By Melissa Patrick
Kentucky Heath News
The state House has passed a bill to let physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, the only state where PAs lack such authority.
House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow "modified prescriptive authority" of controlled substances in federal Schedules II, III, IV, and V after the assistant has been licensed and has practiced for one year.
It passed the House Feb. 6 on a 91-1 vote, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.
Sheldon said the Kentucky Board of Medical Licensure, the Kentucky Academy of Physician Assistants, the Kentucky Pharmacist Association and the Kentucky Medical Association were involved in the drafting of this bill.
Rep. Susan Westrom, D-Lexington, asked about KMAs position on this measure, since they have not supported it in the past. Sheldon and other House members assured her that KMA was not opposed to the bill.
KMA told Kentucky Health News in an e-mail, "The KMA continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants (KAPA) to ensure safeguards such as a “team approach” were included in House Bill 135 that promote public safety, along with oversight by the Kentucky Board of Medical Licensure. KMA will monitor the progress of this bill and urge that measures such as these be included as the legislative process continues."
Danielle Elliot, R-Danville, who has introduced this bill in the past, summarized the benefits of this bill, as described in a letter from a PA. He said it would result in more efficient and better access to health care and would allow a more accurate account of who is actually prescribing scheduled drugs across the state, since right now all scheduled drugs prescribed by a PA are attributed to the supervising physician.
"Kentucky is the only state in the nation which presently has a complete prohibition on physician assistants prescribing controlled medications," he said.
Rep. John Blanton, R-Salyersville, said he used to have reservations about this bill, having sent the first doctor from a major opioid investiation back in 2001 to prison for overprescribing opioids, but has since changed his mind.
"The first thought to me was that we don't need more people prescribing opioids, we've already got a problem," he said. "But I also realized that we can't punish the good people that are doing good work because of someone we fear to be a bad actor -- there are things in place to take care of those bad actors."
He also spoke to the need for increased access to care. He said, "In Eastern Kentucky, they are vitally important to us because oftentimes, when we go in, that's who we're seeing, rather than a doctor and they need to have every tool in their toolbox they can to be able to administer good health care to the people that they see each and every day."
Rep. Tina Bojanowski, D-Louisville, said PAs have told her that if they can't practice to the full scope of their practice, as they can in other states, they will leave Kentucky.
Moser, who is well-known for her opposition to increasing the scope of practice for non-physicians, especially when it comes tp prescribing controlled substances, said she could support this bill because it requires PAs to get additional training and continuing education for prescribing at every level of drug classification; it maintains a strong collaborative agreement with a physician; because a supervising physician can decide which drugs their PA prescribes, if at all; and because they will be regulated under the Kentucky Board of Medical Licensure.
Stan Lee, who voted for the bill, cautioned that non-physician groups keep coming back to ask to expand their scope of practice and that while this piece of legislation provides a strong collaborative agreement between a PA and their supervising physician, "other collaborative agreements with other professions have been under assault."
Nurse practioners are also asking to expand prescriptive authority
Lee was likely referring to a bill that has been filed to expand the prescriptive authority of advanced practice registered nurses, They too, say this would increase health care access for Kentuckians. So far, their bill hasn't gained any traction.
Nurse practioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. House Bill 286, a bipartisan bill sponsored by Rep. Russell Webber, R- Shepherdsville, would allow them to work without a supervisiong physician after four years, if their licence is in good standing. The General Assembly approved a similar request in 2014 for nonscheduled dugs.
Lawmakers continue to express concerns that such a move will increase the number of opioids prescribed in the state, but that hasn't been the case, according to a fact-sheet from the APRN lobbying group.
It says, ""HB 286 will NOT increase the problem with substance abuse. In fact, although the number of APRNs in Kentucky has increased, the average APRN prescribing of Schedule II opioids has decreased 33% from 2015 through 2018, the last year for which we have complete data. In contrast, the average dentist prescribing Schedule II opoids has decreased 25.8% and the average physician prescribing of Schedule II opioids has decreased 21.2%."
HB 286 has a total of 28 sponsors. It has been assigned to the House Licensing, Occupations and Administrative Regulations Committee.
What's in the PA bill?
The PA bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.
It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).
Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.
Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.
Kentucky Heath News
The state House has passed a bill to let physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, the only state where PAs lack such authority.
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| Rep. Steve Sheldon discusses his bill. (KET image) |
It passed the House Feb. 6 on a 91-1 vote, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.
Sheldon said the Kentucky Board of Medical Licensure, the Kentucky Academy of Physician Assistants, the Kentucky Pharmacist Association and the Kentucky Medical Association were involved in the drafting of this bill.
Rep. Susan Westrom, D-Lexington, asked about KMAs position on this measure, since they have not supported it in the past. Sheldon and other House members assured her that KMA was not opposed to the bill.
KMA told Kentucky Health News in an e-mail, "The KMA continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants (KAPA) to ensure safeguards such as a “team approach” were included in House Bill 135 that promote public safety, along with oversight by the Kentucky Board of Medical Licensure. KMA will monitor the progress of this bill and urge that measures such as these be included as the legislative process continues."
Danielle Elliot, R-Danville, who has introduced this bill in the past, summarized the benefits of this bill, as described in a letter from a PA. He said it would result in more efficient and better access to health care and would allow a more accurate account of who is actually prescribing scheduled drugs across the state, since right now all scheduled drugs prescribed by a PA are attributed to the supervising physician.
"Kentucky is the only state in the nation which presently has a complete prohibition on physician assistants prescribing controlled medications," he said.
Rep. John Blanton, R-Salyersville, said he used to have reservations about this bill, having sent the first doctor from a major opioid investiation back in 2001 to prison for overprescribing opioids, but has since changed his mind.
"The first thought to me was that we don't need more people prescribing opioids, we've already got a problem," he said. "But I also realized that we can't punish the good people that are doing good work because of someone we fear to be a bad actor -- there are things in place to take care of those bad actors."
He also spoke to the need for increased access to care. He said, "In Eastern Kentucky, they are vitally important to us because oftentimes, when we go in, that's who we're seeing, rather than a doctor and they need to have every tool in their toolbox they can to be able to administer good health care to the people that they see each and every day."
Rep. Tina Bojanowski, D-Louisville, said PAs have told her that if they can't practice to the full scope of their practice, as they can in other states, they will leave Kentucky.
Moser, who is well-known for her opposition to increasing the scope of practice for non-physicians, especially when it comes tp prescribing controlled substances, said she could support this bill because it requires PAs to get additional training and continuing education for prescribing at every level of drug classification; it maintains a strong collaborative agreement with a physician; because a supervising physician can decide which drugs their PA prescribes, if at all; and because they will be regulated under the Kentucky Board of Medical Licensure.
Stan Lee, who voted for the bill, cautioned that non-physician groups keep coming back to ask to expand their scope of practice and that while this piece of legislation provides a strong collaborative agreement between a PA and their supervising physician, "other collaborative agreements with other professions have been under assault."
Nurse practioners are also asking to expand prescriptive authority
Lee was likely referring to a bill that has been filed to expand the prescriptive authority of advanced practice registered nurses, They too, say this would increase health care access for Kentuckians. So far, their bill hasn't gained any traction.
Nurse practioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. House Bill 286, a bipartisan bill sponsored by Rep. Russell Webber, R- Shepherdsville, would allow them to work without a supervisiong physician after four years, if their licence is in good standing. The General Assembly approved a similar request in 2014 for nonscheduled dugs.
Lawmakers continue to express concerns that such a move will increase the number of opioids prescribed in the state, but that hasn't been the case, according to a fact-sheet from the APRN lobbying group.
It says, ""HB 286 will NOT increase the problem with substance abuse. In fact, although the number of APRNs in Kentucky has increased, the average APRN prescribing of Schedule II opioids has decreased 33% from 2015 through 2018, the last year for which we have complete data. In contrast, the average dentist prescribing Schedule II opoids has decreased 25.8% and the average physician prescribing of Schedule II opioids has decreased 21.2%."
HB 286 has a total of 28 sponsors. It has been assigned to the House Licensing, Occupations and Administrative Regulations Committee.
What's in the PA bill?
The PA bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.
It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).
Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.
Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.
from KENTUCKY HEALTH NEWS https://ift.tt/2SunnDc PA bill to prescribe controlled substances moves through the House, with only one no voteHealthy Care
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