Continuing actions from federal and state lawmakers attempt to address the national opioid crisis. Louisiana, like most states, requires prescribers to query the state’s Prescription Drug Monitoring Program. Education requirements ensure that all providers have the tools to navigate the opioid epidemic. In addition to the pharmacy board mandates, individual pharmacies’ policies have a growing impact on some patient’s access to controlled substances, even when prescribed within the exceptions allowable.
To address part of this issue, Act 426 of 2019 now requires prescribers to indicate on the prescription that more than a 7-day supply of an opioid is medically necessary. Because prescribers can already prescribe more than a 7-day supply under specific circumstances, the new law aims to reduce the amount of new or corrected prescriptions a provider has to make if pharmacies reject a prescription. Still, some pharmacies may require more, especially when paper scripts are used.
Below are some risk-mitigating tips to ensure patients receive their intended prescription when, in the professional judgment of the provider, more than a 7-day supply is prescribed:
- Document in the patient’s medical record the condition triggering the prescription of an opioid for more than a 7-day supply and that a non-opioid alternative is not appropriate to address the medical condition.
- Inform the patient of the risks of opioid dependence and discuss with the patient the quantity of opioids and the patient’s option to fill the prescription in a lesser quantity. Document that this discussion occurred prior to issuing the prescription for an opioid.
- Inform the patient that the pharmacy may fill less than the full quantity if the patient chooses. Some pharmacies have policies that prevent a patient from filling a prescription lasting more than a 7-day supply. Adding the phrase, “more than a 7-day supply of the opioid is medically necessary” on prescriptions lasting longer than 7 days is important. Remembering to add the diagnosis code or ICD-10-CM code can help to prevent a scenario in which a pharmacy refuses to fill a prescription lasting longer than 7 days.
LAMMICO policyholders may access and complete “Louisiana Act 76, Controlled Substances: Prescribing, Diversion Prevention and Addiction Treatment” free of charge by logging in as a Member at lammico.com. The course is approved by the LSBME and satisfies the board’s three-hour controlled substances education requirement for Louisiana prescribers.
Members of the Louisiana State Medical Society (LSMS) who are not LAMMICO insureds may also access the course free of charge by logging in to the LSMS website at lsms.org. The LSMS also prepared a summary of important bills from the 2019 Louisiana Legislative Session, including those regarding opioids, which can be found here.
For more information, please contact the LAMMICO Risk Management and Patient Safety Department at 504.841.5211.