SB1111 - 532R

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. Use of controlled substances; prescription of schedule II controlled substances; reports; treatment plans; monitoring program inquiries; preauthorizations; definitions

A. A physician shall limit the initial prescription for any opioid medication for an employee to not more than a five-day supply, except that an initial prescription for an opioid medication following a surgical procedure is limited to not more than a fourteen-day supply.

B. Subsection A of this section does not apply to initial prescriptions for any opioid medication if the employee:

1. Has an active oncology diagnosis.

2. Has a traumatic injury, not including a surgical procedure.

3. Is receiving hospice care.

4. Is receiving end-of-life care.

5. Is receiving palliative care.

6. Is receiving skilled nursing facility care.

A. C. A physician shall include in the report required under commission rule the following 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 use of a narcotic or opium-based controlled substance that is listed in schedule II or the prescription of any opioid medication:

1. Justification for the use of the controlled substance, and including documentation of the following:

(a) That a physical examination of the employee was conducted.

(b) That a substance use risk assessment of the employee was conducted.

2. A treatment plan that includes a description of describing the measures that the physician will implement to monitor and prevent the development of abuse, dependence, addiction or diversion by the employee. The physician shall include in the treatment plan all of the following:

(a) A medication agreement. , a plan for subsequent

(b) The frequency of face-to-face follow‑up visits and to reevaluate the employee's continued use of opioids.

(d) Documentation that the medication regime is providing relief that is demonstrated by clinically meaningful improvement in function.

(e) Criteria and procedures for tapering and discontinuing opioid prescription or administration as part of the treatment.

(f) Criteria and procedures for offering or referring the employee for treatment for dependence on or addiction to opioids.

D. 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. E. 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. Before prescribing an opioid analgesic or benzodiazepine controlled substance that is listed in schedule II, III or IV for an employee and at least quarterly while that prescription remains a part of the treatment, the physician shall make inquiry of and obtain a utilization report regarding the employee from the controlled substances prescription monitoring program's central database tracking system as required by section 36-2606. The physician shall report the results to the carrier, self‑insured employer or commission as soon as reasonably practicable but no not later than thirty days from after the date of the inquiry. Thereafter, the carrier, self‑insured employer or commission may request no not more than once every two months that the physician perform additional inquiries to the Arizona state board of pharmacy controlled substances prescription monitoring program's central database tracking system.

D. F. If the result of an inquiry to the Arizona state board of pharmacy controlled substances prescription monitoring program's central database tracking system 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. G. If the physician does not comply with this section:

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

2. Except for a self-insured employer that provides medical care pursuant to section 23‑1070, an the employer, carrier or commission may request a change of physician after making a written request to the physician to comply with this section and the request identifies the area of noncompliance. If a change of physician is ordered and the order becomes final, 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 employer, 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.

F. H. 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.

G. I. If the employee resides out of state, the carrier, self‑insured employer or commission may is 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 E of this section.

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

I. J. A carrier, a self‑insured employer or the commission may require physician compliance with this section notwithstanding the existence of a prior award addressing medical maintenance benefits for medications. 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 or any act reasonably necessary to monitor or assess the appropriateness and effectiveness of an employee's opioid use.

J. K. For the purposes of this section:

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

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

(b) (a) An increase A significant improvement in the performance of activities of daily living or a reduction in work restrictions.

(b) A reduction in dependency on continued medical treatment.

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.

3. "Initial prescription" means a prescription that has not been filled within the previous sixty days.

4. "Substance use risk assessment" means an evaluation of an employee's unique likelihood for addiction, misuse, diversion or another adverse consequence resulting from the employee being prescribed or receiving treatment with opioids.

5. "Traumatic injury" means a serious and life-threatening physical injury caused by external force and potentially resulting in secondary complications such as shock, respiratory failure or death. END_STATUTE

Sec. 2. Title 23, chapter 6, article 9, Arizona Revised Statutes, is amended by adding section 23-1062.04, to read:

START_STATUTE23-1062.04. Dispensed medications; definition

A. An insurance carrier, a self-insured employer or the commission is responsible for the payment for medications only if the medications are dispensed by a licensed pharmacist in a pharmacy setting, including an online pharmacy, that is accessible to the general public.

B. Notwithstanding subsection A of this section, an insurance carrier, a self-insured employer or the commission is responsible for the payment for medications that are dispensed in a closed-door pharmacy if all of the following apply:

1. The medication is dispensed within seventy-two hours after the employee first seeks medical treatment for the injury.

2. The medication dispensed is for not more than an initial, onetime five-day supply of opioid medication or a fourteen-day supply of a nonopioid medication.

3. The medication conforms to dosages that are customarily available when the medication is dispensed by a licensed pharmacist in a pharmacy setting that is accessible to the general public.

C. For the purposes of this section, "closed-door pharmacy":

1. Means 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.

2. Does not include a hospital pharmacy. END_STATUTE