Missouri Senate

House Amendment

LIMITATIONS ON PRESCRIBING OPIOIDS (Sections 195.010 and 195.080)

This act limits certain initial prescriptions of opioid controlled substances to no more than a 7-day supply for the treatment of acute pain. Prior to prescribing the opioid, a practitioner shall consult with the patient regarding the quantity of the opioid and the patient's option to fill the prescription in a lesser quantity, as well as inform the patient of the risks associated with the prescribed opioid. If, in the practitioner's medical judgment, more than a 7-day supply is required to treat the patient, the practitioner may issue a prescription for the quantity needed after noting in the patient's medical record the condition triggering the necessity for a greater quantity and that a nonopioid was not appropriate. The provisions of this act shall not apply to prescriptions for a patient who is currently undergoing treatment for cancer, is receiving hospice care or palliative care, is a resident of a long-term care facility, or is receiving treatment for substance abuse or opioid dependence.

No pharmacy or pharmacist shall be liable or subject to disciplinary action for dispensing or refusing to dispense medication pursuant to an otherwise valid prescription that exceeds these prescribing limits.

These provisions are substantially similar to SCS/SB 825 (2018).

DISPOSAL OF UNUSED CONTROLLED SUBSTANCES (Sections 195.070 and 195.265)

Under this act, a Drug Enforcement Agency-authorized collector, in accordance with federal regulations, may accept unused controlled substances from ultimate consumers, even if the authorized collector did not originally dispense the drug. This provision shall supercede and preempt any local drug disposal ordinance or regulation.

This provision has an emergency clause.

Additionally, the Department of Health and Senior Services shall develop an education and awareness program regarding drug disposal, including the development of a web-based resource and promotional activities.

VACCINE PROTOCOLS (Section 338.010)

This act modifies the minimum age for the administration of certain vaccines from twelve years of age to seven years of age or the Centers for Disease Control and Prevention recommendations, whichever is higher. The rules regulating the use of protocols for the administration of viral influenza vaccines shall no longer be jointly promulgated by the State Board of Registration for the Healing Arts and the State Board of Pharmacy, but shall be promulgated solely by the State Board of Pharmacy.

The act adds to the practice of pharmacy the administration of viral influenza vaccines by written protocol authorized by a physician for a specific patient.

Additionally, a pharmacist shall inform the patient that the administration of the vaccine will be entered into the ShowMeVax system. The patient shall attest to the inclusion of such information in the system by signing a form provided by the pharmacist or may indicate that he or she does not want such information entered into the system.

These provisions are identical SCS/SB 776 (2018).

PRESCRIPTIONS (Section 338.056)

This act modifies current law regarding written prescriptions to permit a pharmacist who receives a prescription for a brand name drug or biological product to select a less expensive generically equivalent drug or interchangeable biological product unless requested otherwise by the patient or prescribing practitioner who indicates that substitution is prohibited, as specified in the act. If an oral prescription is involved, the practitioner or practitioner's agency shall instruct the pharmacist if a generic drug or interchangeable biological product shall not be substituted.

This provision is identical to a provision in HCS/SS/SCS/SB 826 (2018) and substantially similar to HB 2395 (2018).

SARAH HASKINS

HA#1: MODIFIES MAINTENANCE MEDICATION PROVISIONS RELATING TO OUT-OF-STATE PRACTITIONERS OR U.S. ARMED FORCES MEMBERS SERVING OUTSIDE OF THE U.S.

HA#2: MODIFIES PROVISIONS RELATING TO EYE DROPS FOR NEWBORNS

HA#3: PROVIDES FOR THE TRANSFER OF UNUSED LONG-ACTING REVERSIBLE CONTRACEPTIVES AMONG MO HEALTHNET PARTICIPANTS

HA#4: MODIFIES PROVISIONS RELATING TO HEALTH CARE RECORDS

HA#5: REQUIRES THE DEPARTMENT OF MENTAL HEALTH TO DEVELOP TREATMENT PROTOCOLS FOR OPIOID-DEPENDENT PATIENTS

HA#6: MODIFIES THE INITIAL PRESCRIPTION LIMITS, DRUG TAKE BACK, VACCINE PROTOCOLS; AND PRESCRIPTION PROVISIONS OF THE HCS; ADDS LANGUAGE CREATING AN ADVISORY COUNCIL ON RARE DISEASES AND PERSONALIZED MEDICINE

HSA#1 TO HA#9: PROHIBITS CERTAIN ACTIONS BY PHARMACY BENEFIT MANAGERS