Central PA Medicine - February 2017 - 22

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Legislative Updates

each time they prescribe an opioid or
a benzodiazepine.
SB 1367, also signed into law on Nov. 2,
2016, limits the amount of an opioid that may
be prescribed to a minor to no more than a
seven-day supply unless a prescriber determines
that more than a seven-day supply is needed to
stabilize the minor's acute medical condition.
Before prescribing an opioid for the first time
to a minor, the new law (Act 125) requires
a prescriber to assess whether the minor has
taken or is currently taking prescription drugs
for treatment of a substance use disorder,
discuss with the minor and the minor's parent/
guardian certain specified risks and dangers,
and obtain written consent from the minor's
parent, guardian, or authorized adult in order
to prescribe an opioid to that minor.
SB 1368 requires licensing boards to implement curriculum regarding safe prescribing
practices for opioids. The curriculum may be
offered by medical schools, training facilities,
dental schools, and other providers. In the
last week of the legislative session, SB 1368
was amended to also provide for a voluntary
non-opioid directive form, which the Department of Health (DOH) will create and make
available for patients who wish to refuse or deny
the administration or prescribing of an opioid
drug by a practitioner. SB 1368 was signed into
law on Nov. 2 as Act 126.
HB 1699, signed into law on Nov. 2 as Act
122, limits the prescribing of opioids to patients
receiving treatment in certain settings - an
emergency department (ED), an urgent care
center, or while in observation status in a hospital - to no more than a quantity sufficient
to treat that individual for up to seven days. An
exception is provided for treatment of a patient's
acute medical condition or for treatment of
pain associated with a cancer diagnosis or
palliative care. This new law also clarifies that
the requirement to query the state PDMP does
not apply to medication provided in the course
of treatment while a patient is undergoing care
in an ED.
One of the bills that did not win final Senate
approval, HB 1698, would have mandated
health insurers to cover the cost of abuse
22 February 2017 Central PA Medicine

deterrent opioids (ADOs). While PAMED
strongly supported the underlying purpose
of HB 1698, we expressed concern when a
last-minute amendment was added to the
legislation. The amended version of HB 1698
would have directed the DOH to create mandatory prescribing guidelines for ADOs. It also
would have required prescribers to distribute
educational materials developed by DOH
to every patient they prescribe any opioid to.
PAMED ultimately opposed HB 1698, on the
grounds that the amended language would have
created unnecessary obstacles for physicians and
a "one-size-fits-all" approach that would not
have taken into account the unique clinical
needs of each patient.
Each of the bills mentioned above had a
much different starting point from its final
version, and a far greater potential to negatively
impact the practice of medicine in Pennsylvania
and infringe on physicians' ability to address
the individual needs of their patients. PAMED
worked closely with legislative leaders and staff
to ensure that what ultimately was signed into
law was clinically sound and in the best interest
of patient care. The bills described above are the
result of a dialogue between PAMED and the
legislature, with compromises on both sides.
Naturopaths
Once again this session, legislation was
introduced to establish state licensure for
naturopathic practitioners and grant them a
broad scope of practice. The original version
of HB 516 - which PAMED opposed on
the basis of patient safety concerns - would
have permitted licensed naturopaths to independently prevent, diagnose, and treat human
health conditions, injuries, and diseases. It
also would have given naturopaths authority
to order and perform physical and laboratory
examinations, order diagnostic imaging studies,
and utilize invasive routes of administration
for their tests and treatments. "Naturopathic
medicine" was defined in the bill as "a system
of primary health care."
Ultimately, the final version of HB 516
signed into law in November 2016 looked
very different from the bill's original language.
Now Act 128 of 2016, the Naturopathic Doctor

Registration Act, requires doctors of naturopathic
medicine to register with the State Board of
Medicine. Any individual who calls himself or
herself a naturopath will be required to meet
certain education and training qualifications.
Naturopathic doctors may also be subject to
disciplinary action by the Board for a number
of reasons, including unprofessional conduct
and acting in such manner as to present an
immediate and clear danger to public health
or safety.
PAMED supported the final version of HB
516, which appropriately ensures patient safety
by ensuring that anyone who calls themselves
a naturopath in Pennsylvania is appropriately
trained and meets certain basic qualifications.
Pharmacist immunization
of minors
Another fruitful negotiation this session
centered on HB 182, legislation providing for
the ability of pharmacists to provide immunizations to minors.
Pennsylvania law previously allowed pharmacists to administer injectable immunizations,
biologicals, and other medications to individuals over the age of eighteen. Legislation was
first introduced in the 2011-2012 session to
eliminate any minimum age restriction in the
law. PAMED opposed that bill on patient
safety grounds, as did all of the primary care
physician specialties, and the bill died without
any legislative action.
In the 2013-2014 session, the legislation
was reintroduced, but scaled back to allow
pharmacists to administer injectable immunizations only to individuals over the age of
seven. Despite the less ambitious reach of this
legislation, PAMED still had serious concerns
regarding the safety of pharmacists administering
specific immunizations, including hepatitis
and meningitis, along with the possibility of
physicians receiving urgent calls from parents
regarding delayed reactions to immunizations
that the physician did not even know had been
administered. Again, the legislation was defeated
in the 2013-2014 session.

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Table of Contents for the Digital Edition of Central PA Medicine - February 2017