Orange County Medical Society
Seminole County Medical Society
We are almost two months into the implementation of legislation related to the prescribing of Controlled Substances (HB 21) and our organizations continue to monitor the issues and concerns being expressed by our members and patients.
The most common compliance question we have received relates to how physicians and their designees are required to handle the data included in the Prescription Drug Monitoring Database (E-FORSCE). Since every health care professional is required to consult the PDMP prior to writing a prescription for any controlled substance (other than non-opioid Schedule V and for minors), the frequency for potential compliance issues has drastically increased.
As previously discussed in this column, when we have asked Rebecca Poston, Program Manager, EFORSCE, to clarify whether health care practitioners could print and maintain a copy of the EFORSCE record in the patient's medical record she referenced the rule that dictates appropriate use of these records.
Rule 64K-1.005(7), Florida Administrative Code, provides that "to prevent inadvertent release or disclosure of the confidential and exempt information in the database, pharmacists, prescribers and dispensers should avoid downloading and printing information from the database."
It is our understanding that scanning the report into the chart is not prohibited, however it may not be released to a patient, or pursuant to any other record release request or subpoena, therefore it should be maintained in a manner preventing such disclosure. Protecting against any disclosure is the challenge for practices that decide to scan the report into the chart. Due to potential inadvertent disclosure it is recommended that physicians simply dictate into the chart that the PDMP was consulted.
What is the most common complaint we hear from our physicians and patients? Without question it is concern with the implementation of corporate pharmacy policy that limits the daily Morphine Milligram Equivalent (MME) dose they allow their pharmacists to fill for Schedule II opioids used for the treatment of acute pain.
Why this issue is so troubling to clinicians is that they often cannot control where their patients fill their prescriptions which may result in their patient either being denied their legitimate prescription or the prescription amount being altered due to these corporate policies. HB 21 does not define a daily limitation on MME which has enabled some variation in interpretation. The variability of policies depending on the pharmacy used has caused significant confusion for patients as well as administrative challenges for physicians and their staff.
While we continue to work on this issue with the pharmacy community and regulators, we are encouraging our members to identify those pharmacies in their community that have enacted these corporate restrictions and make sure your patients are aware that their policies may impact the ability to fill their prescription. Another recommendation for physicians is to use one of the MME calculators that are readily available online to see how frequently your preferred prescription for Schedule II opioids for the treatment of acute pain may exceed some of these MME limitations.
Finally, there are some portions of the legislation that are still not fully implemented due to the rule making process. Those components of the bill relate to the Standards of Practice for the Treatment of Acute Pain being implemented by the Board of Medicine and other impacted Boards, as well as the official "Application for Exemption from Pain Management Clinic Registration" that is being finalized by the Agency for Health Care Administration. Our organizations will continue to participate in those discussions as those rules are finalized.
Physicians and patients are encouraged to continue to reference the Florida Department of Health website for more information on the impact and implementation of HB 21. This is the definitive source for information regarding this legislation: http://www.flhealthsource.gov/FloridaTakeControl/