14- 118 C.M.R. ch. 11, § 4

Current through 2024-52, December 25, 2024

Section 118-11-4 - General Requirements for Prescribing and Dispensing

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.

14- 118 C.M.R. ch. 11, § 4