In response to the Governor John Kasich’s announced limits on prescription opiate prescribing for acute pain, the State of Ohio Board of Pharmacy (SOBP) has already released its proposed amendments to rules 4729-5-30, 4729-37-04 and 4729-37-05 of the Ohio Administrative Code to implement the governor’s restrictions. A copy of the proposed rule amendments can be accessed on the SOBP website.
Under the proposed rules, a prescription for a controlled substance, must include the ICD-10-CM medical diagnosis code (10/1/2016), including the description of the code, of the primary disease, or condition that the controlled substance is being used to treat.
Public comments will be accepted through close of business on Wednesday, April 19, 2017. The Ohio Academy of Family Physicians submitted the following comments on April 18:
On behalf of the 4,900 family physician, family medicine resident, and medical student members of the OAFP, we submit the following comments on the SOBP’s approved amendments to rules 4729-5-30, 4729-37-04 and 4729-37-05 of the Ohio Administrative Code:
Requiring the ICD-10-CM medical diagnosis code on the prescription, including the description of the code, the primary disease, or condition that the controlled substance is being used to treat, violates patient confidentiality. In order to preserve patient confidentiality, the American Academy of Family Physicians and the OAFP oppose any requirement that diagnosis information be placed on a prescription form.
It is our understanding from the FAQ document published on the SOBP website, the diagnosis or procedure code for every controlled substance script will be entered into OARRS by the pharmacist. For what purpose is this confidential information being collected? How will this information be used? Who is authorized to review the patient’s confidential information? Will investigations be opened and/or disciplinary actions be taken against prescribers based on this diagnosis code information? It is certainly understandable that prescribers feel they will be judged, but have no idea by what standard or by whom. Since the stated purpose of the governor’s restrictions is limiting controlled substance scripts, it can reasonably be assumed that data will be used in this fashion by regulators to further insert themselves into the practice of medicine. This is most concerning.
The number of opioids prescribed by physicians and dispensed to patients decreased in 2016 for the fourth consecutive year. During the process of drafting acute pain guidelines, the OAFP and other participants in the process were told that if controlled substance prescriptions decreased in number, the guidelines would not be made mandatory. And now that is exactly what is happening so our concerns are not misplaced.
Data shows physicians are doing their part to curb doctor shopping and overprescribing but we continue to be the focus of a seemingly very one-dimensional campaign to fight Ohio’s opioid crisis. This is a multi-dimensional problem that requires an approach beyond just continually hitting physicians with more mandates particularly when the mandates violate patient confidentially and cause further erosion of the practice of medicine by regulators.
Thank you for allowing us to submit comments. We hope that they will be given thoughtful consideration.