HB2221 - 512R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 23-1062.02, Arizona Revised Statutes, is amended to read:

START_STATUTE23-1062.02. Off-label and prescription use of controlled substances; prescription of schedule II controlled substances; reports; treatment plans; monitoring program inquiries; preauthorizations; definitions

A. On written request of an interested party as defined in section 23‑901, A physician shall include in the report required under commission rule information pertaining to the following:

1. The off-label use of a narcotic, opium-based controlled substance or schedule II controlled substance by a claimant.

2. The use of a narcotic or opium-based controlled substance or the prescription of a combination of narcotics or opium-based controlled substances at or exceeding a one hundred twenty milligram morphine equivalent dose per day.

3. The prescription of a long-acting or controlled release opioid for acute pain.

B. The information required pursuant to subsection A of this section shall include the justification for use of the controlled substance, and a treatment plan that includes a description of measures that the physician will implement to monitor and prevent the development of abuse, dependence, addiction or diversion by the employee. The interested party may also request that the physician submit and report the results of an inquiry to the Arizona state board of pharmacy requesting prescription information for the employee compiled under the controlled substances prescription monitoring program prescribed in title 36, chapter 28, and that The physician shall include in the treatment plan a medication contract agreement, a plan for subsequent follow‑up visits and drug testing and documentation that the medication regime is providing relief that is demonstrated by improved clinically meaningful improvement in function. if the drug test of the employee reveals inconsistent results, the physician within five business days shall provide a written report to the carrier, self‑insured employer or commission setting forth a treatment plan to address the inconsistent drug test results.

c. within two business days of writing or dispensing an initial prescription order for at least a thirty‑day supply of an opioid medication for the employee, A physician shall submit an inquiry to the Arizona state board of pharmacy requesting the employee's prescription information that is compiled under the controlled substances prescription monitoring program prescribed in title 36, chapter 28. the physician shall report the results to the carrier, self‑insured employer or commission as soon as reasonably practicable but no later than thirty days from the date of the inquiry. Thereafter, the carrier, self‑insured employer or commission may request no more than once every two months that the physician perform additional inquiries to the arizona state board of pharmacy.

d. if the result of an inquiry to the arizona state board of pharmacy reveals that the employee is receiving opioids from another undisclosed health care provider, the physician shall within five business days report the results to the carrier, self‑insured employer or commission.

e. A preauthorization from the carrier, self‑insured employer or commission is required for a prescription order for opioid medication or a combination of opioid medications equal to a one hundred twenty milligram or more morphine equivalent dose per day and for subsequent escalations of the dose. the carrier, self‑insured employer or commission shall authorize the prescription order within twenty‑four hours unless the carrier, self‑insured employer or commission relies on an opinion of a physician who is licensed in this state, has been provided with the relevant medical records regarding the claim and whose practice includes pain management or relies on applicable evidence-based medical treatment guidelines adopted by the commission that the prescription order is not medically indicated.

C. f. If the physician does not comply with this section:

1. The interested party carrier, self‑insured employer or commission is not responsible for payment for the physician's services until the physician complies with subsection A of this section.

2. The employer, carrier or commission may request a change of physician after the carrier or commission makes a written request to the physician to comply with this section and the request identifies the area of noncompliance. if a hearing is requested from the administrative findings and award of the commission and the administrative law judge finds that the physician did not comply with this section and a change of physician should be ordered, the employee shall select a physician whose practice includes pain management and who agrees to comply with this section. if other medical providers are not available in the employee's area of residence, the carrier or commission shall pay in advance for the employee's reasonable travel expenses, including the cost of transportation, food, lodging and loss of pay, if applicable.

g. If medically necessary, the carrier, self‑insured employer or commission shall provide drug rehabilitation and detoxification treatment for an employee who becomes dependent on or addicted to opioids that are prescribed for a work‑related injury. in the event of a medical conflict regarding the necessity for drug rehabilitation and detoxification, the carrier, self‑insured employer or commission shall continue to provide the opioids until a determination is made after a hearing by an administrative law judge.

H. if the employee resides out of state, the carrier, self‑insured employer or commission may not be responsible for providing medications that are subject to this section if the out-of-state physician fails to comply with this section. if the other state has a controlled substances monitoring program, the physician shall submit an inquiry to the database as prescribed by subsection c of this section.

i. this section does not apply to medications administered to the employee while the employee is receiving inpatient hospital treatment.

D. j. An a carrier, self‑insured employer, a carrier or the commission may request the information required pursuant to subsection A of this section and require physician compliance with this section notwithstanding the existence of a prior award addressing medical maintenance benefits for medications. An employer or a carrier or self‑insured employer is not liable for bad faith or unfair claims processing for any act taken in compliance of and consistent with this section.

E. k. For the purposes of this section: ,

1. "Clinically meaningful improvement in function" means any of the following:

(a) A clinically documented improvement in range of motion.

(b) an increase in the performance of activities of daily living.

2. "inconsistent results" means:

(a) the employee's reported medications, including the parent drugs or metabolites, are not detected.

(b) controlled substances are detected that are not reported by the employee.

3. "Off-label use" means use of a prescription medication by a physician to treat a condition other than the use for which the drug was approved by the United States food and drug administration. END_STATUTE