Testimony in Support of Sb1099/Hb2180 before the Committee on Mental Health, Substance Use and Recovery

The Massachusetts Medical Society wishes to be recorded in strong support of SB1099/HB2180, An Act relative to patient choice to promote prescription safety. This bill would amend prescribing laws to allow patients to partially fill opioid prescriptions at the pharmacy, with the option of filling the remainder of the prescription at a later date within a 30-day period if needed. It specifies that the cost share (through co-pays, deductible payments, etc.) for patient obtaining their prescription through multiple partial fills shall not exceed the cost of the prescription had they obtained it through a traditional full-fill.

The MMS has extensive policy to combat the opioid epidemic in the Commonwealth on multiple fronts, including ensuring that patients receive only the quantity of opioids that they need. Prescriptions that are larger than necessary can lead to opioid dependence and misuse. Limiting certain high volume prescriptions through partially filled prescriptions can also limit the diversion of unused drugs.

The MMS has directly addressed the issue of responsible prescribing through the development of prescribing guidelines for opioid therapies. At the heart of these guidelines is a recommendation that “the starting dose should be the minimum necessary to achieve the desired level of pain control and to avoid excessive side effects.” The MMS is continuing to promote this recommendation through physician outreach and continuing medical education. The reality of complex pharmacology and pain management, however, is that the minimum effective dosage can be difficult to determine and is often a moving target. Additionally, prescriptions issued for post-operative or post-procedural pain cannot anticipate the exact nature of recovery and subsequent pain. The Medical Society believes that “partial fill” policies are an important element to lowering the volume of opioids dispensed at pharmacies in instances where the lowest effective dosage is difficult to determine.

Chapter 52 of the Acts of 2016, An Act Relative to Substance Use, Treatment, Education and Prevention, the comprehensive opioid bill passed in the Commonwealth in 2016, contained a partial fill provision that allowed a registered pharmacist filling a prescription for a Schedule II opioid to dispense the prescribed substance in a lesser quantity than the recommended full quantity indicated on the prescription if requested by the patient. However, that provision does not allow patients who have elected partial fill to later return to the pharmacy and fill the remainder of their prescription. This is an important consideration to ensure that patients do not need to seek excessive, unnecessary follow-up care to obtain the remainder of an original prescription. Partial fill is also an important inducement to the patient. Many more patients would be willing to receive only part of their opioid prescription if they knew they could return for the remainder if the pain persists.

United States Senator Elizabeth Warren and Representative Katherine Clark sponsored the Reducing Unused Medications Act of 2016, which amended the federal Controlled Substances Act to allow pharmacists to partially fill Schedule II Controlled Substances such as prescription opioids, making this legislation in Massachusetts possible.

The MMS also believes that a crucial component to this legislation is communication about partially filled prescriptions. We commend Sen. Keenan for including a requirement that pharmacists communicate to physicians whenever a prescription is partially filled. We also think that it is important that details regarding copayments of partially filled prescriptions ensure that the total copayments paid by a patient received multiple partial fills do not exceed the number of copayments for an initial, total fill. Lastly, we hope that the legislature will seek confirmation from the relevant federal agencies to clarify any compliance issues related to this initiative.

H.2180/S.1099 will promote patient safety and patient choice by empowering patients to receive partial fills of opioid prescriptions while allowing them to access the remainder of the prescription if pain persists.

The MMS urges the Committee on Mental Health, Substance Use and Recovery to report H.2180/S.1099 out of Committee favorably.

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