State Board of Pharmacy: News
- Proposed Opioid Guidelines Changes
- Two New Laws Affect Pharmacists
- New Law Affects CO Prescribers, Limits Opioid Prescriptions
- Revised Opioid Guidelines
- PDMP Delegate Training Video
- Mandatory Reporting Reminder
- Important PDMP Updates
- Colorado End-of-Life Options Act
- Free Access to PainNET System for Colorado Providers
- Pharmacist Application Process Speeds Up
- Naloxone Standing Orders
The Board is soliciting feedback on proposed changes to the Guidelines for Prescribing and Dispensing Opioids (Guidelines), which were discussed at a September 2018 stakeholder meeting. Information has been added to the appendix and addresses new requirements in Senate Bill 18-22 Clinical Practice for Opioid Prescribing. This new state law went into effect on May 21, 2018, immediately upon the Governor’s signature. The law sets forth prescribing requirements, such as the number of opioids to be prescribed, and required Prescription Drug Monitoring Program checks in certain clinical situations. The law also provides specific exemptions to these requirements.
Final changes to the Guidelines will require formal adoption by the Division of Professions and Occupations’ (DPO) prescribing Boards - the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and an endorsement by the State Board of Veterinary Medicine.
The Guidelines were previously revised and released to the public in April 2018. The prescribing Boards under the Division’s auspices remain committed to ensuring that the document serves as a consistent reference that reflects best practices for stakeholders and any new laws the Boards must implement and enforce. To that end, DPO is requesting public feedback in order to fully review any impacts the most recent proposed changes may have on consumer protection.
If you have questions or would like to provide written comments on the proposed changes, please send them to Holli Weaver at firstname.lastname@example.org by December 15, 2018, at 5 p.m.
On May 11, 2018, Governor John Hickenlooper signed House Bill 18-1307 Limit Access To Products With Dextromethorphan. It will go into effect August 8, 2018. The new state law makes it unlawful to sell or knowingly dispense medication containing any quantity of dextromethorphan to a person under the age of 18. Anyone selling a medication containing dextromethorphan must obtain proof of age as specified in the bill, unless he or she reasonably believes the purchaser is at least 25 years old. This bill does not require:
- restrictions on consumer access to medication containing dextromethorphan,
- transaction record keeping.
It does not apply to medication sold pursuant to a valid prescription. The Colorado State Board of Pharmacy encourages licensees to read the bill to better understand its new requirements. If you have questions, please send them to email@example.com.
Cost of Prescription Drugs Purchased at a Pharmacy
Patient Drug Costs Savings Act
On April 30, 2018, Governor John Hickenlooper signed House Bill 18-1284 Disclosure Of Prescription Costs At Pharmacies. The new state law allows pharmacies/pharmacists to disclose to patients the cost share for the covered prescription drug on his or her insurance, and the clinical efficacy of a more affordable alternative drug that is therapeutically equivalent, if available. In addition, pharmacies must charge the patient the retail price of a medication if that price is less than the copay for that drug. The new law goes into effect August 8, 2018.
The Colorado State Board of Pharmacy encourages all licensees to read the bill to better understand how it affects pharmacies and pharmacists. If you have questions, please send them to firstname.lastname@example.org.
Note: The prescribing and dispensing Boards are reviewing Senate Bill 18-22 Clinical Practice for Opioid Prescribing, and considering its impact, if any, on the Guidelines for Prescribing and Dispensing Opioids. Please check back for updates.
On Monday, May 21, 2018, Governor John Hickenlooper signed Senate Bill 18-22 Clinical Practice for Opioid Prescribing. The bill went into effect immediately upon the Governor’s signature. This new state law limits the number of opioid pills a healthcare provider can prescribe and affects physicians, physician assistants, advanced practice registered nurses with prescriptive authority, dentists, optometrists, podiatrists, and veterinarians.
Under the new law, a prescriber must limit a patient’s initial prescription of an opioid to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the last 12 months. The prescriber may exercise discretion in including a second fill for a seven-day supply. These limits do not apply, if, in the judgment of the prescriber, the patient:
- Has chronic pain that typically lasts longer than 90 days or past the time of normal healing, as determined by the prescriber, or following transfer of care from another prescriber who prescribed an opioid to the patient;
- Has been diagnosed with cancer and is experiencing cancer related pain; or
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.
- Is undergoing palliative care or hospice care focused on providing the patient with relief from symptoms, pain and stress resulting from a serious illness in order to improve quality of life. (This exemption is allowed for physicians, physician assistants and advanced practice registered nurses only.)
After the first prescription, the prescriber is required to check the Prescription Drug Monitoring Program (PDMP) database before prescribing any additional opioids for the same patient. Failure to check the PDMP constitutes unprofessional conduct if the prescriber repeatedly fails to comply with this new requirement. The second fill requirement to check the PDMP does not apply when a patient:
- Is receiving the opioid in a hospital, skilled nursing facility, residential facility, or correctional facility;
- Has been diagnosed with cancer and is experiencing cancer related pain; or
- Is undergoing palliative care or hospice care;
- Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;
- Is receiving treatment during a natural disaster or during an incident where mass casualties have taken place; or has received only a single dose to relieve pain for a single test or procedure.
After the second opioid prescription, the law has no further restrictions on the healthcare provider’s prescribing practices. The new law does require a healthcare provider, or the provider’s designee, to specify the provider’s specialty upon the initial query of the PDMP. It also states a violation of the new requirements does not constitute negligence or contributory negligence per se and does not create a private right of action or serve as the basis of a cause of action.
On March 16, 2018, the revised Guidelines for Prescribing and Dispensing Opioids were adopted by all six of Colorado’s prescribing and dispensing Boards: the Colorado Dental Board, the Colorado Medical Board, the State Board of Nursing, the State Board of Optometry, the Colorado Podiatry Board, and the State Board of Pharmacy, and endorsed by the State Board of Veterinary Medicine.
This revised Policy is a product of the collaboration between the seven Boards and a robust stakeholder engagement process. Stakeholder views, opinions and comments were essential in the revision of the 2014 Policy for Prescribing and Dispensing Opioids.
A training video is available to show prescribers and pharmacists how to set up delegate accounts for the PDMP. Any prescriber or pharmacist can create up to three delegate accounts for trained individuals who can check the PDMP on the prescriber or pharmacist's behalf. You can utilize the PDMP more frequently to get the most complete medical history possible.
Did you know you are a mandatory reporter? Under Colorado law, more than 40 professions are required to report suspected child abuse and elder abuse. These professions include many regulated through the Division of Professions and Occupations (DPO) at DORA, such as:
- Physicians (including physician assistants and physicians in training);
- Dentists and dental hygienists;
- Nurses (including registered nurses, licensed practical nurses, and nurse practitioners);
- Nursing home administrators;
- Occupational therapists;
- Physical therapists;
- Mental health professionals (including psychologists, social workers, professional counselors, marriage and family therapists, registered psychotherapists and all candidates for licensure);
Online trainings help mandatory reporters recognize and report abuse, neglect and exploitation. Licensees of the regulatory boards at DPO may accrue credit towards continuing education and continuing competency requirements for completing the trainings (should they exist for their profession).
Section 19-3-304, C.R.S. outlines the persons required by law to report child abuse and/or neglect. To assist mandatory reporters, a training is available on the Colorado Department of Human Services website at http://coloradocwts.com/mandated-reporter-training.
Section 18-6.5-108, C.R.S outlines the persons required by law to report abuse and exploitation of at-risk elders and at-risk adults with intellectual and developmental disabilities. Further information and an online training can be found on the Colorado Department of Human Services website at http://www.coloradoaps.com/about-mandatory-reporting-update.html.
If you have further questions regarding these requirements, please contact the Colorado Department of Human Services.
For questions regarding mandatory reporting of at-risk elders and at-risk adults with intellectual and developmental disabilities, please contact the Office of Community Access and Independence’s Division of Aging and Adult Services at email@example.com.
As we work together to tackle prescription drug misuse, abuse and diversion, we see PDMP utilization rates continue to increase as the database continues to serve as an important tool for meeting the standard of care for safe prescribing.
We are pleased to announce a new and improved PDMP website: colorado.gov/dora-pdmp. We listened to your challenges and ideas and hope you’ll find the new website easier to navigate and more relevant to your needs. You will be able to link to your PDMP account and access other information directly from the homepage. We also selected a new vendor, APPRISS, and will be utilizing the PMP AWARxE system. The database interface will look different and make PDMP queries easier and quicker. We encourage your continued feedback for ongoing improvement efforts.
New State Law Improves Access to PDMP
To make the PDMP more accessible and easier for health professionals to incorporate into daily use, the Colorado General Assembly passed legislation in 2017. On April 6, 2017, Governor John Hickenlooper signed Senate Bill 17-146 Access To Prescription Drug Monitoring Program, which clarifies health professionals' access to the PDMP database by:
- Allowing a health care provider with prescribing authority to query the PDMP about a current patient, including checking on drug interactions and side effects, thus making the PDMP an even more useful tool for health professionals in their clinical decision-making for patients;
- Allowing a veterinarian with prescribing authority to query the PDMP about a current client if the veterinarian has a reasonable basis to suspect the client has committed drug abuse or has mistreated an animal; and
- Allowing a pharmacist to query the PDMP about a current patient for whom the pharmacist is dispensing any prescription drug, rather than only patients receiving controlled substances.
The law became effective immediately, and the Division is working with the appropriate Boards to implement the new law including rulemaking, outreach and education. If you have questions about the Colorado PDMP, please contact Division staff at 303-894-5957 or firstname.lastname@example.org. If you need technical assistance with the PMP AWARxE system, please contact the vendor help desk at 1-855-263-6403.
In 2016, Colorado voters approved Proposition 106, “Access to Medical Aid In Dying,” which amends Colorado statutes to include the Colorado End-of-life Options Act at Article 48 of Title 25, C.R.S. This Act requires licensed physicians or pharmacists prescribing or dispensing aid-in-dying medication to provide the Colorado Department of Public Health and Environment (CDPHE) with certain information as outlined in the respective forms below.
Rules 6 CCR 1009-4 have been adopted by the Board of Health within CDPHE describing these reporting requirements.
The Division of Professions and Occupations (Division) advises any licensed physician or pharmacist who participates in this practice to comply with all applicable provisions of the Act and corresponding rules implemented by CDPHE. The Division further recommends that you seek the advice of your employer, insurance carrier and private counsel for matters related to this law.
Additionally, the Medical Board has provided guidance to physicians in Policy 40-6.
The Colorado Department of Health Care Policy and Financing (HCPF) has worked with the vendor of its Project ECHO Pain Management Program, Community Health Center, to expand access to the program website known as PainNET.
The PainNet website is an online learning community that aims to improve pain care expertise among primary care providers. The website is also now available to other Health First Colorado (Colorado’s Medicaid Program) primary care medical providers (PCMPs) for free.
The PainNET learning community enables PCMPs to develop expertise to treat patients with complex chronic pain through a combination of archived Project ECHO Pain case presentations, resource libraries, community forums and expert consultations. Providers and specialists are able to communicate through discussion boards, chat rooms and direct messaging.
This is a great resource for Colorado providers to access resources that can increase their knowledge on how to manage chronic pain more effectively.
Learn More About PainNET
- Download the PainNET Access flyer.
- Watch the Introduction to PainNET video.
- Sign up for access by contacting Agi Erickson at email@example.com.
- Contact JD Belshe, Consultant/Policy & Program Analyst for HCPF, at firstname.lastname@example.org for any other questions about the PainNET program.
We want to make sure all Pharmacy Interns know about some exciting changes in our application process for aspiring pharmacists. These changes streamline the process and allow new grads to enter the workforce more quickly.
Beginning May 1, 2016, applicants for a pharmacist license in Colorado will apply directly to the National Association of Boards of Pharmacy (NABP) to take the NAPLEX and MPJE (Colorado) exams without first needing to apply for a Colorado pharmacist license. The new process allows graduates to schedule and take the licensing exams without waiting on prior approval from DPO. NABP will now evaluate your eligibility for the exams and determine the documentation needed to prove you have graduated from an approved school of pharmacy. To have NABP determine your eligibility, complete the NAPLEX/MPJE Eligibility Request Form and submit to NABP with the one-time $85 processing fee. NABP will also be evaluating any requests for testing accommodations. To make an accommodation request, complete and submit to NABP the Accommodation Request Form. For more information about NABP's process, see the NAPLEX - MPJE Registration Bulletin.
Additionally, a new online application provides a more user-friendly and intuitive pathway, replacing the cumbersome paper applications. Once you have passed the NAPLEX and MPJE (Colorado) and completed your 1500 experiential intern hours, you may apply for your Colorado pharmacist license. To apply, complete the PHA - Original License Score Transfer application and submit with the required fee.
We look forward to helping you join Colorado’s healthcare workforce. If you have questions, please contact us at email@example.com.
In April 2015, Colorado passed a new law, Senate Bill 15-053, expanding access to the life-saving drug naloxone, which is used to reverse overdoses to narcotic drugs, such as certain prescription medications and heroin. As a result of the new law, a physician — or any medical professional with prescriptive authority — can write a standing order for naloxone that can be dispensed by other designed individuals (such as pharmacists and harm reduction organizations).
With these standing orders, pharmacists and harm reduction organizations can now provide naloxone to those who might benefit from it the most, including:
- A family member, friend or other person in a position to assist a person at risk of overdose
- An employee or volunteer of a harm reduction organization
- A first responder
- An individual at risk of overdose