S T A T E O F N E W Y O R K
________________________________________________________________________
7999
I N S E N A T E
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 ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. This act shall be known and may be cited as the "alterna-
tives 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 subdivi-
sion, a practitioner, within the scope of his or her professional opin-
ion 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 appro-
priate 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 RECOM-
MENDATIONS 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
S. 7999 2
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 ANTAG-
ONISTS 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 POSI-
TION 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 PUBLICA-
TIONS 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-O-
PIOID 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 TREAT-
ED BY THE SAME PROVIDER; THE SIGNATURE OF THE PATIENT AND/OR AN ATTESTA-
TION BY THE PRESCRIBER THAT THE PATIENT VERBALLY AGREED TO THE TREATMENT
PLAN; AND ANY OTHER INFORMATION REQUIRED BY THE DEPARTMENT. SUCH TREAT-
MENT 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 COMPRE-
HENSIVE-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
S. 7999 3
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 INFOR-
MATION 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 INITI-
ATION 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 THERA-
PIES HAVE BEEN TRIED AND OPTIMIZED OR ARE CONTRAINDICATED; A STATEMENT
THAT THE PRESCRIBER HAS EXPLAINED TO THE PATIENT THE RISKS OF AND ALTER-
NATIVES 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 INFORMA-
TION 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 OPTI-
MIZED OR ARE CONTRAINDICATED; A STATEMENT THAT THE PRESCRIBER HAS
EXPLAINED TO THE PATIENT THE RISKS OF AND ALTERNATIVES TO OPIOID TREAT-
MENT; 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
S. 7999 4
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 ADMINIS-
TRATION 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 CONSUL-
TATION 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 EFFEC-
TIVE TREATMENT AND THE SIDE EFFECTS OF MISUSE AND ADDICTION CAN BE DEAD-
LY. 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 TEMPO-
RARY PRESIDENT OF THE SENATE ON THE EFFECTIVENESS OF THE OPIOID ALTERNA-
TIVE 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.
