New California Laws Going into Effect in 2019
Do you prescribe controlled substances?
Do you provide prenatal or postpartum care, or pediatric care for infants?
If you answered “yes” to any of these, you will want to know about some new laws taking effect in 2019. Laws are effective January 1, 2019 unless otherwise noted.
AB 1753 (Low) Controlled Substance: Security Prescription Forms
This law requires controlled substance security prescription forms to include a unique serialized number in a format approved by the Department of Justice (DOJ). The legislation did not include a transition period to allow for continued use of old prescription forms after January 1. Physicians who have yet to obtain the new forms should do so as soon as possible.
Pharmacists will not necessarily refuse to fill prescriptions made on outdated forms. The Board of Pharmacy has issued guidance (link: https://www.pharmacy.ca.gov/licensees/unique_serial.pdf) including the following options for pharmacists:
- Communicating with the prescriber about the need for a compliant security prescription;
- Advising the prescriber to substitute an electronic prescription;
- Consulting with the prescriber about whether the patient might be terminally ill and eligible for a “11159.2 exemption” prescription;
- Treating prescription orders written on the outdated forms for Schedule III, IV and IV medications as oral prescriptions, and verifying the order telephonically with the prescriber’s office;
- Schedule II prescriptions on non-compliant security prescription forms present unique challenges, because of the inability to substitute an oral prescription. Pharmacists are advised to use their best professional judgment to get needed Schedule II medications to their patients;
- If failure to dispense may result in loss of life or intense suffering, dispensing pursuant to the emergency situation requirements of Health and Safety Code section 11167, and curing with a compliant controlled substance security prescription form within seven days; and
- Refusing to fill the prescription.
A list of approved security form printers can be found at: https://oag.ca.gov/security-printers/approved-list.
AB 2760 (Wood) Prescription Drugs: Prescribers: Naloxone Hydrochloride and other FDA approved drugs
This law requires prescribers to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:
- The prescription dosage for the patient is 90 or more morphine milligram equivalents of an opioid medication per day.
- An opioid medication is prescribed concurrently with a prescription for benzodiazepine.
- The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.
The law also requires prescribers to provide education to patients and their representatives regarding overdose prevention and the use of naloxone hydrochloride or another approved drug for the complete or partial reversal of opioid depression.
Before prescribing an opioid, MIEC recommends that physicians:
- Screen for increased risk of overdose and document whether the patient is considered to be at increased risk;
- Document informed consent discussions with patients and/or representatives, including overdose prevention and use of naloxone.
For more information, please see the FAQ published by the Medical Board of California: http://www.mbc.ca.gov/Licensees/Prescribing/OverdosePrevention/AB2760FAQs.pdf
AB 2193 (Maienschein) Maternal Mental Health Screening
Effective July 1, 2019, this law requires practitioners who provide prenatal or postpartum care for a patient or pediatric care for an infant to “ensure that the mother is offered screening or is appropriately screened” for maternal mental health conditions (excepting practitioners providing emergency care).
MIEC recommends that practitioners who provide prenatal, post-partum, or ante-natal infant care incorporate maternal mental health screening into their practices, if they are not already doing so. Screening tools and guidelines are available through ACOG and AAP. Document that screening has been conducted, or, if appropriate, that screening has been offered and the patient declines.