate materials including medical journals subject to peer review and publications by medical associations.
§ 4. Subdivision 4 of section 365-a of the social services law is amended by adding a new paragraph (h) to read as follows:
(h) opioids prescribed to a patient initiating or being maintained on opioid treatment for pain which has lasted more than one month or past the time of normal tissue healing, unless the medical record contains a written treatment plan that includes: goals for pain management and functional improvement based on diagnosis; information on whether non-opioid therapies have been tried and optimized or are contraindicated; a statement that the prescriber has explained to the patient the risks of and alternatives to opioid treatment; an evaluation of the patient for risk factors of harm and misuse of opioids; an assessment of the patient's adherence to treatment with respect to other conditions treated by the same provider; the signature of the patient and/or an attestation by the prescriber that the patient verbally agreed to the treatment plan; and any other information required by the department. Such treatment plan shall also include a prescription for an opioid antagonist and information on the administration and use of such opioid antagonists. The treatment plan shall be updated twice within the year immediately following its initiation and annually thereafter. The requirements of this paragraph shall not apply in the case of patients who are being treated for cancer that is not in remission, who are in hospice or other end-of-life care, or whose pain is being treated as part of palliative care practices.
§ 5. Section 4303 of the insurance law is amended by adding a new subsection (rr) to read as follows:
(rr) Every contract issued by a corporation subject to the provisions of this article which provides medical, major medical or similar comprehensive-type coverage shall not be required to cover opioids prescribed to a patient initiating or being maintained on opioid treatment for pain which has lasted more than one month or past the time of normal tissue healing, unless the medical record contains a written treatment plan that includes: goals for pain management and functional improvement based on diagnosis; information on whether non-opioid therapies have
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been tried and optimized or are contraindicated; a statement that the prescriber has explained to the patient the risks of and alternatives to opioid treatment; an evaluation of the patient for risk factors of harm and misuse of opioids; an assessment of the patient's adherence to treatment with respect to other conditions treated by the same provider; the signature of the patient and/or attestation by the prescriber that the patient verbally agreed to the treatment plan; and any other information required by the department. Such treatment plan shall also include a prescription for an opioid antagonist and information on the administration and use of such opioid antagonists. The treatment plan shall be updated twice within the year immediately following its initiation and annually thereafter. The requirements of this subsection shall not apply in the case of patients who are being treated for cancer that is not in remission, who are in hospice or other end-of-life care, or whose pain is being treated as part of palliative care practices.
§ 6. Section 3216 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) No policy of accident and health insurance delivered or issued for delivery in this state shall provide for reimbursement or coverage of opioids prescribed to a patient initiating or being maintained on opioid treatment for pain which has lasted more than one month or past the time of normal tissue healing, unless the medical record contains a written treatment plan that includes: goals for pain management and functional improvement based on diagnosis; information on whether non-opioid therapies have been tried and optimized or are contraindicated; a statement that the prescriber has explained to the patient the risks of and alternatives to opioid treatment; an evaluation of the patient for risk factors of harm and misuse of opioids; an assessment of the patient's adherence to treatment with respect to other conditions treated by the same provider; the signature of the patient and/or attestation by the prescriber that the patient verbally agreed to the treatment plan; and any other information required by the department. Such treatment plan shall also include a prescription for an opioid antagonist and information on the administration and use of such opioid antagonists. The treatment plan shall be updated twice within the year immediately following its initiation and annually thereafter. The requirements of this subsection shall not apply in the case of patients who are being treated for cancer that is not in remission, who are in hospice or other end-of-life care, or whose pain is being treated as part of palliative care practices.
§ 7. Section 3221 of the insurance law is amended by adding a new subsection (j-1) to read as follows:
(j-1) No policy of group or blanket accident and health insurance delivered or issued for delivery in this state shall provide for reimbursement or coverage of opioids prescribed to a patient initiating or being maintained on opioid treatment for pain which has lasted more than one month or past the time of normal tissue healing, unless the medical record contains a written treatment plan that includes: goals for pain management and functional improvement based on diagnosis; information on whether non-opioid therapies have been tried and optimized or are contraindicated; a statement that the prescriber has explained to the patient the risks of and alternatives to opioid treatment; an evaluation of the patient for risk factors of harm and misuse of opioids; an assessment of the patient's adherence to treatment with respect to other conditions treated by the same provider; the signature of the patient and/or attestation by the prescriber that the patient
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verbally agreed to the treatment plan; and any other information required by the department. Such treatment plan shall also include a prescription for an opioid antagonist and information on the administration and use of such opioid antagonists. The treatment plan shall be updated twice within the year immediately following its initiation and annually thereafter. The requirements of this subsection shall not apply in the case of patients who are being treated for cancer that is not in remission, who are in hospice or other end-of-life care, or whose pain is being treated as part of palliative care practices.
§ 8. Subparagraph (v) of paragraph (a) of subdivision 2 of section 3343-a of the public health law, as added by section 2 of part A of chapter 447 of the laws of 2012, is amended to read as follows:
(v) a practitioner prescribing a controlled substance in the emergency department of a general hospital, provided that the quantity of controlled substance prescribed does not exceed a [five] three day supply if the controlled substance were used in accordance with the directions for use;
§ 9. The public health law is amended by adding a new section 2827 to read as follows:
§ 2827. Opioid alternative pilot project. There shall be established an opioid alternative pilot project whereby the commissioner, in consultation with the commissioner of alcoholism and substance abuse services, shall identify at least five acute care emergency departments in the state to participate in the opioid alternative pilot project. While traditionally opioids have been the primary treatment for acute pain in emergency departments, they are not always necessary or the most effective treatment and the side effects of misuse and addiction can be deadly. The opioid alternative pilot project shall be designed to reduce the use of opioids in emergency departments by using a multimodal treatment approach to pain including coordination across providers, pharmacies, clinical staff and administrators, as well as looking at new procedures, methods of treatment and less addictive alternatives. Within one year of the effective date of this section the participants in the project shall report to the commissioner, the speaker of the assembly and the temporary president of the senate on the effectiveness of the opioid alternative pilot project in reducing opioid use and any recommendations for expansions of or alterations to the project.
§ 10. This act shall take effect on the ninetieth day after it shall have become a law; provided, however, that sections five, six and seven of this act shall take effect on the first of January next succeeding the date on which this act shall have become a law and shall apply to all policies issued, modified or renewed on and after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
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
Purpose
To enact the Alternatives to Opioids (ALTO) Prescribing Act.
Summary of provisions
Sections one cites the legislation as the Alternative to Opioids (ALTO) Prescribing Act.
Read the full memo (756 words)
Section two amends Public Health Law (PHL) § 3331 to limit initial scripts for schedule 2, 3 or 4 opioids for acute pain to a three day supply from the current seven day supply. It also requires that before issuing a prescription for such opioids for chronic pain, the prescriber shall consider the CDCs recommendations including that nonpharmacologic therapy and nonopioids pharmacologic therapies are preferred for chronic pain and that the initial script should be immediate release and not exceed 50 morphine milligram equivalents.
Section three amends PHL § 3346 to require the Commissioner of Health, in consultation with the state board of pharmacy and various appropriate published materials, to adopt guidelines for the prescribing of opioid antagonists when an opioid medication is also prescribed.
Sections four, five, six and seven amend various provisions of the Social Services and Insurance Law to require a written treatment plan as a condition of coverage by Medicaid or insurance for opioid treatment lasting more than one month. A treatment plan must include a prescription for an opioid antagonist. Patients under treatment for cancer, or are in hospitals or other end-of-life care, or whose pain is being treatment as part of palliative care practices are exempt from this provision.
Section eight amends PHL to limit emergency room opioids prescriptions to a three day supply, down from the current limitation of five days.
Section nine adds a PHL § 2827 to establish an Opioid Alternative Pilot Project where at least five emergency departments in the state will work to reduce the use of opioids in emergency departments by using a multi- modal treatment approach to pain including coordination across provid- ers, pharmacies, clinical staff and administrators, as well as looking at new procedures, methods of treatment and less addictive alternatives.
Section ten provides an effective date.
Justification
The opioid crisis continues to worsen, with the number of individuals addicted to and overdosing from opioid abuse, which often starts with prescription medications, continuing to increase. New York has taken the lead over the last few years instituting the I-STOP prescription moni- toring program, limiting initial scripts for acute pain and requiring prescribers to complete medical education on addiction. However, more is needed to stem this crisis. Changing the culture of opioid prescrib- ing and moving to alternative pain treatments when appropriate will help stop addiction before it starts.
Recognizing that opioids are highly addictive and are not always appro- priate as the first line of treatment, this legislation further limits prescribing for acute pain to a three day supply. The legislation also requires codifies guidelines for prescribing opioids for chronic pain, which include the recommendation that nonpharamacologica and nonopioid therapies are preferable. Further, for chronic pain, where opioids are being prescribed for more than 30 days, practitioners must have written treatment protocols, which are periodically, updated to ensure opioids are the most appropriate treatment protocol and that they are closely monitored. The treatment plan shall also include a prescription for Naloxone. Exemptions from this treatment plan requirement are included for certain patients. In addition, the Commissioner of Health is required to provide guidelines on when Naloxone scripts should be co-prescribed with opioids. Lastly, the Department shall establish an emergency room Opioid Alternative Pilot Project modeled after a success- ful program administered in Colorado which resulted in decreased opioid use.
Legislative history
New bill.
Fiscal implications
Savings as the number of people who become addicted to opioids should drop, thus limiting the associated health care costs.
Effective date
This act shall take effect on the ninetieth day after in shall have become law, provided provisions amending the insurance law shall take effect on the first January next succeeding the date it shall become a law and apply to policies issued, modified or renewed on and after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.