Thursday, March 7, 2013

KY Leads in Rx Controls

Kentucky has been at the forefront in the control of prescription drug abuse and took more steps yesterday when Kentucky Gov. Steve Beshear signed into law House Bill 217, sponsored by House Speaker and former state Attorney General Greg Stumbo.

HB 217 builds on last year's landmark HB 1, which gave the state's licensing boards the authority to expand the list of drugs for which doctors are required to check KASPER and to modify pharmacy reporting requirements.

KASPER is the Kentucky All Schedule Prescription Electronic Reporting system. The state requires doctors to check KASPER before prescribing drugs on Schedule II and drugs containing hydrocodone on Schedule III of the U.S. Drug Enforcement Administration's controlled substances list and required Kentucky pharmacies to upload data on all prescriptions for controlled substances every seven days.

HB 217 codifies a regulation adopted by the state Board of Pharmacy that will require pharmacies to report the filling of all controlled-substance prescriptions once every business day beginning on July 1, 2013.
In addition HB 217:
  • Requires doctors to obtain 12 months of history from KASPER before prescribing Schedule II drugs and Schedule III drugs containing hydrocodone to a patient on the first visit and every three months thereafter.
  • Removes Schedule V drugs from those for which doctors must check the database. Doctors still would be required to check the database before prescribing some Schedule III and IV drugs.
  • Removes a requirement by the Board of Medical Licensure that physicians conduct random urine tests for all patients receiving controlled substances. Doctors, instead, would be required to conduct the random tests they deem appropriate to check for abuse of each specific drug being prescribed.
The bill also allows the state's licensing boards to exempt from the KASPER requirements:
  • A doctor prescribing a controlled substance within 14 days following surgery.
  • A doctor prescribing drugs in a hospital or long-term care facility, as long as the facility has obtained a 12-month drug history on the patient within 12 hours of the patient's admission to the facility.
  • Prescriptions of controlled substances for hospice or other end-of-life care.
  • Prescriptions for the treatment of pain associated with cancer.
The bill allows the state's licensing boards to grant other exemptions to treatment protocols as long as they are approved by the Kentucky Office of Drug Control Policy.

The bill mandates that all state licensing boards require fingerprint-supported criminal record checks conducted by the Kentucky State Police and the FBI of anyone applying for a license to prescribe or dispense controlled substances.

The International Association of Industrial Accidents Boards & Commissions (IAIABC) earlier this year ultimately declined to publish its model law for the control of prescription drugs but the National Organization of Insurance Legislators (NCOIL) has taken up the task. It seems that what Kentucky has done is a good model to start from.

And it also seems that the states that have database systems established for doctors and pharmacists to report to and check likewise have something to model after.

As in any legislation there are some who are not quite thrilled with the laws, but at least according to WorkCompCentral news on the bill the major players are, if not happy with the end result, at least are not unhappy with it.

The Kentucky Medical Association, Kentucky Pharmacy Association and Board of Medical Licensure have indicated that the changes made by HB 217 are workable.

And that is a pretty good endorsement for a law that has such broad and sweeping impact.


  1. I think someone should tell all the doctors in Kentucky that are refusing to treat chronic pain patients (even ones with clean KASPER's) since HB 1 (2012) was enacted that: "the major players are, if not happy with the end result, at least are not unhappy with it." and "The Kentucky Medical Association, Kentucky Pharmacy Association and Board of Medical Licensure have indicated that the changes made by HB 217 are workable." Because to a chronic pain patient in Kentucky who is unable to get their pain medications since HB1 was first enacted back in July of 2012, HB1 is pretty flippin' far from "workable"!
    “It seems that what Kentucky has done is a good model to start from. And it also seems that the states that have database systems established for doctors and pharmacists to report to and check likewise have something to model after.” If so many chronic pain patients in Kentucky weren’t going without their meds and completely unable to find a doctor to prescribe those meds I would laugh at these assertions!!!! So, other states should pass legislation like Kentucky has so more innocent people can suffer! Since HB! Was passed in July of 2012, people in pain from all walks of life and from all kinds of circumstances have been unable to get treated for their pain! This includes chronic pain patients, emergency room patients, and even some hospice patients (which are some of the reasons why HB 217 was passed so darn quickly!).Chronic pain patients who have been going to the same doctor for years, who have taken the same medications for years without incident, and who have clean KASPER’s, can no longer get their pain medications because of HB 1! Doctors all over KY are now afraid of losing their license or being investigated by the DEA because of HB 1- they have been dropping their chronic pain patients left and right because they are afraid to prescribe any kind of narcotic to anyone for any reason! They have been told by their attorney’s “better safe than sorry”, and now they are dropping chronic pain patients or funneling them into pain management clinics rather than treating the patients that in many cases they have seen for years!
    HB 1 is a piece of “shotgun legislation”. It was not well thought out, it had little input from the medical community, and no input from the people affected most by this heinous law- the chronic pain patients that depend on these medications for a certain quality of life! HB1 punished the many innocent for the acts of the guilty few! HB1 is pretty darn far from being “model” legislation!How would you feel if everytime you had a migraine headache you had to pee in a cup (even if you have never been convicted of a drug offense) and pay between $250 - $500 for a Pain Management office appointment? Chronic pain patients in KY can no longer just go see our general physician (for $25 - $150) every 3- 6 months to get a checkup and our prescriptions. Now, chronic pain patients are being forced to go to very expensive pain management clinics (at $250 - $800 a visit) that require a minimum of 4 visits before they will even write a prescription! One visit to do a medical history, one visit to do a physical exam, one visit to the pain psychologist (to see if you’re a drug addict or not even if you have a clean KASPER and no drug convictions), and finally one visit to write the prescription!!!!!! Oh! Did I mention that they hand you a cup to pee in even before they take your blood pressure and medical history? And that they make YOU pay for it because many insurances are refusing to pay for the piss tests! And that KY chronic pain patients are being FORCED into invasive medical procedures like injection therapy and pain pump surgeries because the doctors are too afraid to just prescribe a darn pill! Yeah, Great law! OBVIOUSLY Mr DePaolo you have failed to get the whole story. If you would like the whole story, my name is Justin Theobald and I can be reached at 859 398 8724. I will be glad to give you the real facts behind the political grandstanding!

  2. HB1/HB217 does not address the needs of patients with chronic pain. While prescription drug abuse does need to be curtailed in Kentucky, this law passes the consequences of drug abuse from the abusers onto the backs of law abiding citizens and hard-working Ky families.
    I and many others appreciate the sweeping revisions of HB217, however, for patients with a confirmed diagnosis that clearly establishes their need for pain medication, HB 217 does not go far enough. People with Adhesive Arachnoiditis, RA, MS, and painful conditions like Shingles, are all reporting that their pain is not being adequately treated because of HB1/HB217.
    Of course there are going to be angry patients who were innapropriately allowed to stay on opiod pain medications for many years, and now must face the fact that they are no longer allowed to remain addicts. But these long term "fakers" need to be separated from the patients who really need pain relief, by using lab and radiological tests. An X-ray confirming Degenerative Disc Disease or a herniated disc doesn't lie. Adhesive Arachnoiditis had a hallmark appearance that is chillingly distinct.
    Law abiding citizens who are the victims of violent crime, bad medicine (such as the rash of faulty female reproductive appliances such as Mirena and the Vaginal Mesh, and faulty replacement hips), and injured veterans should not have to suffer in pain or be treated like criminals because they need pain care.

    1. Not aware of any lab tests or diagnostic studies that can confirm three of my diagnoses: fibromyalgia, restless legs syndrome, or interstitial cystitis. Where would that put me in the "angry patients" theory that sorts out the fakers by confirming their need for pain medications through lab and x-ray results?

  3. This law was aimed at stopping abuse which is a great idea, however I do not think law makers thought this through on how it would hurt many many people. When people have had TEST AFTER TEST (TESTS SUCH AS MRI'S CATS SCANS, PET SCANS, EX-RAYS, ULTRA SOUNDS, ECHO'S ECT DO NOT LIE) to prove they have the medical condition in which they need medication for and Doctors will NOT even allow them to come to their office due to fear this law has created is a travesty. I for one have seen many many people suffer, including a family member that received a organ transplant and was allowed 3 days worth of pain medication after being released from UK hospital. I personally have worked with several law makers making them aware of these problems which helped to change HB 1 and make HB 217....I will keep this fight up until every pain patient in KY receives the MEDIAL CARE EVERY AMERICAN IS ENTITLED TO.I have a Face book group of members that are calling law makers, writing letter and faxes to the same and we are making great head way....If you would like to join us please contact me (270) 924-6057

  4. Thanks Justin, Laura & Shelia for putting another perspective on this.

    1. Mr.DePaolo,

      Thank you for writing this story. I am sure you will be getting many more comments from the NON Profit group I run. I will have to say the KMA and the KBML will not admit that even though these changes were made, doctors in Kentucky are still refusing to treat pain patients every day. Also Many doctors are dropping patients everyday with the explanation that due to HB 1 and HB 217 they are in fear of writing opioid medication for any reason. This is throwing many pain patients out to suffer not only pain but horrible withdrawals as well.This is not even touching on the fact of the mental heath patients not having access to medication and Children who suffer from ADD and or ADHA who must go to the doctor and miss school one day every month also the financial strain this law is putting on families. I could keep going with all the information I have on this law that was provided to me Via several state Representatives. I hope this sheds even more light on this for you.

      Thank you again for taking the time to write this story.

  5. I understand that these laws were signed in to try Nd help the drug problem however the fact is this has caused many legitimate pain patients a lot of misery that could have been avoided. The doctors should not stop treating patients just because they r being asked to run backgrounds on people. As soon as the law was signed my doctor refused to help me with my pain anymore. So why is it we have to suffer while the doctors can turn their back on us the patient and for tjose of us with no insurance we cannot afford to goto a pain clinic and there r very few that accepts cash. This HB217 still needs some fixing.

  6. HB 217 is proof that HB 1 wasn't very well thought out. Lawmakers obviously didn't consider the suffering of cancer, hospice/end of life and surgery pain to begin with. Are we to assume they didn't have the knowledge or do they lack compassion or both? It's scary to think they're deciding who suffers and who doesn't. No, I'm not quite thrilled with the law or lawmakers for that matter I'm outraged! The "Major Players" would have done things different if THEY or their loved ones were suffering needlessly. Why name it the Pill Mill Bill if legitimate chronic pain patients can't get the medications they need! Shut down the pill mills but don't leave thousands of legitimate chronic pain patients to suffer in agony. Quality of life should't just apply to those that get high on pain medications. Iv'e never been to a pill mill but thanks to HB 1 my legitimate doctor can't prescribe this legitimate chronic pain patient with the small amount of medication that helped make life worth living without too much suffering. All this talk about tests, seriously? Iv'e got a whole pile for ya, metal plates & screws and numerous other legitimate sources of visual pain sources but apparently I'll have to hope for cancer to get any relief......REALLY? Might as well just stop making ANY pain medications if it's going to be assumed that chronic, debilitating and agonizing pain isn't real. Insurance companies are saving a fortune too, they're denying payment for much needed tests and getting away with it. How many chronic pain sufferers will choose death before something is done to right the wrong this legislation has caused? Will their loved ones miss them any less then the people that overdosed? Stop the madness, help don't hurt either way chronic pain patients deserve just as much help as addicts and vice verse. Who do they think they're helping by pushing everyone off a cliff then months or years later they say " oh well, only certain people deserve to live a quality life" sickens me...