Assigned to COMPS FOR
COMMITTEE
Assigned to COMPS FOR
COMMITTEE
ARIZONA STATE SENATE
Fifty-Third Legislature, Second Regular Session
workers' compensation; opioids; dispensed medications
Purpose
Establishes requirements for the prescribing, monitoring and dispensing of opioid medication in workers' compensation treatment.
Background
Laws 2018, 1st Special Session, Chapter 1 § 29 limits, with exceptions, an initial prescription for a schedule II controlled substance opioid to five days for non-surgical treatment and two weeks following a surgical procedure. Exceptions to the limitation include treatment for burns, traumatic injuries and certain skilled care settings. Before dispensing a new prescription of a schedule II drug or benzodiazepine, a pharmacist must obtain the patient's past year utilization report from the Controlled Substances Prescription Monitoring Program (CSPMP). Laws 2007, Chapter 269 § 4 establishes the CSPMP, administered by the Board of Pharmacy, to track the controlled substance dispensing information of specific patients.
The Industrial Commission of Arizona (ICA) administers the state workers' compensation system prescribed by Article 18 § 8 of the Arizona Constitution. Under this exclusive system, employers are required to cover an employee's medical treatment and lost wages caused by an accident arising out of and in the course of employment (A.R.S. § 23-1021). Under current law, a physician prescribing an opioid to an employee for certain treatment must provide the ICA with documentation that the medical regime provides relief demonstrated by clinically meaningful improvement in function. A clinically meaningful improvement in function can be a documented improvement in range of motion, an increase in performance of daily activities or a return to gainful employment (A.R.S. § 23-1062.02).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Workers' Compensation: Opioid Justification and Monitoring
1. Requires a physician to justify that a narcotic or opioid prescription will reduce an employee's dependency on continued medical treatment and that the employee will have either:
a) a significant improvement in the performance of daily activities; or
b) reduced work restrictions.
2. Repeals, from acceptable justifications for a narcotic or opioid prescription, improvements in function providing:
a) a clinically documented improvement in range of motion;
b) an increase in the performance of daily activities, unless the performance is a significant improvement; or
c) a return to gainful employment.
3. Indemnifies an insurance carrier or self-insured employer from any act reasonably necessary to monitor or assess the appropriateness and effectiveness of an employee's opioid use.
4. Requires a physician to submit the justification and treatment plan for any narcotic or opium-based schedule II controlled substance prescription, rather than for a narcotic, opioid or schedule II controlled substance prescription for:
a) an off-label use;
b) a dosage equivalent to 120 milligrams of morphine or more; or
c) treating acute pain with a long-acting or controlled-release opioid.
5. Requires the filed justification to document the employee's informed consent and that a physical examination and substance use risk assessment were conducted.
6. Requires the filed treatment plan to include:
a) the frequency of face-to-face follow-up visits to reevaluate the employee's continued use of opioids;
b) procedures for tapering and discontinuing opioid treatment; and
c) criteria for referring the employee to opioid dependence or addiction treatment.
7. Requires a physician to obtain an employee's CSPMP utilization report before prescribing an opioid analgesic or benzodiazepine controlled substance listed as schedule II, III or IV.
8. Requires the physician to perform a CSPMP inquiry of an employee at least once every four months, or every two months if requested by an insurer or the ICA.
9. Allows, in a change of physician for physician noncompliance, an employee to select any complying physician, rather than only a physician whose practice includes pain management.
10. Limits, for workers' compensation treatment of employees, initial opioid prescriptions to 5 days for non-surgical treatment and 14 days following a surgical procedure, unless the employee:
a) has an oncology diagnosis;
b) has a traumatic injury, not including a surgical procedure;
c) is receiving hospice care;
d) is receiving end-of-life care;
e) is receiving palliative care; or
f) is receiving skilled nursing facility care.
11. Defines initial prescription as a prescription that has not been filed within the previous 60 days.
12. Defines substance use risk assessment as an evaluation of an employee's unique likelihood for addiction, misuse, diversion or other adverse consequence resulting from an opioid prescription or treatment.
13. Defines traumatic injury as a serious and life-threatening physical injury caused by external force and potentially resulting in secondary complications, such as shock, respiratory failure or death.
Worker's Compensation: Dispensed Medications
14. Requires medication in workers' compensation treatment to be dispensed by a licensed pharmacist in a pharmacy setting or online pharmacy that is accessible to the general public, except that an initial, one-time prescription may be dispensed in a closed-door pharmacy if the medication:
a) is dispensed within 72 hours after the employee first seeks medical treatment for an injury;
b) is limited to a five-day supply of an opioid medication or a two-week supply of non-opioid medication; and
c) conforms to dosages customarily dispensed by a licensed pharmacy in a pharmacy setting accessible to the general public.
15. Defines a closed-door pharmacy as a pharmacy that provides pharmaceutical care to a defined and exclusive group of patients who have access to the services of the pharmacy because they are treated by or have an affiliation with a specific entity or practitioner, excluding a hospital.
Miscellaneous
16. Makes technical and conforming changes.
17. Becomes effective on the general effective date.
Prepared by Senate Research
February 8, 2018
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