A. Prescriber Requirements
1. This subsection applies to all prescribers
as defined in the Definition section of this policy.
2. Prescriber Numbers
a. Each prescriber must acquire a DEA number.
This number may be obtained from the U.S. Department of Justice, Drug
Enforcement Administration, Office of Diversion Control.
b. Prescribers must clearly indicate their
DEA number on every prescription for a controlled substance written by the
prescriber.
c. If U.S. Military
affiliated prescribers with a service identification number do not have a valid
DEA number, the prescriber's service identification number may be used. These
providers must clearly indicate their service identification number on every
prescription for a controlled substance written by the prescriber.
3. Prescription Code Requirement
when the Prescription is Written for a Patient Under Treatment for Either
Chronic or Acute Pain The prescriber must designate whether a prescription is
for the treatment of acute pain or chronic pain. The following designations
should be used.
i. For Acute pain, the word
"Acute" should be written on the prescription
ii. For Chronic pain, the word "Chronic"
should be written on the prescription
iii. For prescriptions using exemption code F
(Acute pain for an individual with an existing opioid prescription for chronic
pain), the word Acute should be used, as the seven (7) day limit
applies.
4. Requirement
to Include Diagnosis Code and Exemption Code
a. Diagnosis Code
i. All prescribers must include the diagnosis
(ICD-10) code on the prescription for any opioid involving the Palliative Care
Exemption.
ii. Diagnosis codes are
not required on veterinary prescriptions
b.
Exemption Code
i.All prescribers must include the
exemption code, if the member is claiming an exemption from the 100 Morphine
Milligram Equivalent aggregate daily limit. The codes are as follows:
Exemption Code A: Pain associated with active and
aftercare cancer treatment. Providers must document in the medical record that
the pain experienced by the individual is directly related to the individual's
cancer or cancer treatment;
Exemption Code B: Palliative care in conjunction with a
serious illness;
Exemption Code C: End-of-life and hospice
care;
Exemption Code D: Medication-Assisted Treatment for
substance use disorder;
Exemption Code E: A pregnant individual with a
pre-existing prescription for opioids in excess of the 100 Morphine Milligram
Equivalent aggregate daily limit. This exemption applies only during the
duration of the pregnancy;
Exemption Code F: Acute pain for an individual with an
existing opioid prescription for chronic pain. The seven day prescription limit
applies;
Exemption Code G: Individuals pursuing an active taper
of opioid medications, with a maximum taper period of six months, after which
time the opioid limitations will apply, unless one of the additional exceptions
in this subsection apply; or
Exemption Code H: Individuals who are prescribed a
second opioid after proving unable to tolerate a first opioid, thereby causing
the individual to exceed the 100MME limit for active prescriptions. For this
exemption to apply, each individual prescription must not exceed 100 MME.
Dispensers shall provide patients with guidance on proper disposal of the first
prescription.
ii.
Exemption codes are not required on veterinary
prescriptions.
5. Requirement to Include Notation of
Veterinary Prescription
All prescriptions intended for use by an animal must
indicate such use on the prescription.
B. Dispenser Requirements
1. Dispenser Numbers Dispensers must acquire
and maintain an identification number issued to dispensing pharmacies by the
National Council for Prescription Drug Programs ("NCPDP"), or request that an
alternative number be assigned to them by the Monitor or the Office.
2. Partial Dispensing Authorized Partial
dispending is authorized to the extent allowed by
32 MRSA
§13786-B.
3. Early refills
Dispensers may provide an early refill of a prescription
before the refill date if, in the judgment of the dispenser, the early refill
does not represent a pattern of early refill requests by the individual.
4. Verification by Dispensers
Dispensers may contact prescribers by telephone to verify
and document information about prescriptions. However, dispensers cannot change
federally required items on any prescriptions and must adhere to federal DEA
limitations on prescription medications. Examples of allowable modifications
include:
* Adding the terms "acute" or "chronic";
* Adding ICD-10 codes; or
* Adding exemption codes.
5. Out-of-state prescriptions Dispensers may
fill the prescription if the dispenser records an oral confirmation with the
out-of-state prescriber regarding the validity of the prescription and
documents any missing information, such as diagnosis code, Exemption Code, and
acute or chronic pain notation. The dispenser must make a reasonable effort to
determine that the oral confirmation came from the prescriber or prescriber's
agent, such as by contacting the prescribing doctor via telephone, and record
information, including the date and time of a telephone call to the prescriber
and the telephone number.
