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Relating to controlled substance prescriptions and reimbursement for treatment for certain substance use disorders; authorizing a fee.
Estimated Two-year Net Impact to General Revenue Related Funds for HB 2174, Committee
Report 1st House, Substituted: an impact of $0 through the biennium ending August 31, 2021.
HB 2174 would allow a prescription for a controlled substance to be issued in writing, rather than electronically, if the prescription is issued under certain circumstances. This includes circumstances where the prescription is issued by a veterinarian; electronic prescribing is unavailable due to temporary technological or electronic failure; the prescription is dispensed at a pharmacy location outside of Texas; the prescriber and dispenser are in the same location or under the same license; the drug is under a research protocol; or a practitioner received a waiver, among other things.
This bill also requires a written prescription for a controlled substance other than a Schedule II controlled substance to include certain information and the signature of the prescribing practitioner. A prescription for a Schedule II controlled substance must be on an official prescription form and include information required for an electronic prescription, the signature of the practitioner, and the signature of the dispensing pharmacist.
Additionally, this bill would make several other changes relating to controlled substance prescriptions relating to emergency oral and telephonically communicated prescriptions; the authority of the appropriate regulatory agency that issued the license, certification, or registration to a prescriber to grant a waiver from the electronic prescribing requirement; conduct that constitutes fraud under the Texas Controlled Substances Act; limiting the authority of a designated agent to communicate a prescription in an emergency; and professional education related to approved procedures of prescribing and monitoring controlled substances.
HB 2174 would prohibit a practitioner, for the treatment of acute pain, from issuing a prescription for an opioid in an amount that exceeds a 10-day supply or providing for a refill of an opioid. This would not apply to a prescription for an opioid approved by the U.S. Food and Drug Administration for the treatment of substance addiction. Also, this bill would expand the grounds on which the TSBP may discipline an applicant or holder of a nonresident pharmacy license to include the TSBP finding that the applicant or license holder failed to comply with applicable bill provisions. The bill would authorize TSBP to adopt rules to administer its Texas Controlled Substances Act provisions regarding written, oral, and telephonically communicated prescriptions, waivers from electronic prescribing, applicable continuing education, and opioid prescription limits.
An amendment in the House added a provision that would require HHSC to provide medical assistance reimbursement for medication-assisted opioid or substance use disorder treatment without requiring a recipient of medical assistance or health care provider to obtain prior authorization or precertification for the treatment, except as needed to minimize the opportunity for fraud, waste, or abuse. There are several enumerated exceptions.
Texas Action opposes HB 2174 because it infringes on limited government principles. Specifically, we are opposed to limiting an opioid prescription to a 10-day supply because it unduly interferes in the physician-patient relationship. While reducing the misuse of opioids is a worthwhile goal, this bill could create unintended consequences such as creating significant barriers to patients with actual need for opioids, as well as additional administrative hurdles and unwarranted liability for physicians. Patients in need may be unable to access opioids due to a climate of fear among physicians. Therefore, we oppose HB 2174.