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PA Prescribing of Schedule II and III Controlled Substances

Posted By Jen Feirstein, ASAPA Legislative Committee Chair, Tuesday, January 22, 2019
Updated: Friday, February 15, 2019

Update – February 15, 2019

 

Many of you likely already saw the announcement sent out yesterday from the Arizona Regulatory Board of PAs (ARBOPA); however, ASAPA also wanted to send official notice to our members that Governor Ducey has signed HB2075 (SB1108).  The bill had an emergency clause so it is immediately effective.  Any disruptions or barriers to the appropriate prescribing of schedule II and III controlled substances by PAs should now be resolved. 

 

If you encounter any difficulty with prescribing these substances, please refer the pharmacy/pharmacist to the final bill signed into law on February 14, 2019.  If you still encounter barriers after referencing HB2075, please reach out to ASAPA so we can communicate with ARBOPA and the Pharmacy Board.

 

We are proud of the work that went into resolving this issue, and are thankful to our membership for supporting the organization.  Your membership allows for support of our Association lobbyist, an invaluable partner when working on such serious matters affecting PA practice in Arizona.  We urge you to tell your PA colleagues about this situation, and invite them to help make the Association even stronger by becoming members themselves.  Membership applications can be found on the website.

 

Please feel free to reach out with any questions.

 

Sincerely,

 

Jennifer Feirstein, MSPAS, PA-C, DFAAPA

Chair, Legislative Committee

President

Arizona State Association of Physician Assistants


 

Update – February 12, 2019

 

This is an update to prior memos regarding the disruption to schedule II and III controlled substance prescribing. 

 

We are pleased to report that as of February 11, 2019, HB2075 (SB1108) has been passed by both chambers of the Arizona legislature.  The final bill is now ready for review and signature by Governor Ducey, at which time it will be immediately effective.  The Governor has five days to complete this action.

 

We would like to thank the PAs of Arizona for your patience as ASAPA worked with our Association lobbyist and ARBOPA to correct this legislative misinterpretation as expeditiously as possible.  This situation presented a significant barrier to PA practice causing patients to experience unnecessary interruptions in accessing needed medical care.  However, we do feel the resultant legislation is even stronger in identifying and clarifying PA prescriptive authority.

 

Please feel free to reach out with any questions.

 

Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants


Update – January 31, 2019

 

This is an update to prior memos regarding the disruption to schedule II and III controlled substance prescribing. 

 

The amendment to SB1108 (corresponding HB2075) was adopted in the Senate Health and Human Services (HHS) committee on January 30th without any discussion or opposition.  The bills are now ready to be voted on by their respective chambers, and if approved, the last step in this process will be Governor Ducey’s signature.  We will continue to provide the membership with updates as they are received.  Please feel free to reach out with any questions.

 

Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants



Update – January 25, 2019

This is an update to the prior memos of 1/21/19 and 1/23/19 regarding the disruption to schedule II and III controlled substance prescribing.

The amendment to HB2075 was adopted in the House Health and Human Services (HHS) committee on January 24th without any discussion or opposition. The same amendment will now be introduced to SB1108 at the Senate HHS committee on Wednesday, January 30th. We continue to have consensus around this issue, and are optimistic that the Senate amendment will be adopted as seamlessly as the House amendment. The next step would be for both bills to go to their respective chambers for a vote, and then the bill would be ready for signature by the Governor.

As mentioned previously, ASAPA is working closely with our Association lobbyist, who has assured us this is the fastest possible process for getting this situation resolved. We will continue to provide the membership with updates as they are received. Please feel free to reach out with any questions.

 

Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants


Update – January 23, 2019

 

This is an update to the prior memo sent on January 21st.  ASAPA is continuing to work very closely with our Association lobbyist and the Arizona Regulatory Board of Physician Assistants on the controlled substance prescribing issue that is limiting PAs to prescribing a 72-hour supply of schedule II and III controlled substances.

 

As of this morning, an amendment to HB 2075 has been introduced by Senator Nancy Barto.  HB 2075 is a fast-track bill moving through the Legislature to address e-prescribing issues associated with the enactment of the Opioid Act during the 2018 legislative session.  The proposed amendment is attached and addresses the practice barriers PAs have been experiencing in the past week.  Since this is a fast-track bill it would take effect upon signature by Governor Ducey.  There continues to be consensus among physicians and hospitals over the need to correct the interpretation that has created this prescribing limitation so ASAPA continues to be optimistic that this situation will be resolved quickly.

 

ASAPA will continue to communicate updates with you as they are received.  Thank you for your membership in ASAPA; members are vital for supporting advocacy and legislative efforts. If you have colleagues that would like to further support the organization by becoming a member, please direct them to our membership page

 

Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants

 


On January 17, 2019, ASAPA was made aware of many practicing PAs in Arizona being told by pharmacies that PAs can only prescribe a 72-hour supply of schedule II and III controlled substances.  The Association has been actively pursuing additional information and working to resolve the problem.

 

Here is what we know as of this writing:

 

During the 2018 legislative session, HB 2250 passed, which was intended to certify PAs for 90-day prescription privileges for non-opioid schedule II and III controlled substances.  Unfortunately, the final language that was passed in HB 2250 (attached) is being interpreted to restrict the prescribing of schedule II and III controlled substances to 72-hours.


HB 2250 was intended ONLY to increase the prescribing limits of non-opioid schedule II and III controlled substances to 90 days, and to otherwise leave prescribing privileges unchanged.  Unfortunately, explicit language was not included that indicated the ability to prescribe for up to 30 days was remaining unchanged. 


After HB 2250 passed, ASAPA testified at both the rule-making hearing and at the Arizona Regulatory Board of Physician Assistants (ARBOPA) board meeting expressing concerns about possible misinterpretation. 


ARBOPA now understands our concerns and we are working very closely with ARBOPA and our association lobbyist to identify the most expeditious solution to this problem.  Currently, it appears this will likely occur in the form of amending a fast-track bill moving through the Legislature to address e-prescribing issues associated with the enactment of the Opioid Act during the 2018 legislative session.  There is consensus among physicians and hospitals over the need to correct the interpretation that has created the prescribing limitation.


ASAPA will communicate updates with you as they are received.  Please be ready to reach out to your legislators, if needed.  We are aware of the significant burden this is placing on PAs, especially PAs practicing in pain management and other disciplines that regularly prescribe these medications.  Please know that we are doing everything in our power to resolve this barrier to PA practice and to the health care needs of our patients.


Sincerely,

Jennifer Feirstein, MSPAS, PA-C, DFAAPA
Chair, Legislative Committee
President
Arizona State Association of Physician Assistants

Tags:  Legislative 

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Permalink | Comments (19)
 

Comments on this post...

...
Larry P. Fisher DHSC PA-C says...
Posted Wednesday, January 23, 2019
Jennifer and the ASAPA. Board,
This is an insufficient explanation of the process that led to this change. The practice of pain management by PA’s has been severely disrupted and I see no end in sight based on the statements of ASAPA and ARBoPA. PAs in pain management may lose income or even their jobs because of this oversight. Where was our representation during the drafting of this legislation!

Larry P. Fisher DHSc, PA-C
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Kimberly M. Ferguson says...
Posted Thursday, January 24, 2019
This is a huge disruption in oncology as well. How did this issue not get addressed before today?
Kimberly Ferguson PA-C,
ASAPA member
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Larry P. Fisher DHSC PA-C says...
Posted Thursday, January 24, 2019
Some PA’s considering whether to renew their ASAPA membership or whether to attend the upcoming conference would like a better answer than “we are doing everything in power.” Will Arizona PA’s be legislatively dissenfranchiseced again in the future with only a proverbial “my bad” from ASAPA leadership. The membership of ASAPA deserves a real answer.
Larry P. Fisher DHSc, PA-C
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Jennifer Feirstein PA-C says...
Posted Friday, January 25, 2019
Larry,
I’m sorry that you feel communication has been insufficient. I thought that my communication was thorough in identifying the situation and outlining how it is being addressed; if it has not been thorough then I will certainly take ownership and responsibility for that. I have had many PAs reach out to me individually to ask additional questions, and I have been more than willing to answer those questions.

I don’t know how ASAPA could have predicted the current situation. The legislation that was drafted and passed last year (HB2250) was viewed positively as an improvement to PA practice in Arizona. The legislation was vetted through the PA regulatory board (including their Executive Director and legislative council), the ASAPA leadership, and ASAPA’s lobbyist. Additionally, staff at the AAPA office reviewed this legislation as being a positive bill that only expanded prescribing of non-opioid schedule II and III controlled substances from 30 days to 90 days, without making any other changes. HB 2250 became effective on October 1, 2018 and there was no disruption to prescribing until last week. It was last week that the Pharmacy Board started enforcing a different interpretation of the statute. Immediately, upon hearing about this prescribing barrier effecting PA practice, ASAPA began working to resolve the problem. I am proud of the work this organization has done.

If you have solutions for improving the process in the future, I’m sure our leadership would be eager to hear those solutions, and of course, we would encourage you to get involved in leadership to be at the table preventing and solving problems.

Regarding your comment about PAs that are trying to decide whether to renew membership, I am certainly biased, but I would think this situation would strengthen the resolve to be a member of this Association. Having lobbyist representation on behalf of ASAPA is invaluable, and I am certain that solutions would be much more slow-going without the services of our lobbyist. As you know, membership dues support the cost associated with having that representation.

I hope this provided a more sufficient explanation, but please let me know if further information is needed.

Jennifer Feirstein
President
ASAPA
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Randy D. Danielsen PhD PA DFAAPA says...
Posted Friday, January 25, 2019
Jennifer, Thank you for your information posted here and on the AAPA Huddle. You are right on target with your answer. Thank you for not only being the President but also the chair of the legislative & Legal Affairs committee. Quite a commitment. As an ARBoPA member, It is gratifying to see you and ASAPA members at our quarterly meetings. As you know, this past week when PAs started having their prescriptions denied by pharmacists, we at the board were also contacted. President Myles contacted the Executive Director immediately as well as the Assistant AG. The result is the emergency statutes you noted with the support of friends in the AZ house & senate, wanting to make this right. Yes, you are correct that the previous statutes passed were vetted significantly. There was no way to know that the Governer's bill would impact our laws due to misinterpretation (in my opinion). None the less, it was an unintended consequence. My suggestion to my Arizona colleagues is to thank ASAPA for being there and present and willing to act on a moment's notice. I am sure you would be thrilled for a handful of our PA colleagues in the state to stand up and be active members of the LLA committee. As a previous chair of that committee, I can admit it is a 24-7 job. All the best,

Randy
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John J. Shaff PA-C DFAAPA says...
Posted Friday, January 25, 2019
Posted on the Huddle:

I can't Emphasize this enough. ASAPA has done a great job navigating through this and many other things. Having been on both sides, ASAPA and ARBoPA, I know how much work there is to keep our profession moving forward. There are over 3000 licensed PAs in the state of Arizona. We have under 400 members of our state organization. It's the work of few that give their time to continue to try to work on, protect and improve our profession.

As you can see, Jennifer is not only the President, but also the chair of one of the most important committees. She and the other board members of ASAPA can't do it all by themselves. We need more PAs to get involved, financially, personally, or both. It's called professional responsibility.
A lot of the things we do, take not only volunteer time, but money. Our lobbyist for example. With out the work of ASAPA, the lobbyist and ARBoPA, this issue last week could have been on going. You all can see how one little thing, (big actually), affected you personally and your ability to work. Now, imagine that ASAPA wasn't around and this happened. For all those affected, your job could have been in jeopardy. Let that sink in for a moment.

With the example of what happened this last week, and the number of phone calls I received, it became even more apparent for the need for the PAs of Arizona to work together and get involved. Most of the phone calls were from PAs asking what's going on? Why is this or did this happen? Most, non-members. Besides informing them of the situation, one of my answers was, looks like it is time for you to get involved. Too many PAs sit idlely by and ride the wave of the work done by past leaders. Well, that wave is running out. Many hands make light work. For those of you that aren't members of ASAPA or your state and national organization, I ask you to reconsider. For those of you that are, I ask you to talk to your fellow colleagues that aren't and get them involved. I know we all know some.

This post was not meant for me to get on my soap box. I want to personally thank Jennifer, ASAPA, and all parties involved that worked together to correct this.

To echo what Randy said, I know ASAPA would love an influx of members and them volunteering for various roles and projects.

Thank You.

John
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Larry P. Fisher DHSC PA-C says...
Posted Friday, January 25, 2019
John, Randy, and Jennifer,

I have cut and pasted the portion of HB 2250 that appears to have caused this mess. It may be an issue or problem for some, or an inconvenience for others, but if a PA writes 5000+ CII prescriptions per year, be assured it is a disaster. I have re-read this entire thread and I see no examples of anyone questioning whether you all work hard for PAs in Arizona. However, after reading the bill's 8 pages I still do not understand where our representation was and how this was missed. There is no doubt that the current efforts will resolve this issue in due time and this is appreciated beyond measure. However, the explanation of who knew what and when is still absent from this discussion and this casts doubt on ASAPAs ability to prevent a similar episode in the future.

The HB2250 passage in question reads,

" C. Unless certified for thirty-day NINETY-DAY prescription
privileges pursuant to section 32-2504, subsection A, a physician assistant shall not prescribe a schedule II or schedule III controlled
substance for a period exceeding seventy-two hours. For each schedule IV or schedule V controlled substance, a physician assistant may not
prescribe the controlled substance more than five times in a six-month
the period for each patient."

It is easy to see how one might misinterpret this passage in a way that would damage PAs in Arizona, so again I must ask how can this have happened?

I have renewed my membership and registered for the conference. You may count on my presence when this issue is discussed in the future.

I think all of you have my phone number if a phone conversation would be helpful.

Larry
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Randy D. Danielsen PhD PA DFAAPA says...
Posted Friday, January 25, 2019
Larry, I am sorry you feel that way! Rather than throw stones why don’t you work with us! Call me!

Randy
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John J. Shaff PA-C DFAAPA says...
Posted Friday, January 25, 2019
I echo Randy’s comment.
Permalink to this Comment }

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John J. Shaff PA-C DFAAPA says...
Posted Friday, January 25, 2019
Larry,

I invite you to get involved with ASAPA and come to the meetings as well as come to the regulatory board meetings.
Permalink to this Comment }

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Larry P. Fisher DHSC PA-C says...
Posted Saturday, January 26, 2019
John,

Earlier today I renewed for two years and registered for the conference. Please send notifications of the times and places of meetings and I will be there.

Larry
(larry@azfishers.net)
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Randy D. Danielsen PhD PA DFAAPA says...
Posted Sunday, January 27, 2019
The next Regular Session Meeting of the Arizona Regulatory Board of Physician Assistants will be
February 27, 2019, at 1740 W Adams St, Phoenix, AZ 85007 in Suite A
The board convenes at 10:00 a.m.
https://www.azpa.gov/
There is also a chance at the beginning of the meeting for the public to speak to the board. Invite any and all to come and do so.
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Larry P. Fisher DHSC PA-C says...
Posted Sunday, January 27, 2019
I have added this to my calendar, however, I already have patient's scheduled. If this is a monthly meeting, perhaps I can block the time in March? I will monitor the ARBoPA website.
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Randy D. Danielsen PhD PA DFAAPA says...
Posted Sunday, January 27, 2019
You can also attend virtually. Check the website. It is a quarterly meeting. Also, there is still an open position on the board. Go to https://bc.azgovernor.gov/ if interested.

Randy
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John J. Shaff PA-C DFAAPA says...
Posted Sunday, January 27, 2019
All in person meetings and teleconferences for ASAPA are posted on the website in accordance with bylaws. As Randy said ARBoPA meetings are quarterly unless otherwise announced for special meetings or committee work. These are open to public as well.
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Nickie Chouinard PA-C says...
Posted Sunday, January 27, 2019
Randy, John, Jennifer and all other individual PAs involved in Professional Leadership for the state of Arizona- a big THANK YOU to all! I have been a PA in Arizona since 2002, and while I am, and have been, a member of ASAPA I have to admit I have relied on all of you to lead the way. I have not been disappointed by the leadership over my 17 years of practice in Arizona and I can't thank you all enough for being such proactive and forward thinking representatives for the PA profession in Arizona. In my humble opinion, we are the best and most supportive state to practice as a PA and it could not have happened without all of you and your commitment for PAs in AZ!!!! I look forward to the future growth of our profession in Arizona and look forward to becoming involved in the advocacy of our profession! With much gratitude, Nickie Chouinard, PA-C DFAAPA
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Randy D. Danielsen PhD PA DFAAPA says...
Posted Sunday, January 27, 2019
Thanks, Nickie. That is very kind of you. A lot of PAs make this happen. Appreciated the time you took to say so! All the best,

Randy

P.S. Come see us sometime!
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Nannette Sharp PA-C says...
Posted Thursday, January 31, 2019
Thank you Randy and Jennifer. ASAPA and all the Arizona PA's will reap the benefits of your hard work and persistence. I personally have not complaints or grips about this process and I have a strong feeling that we (Az PA's) will be very thankful for all your hard work. I have served the state as President, President elect, secretary, board member,and CME chairman. Thank you Nan Sharp, PA-C
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Elias Villarreal Jr. says...
Posted Thursday, February 14, 2019
Thank you to my fellow members of the ASAPA Board of Directors and thank you especially to Jennifer Feirstein for the tireless and amazing dedication to HB 2075 through to getting signed by the governor. Despite only 10% of the state's PAs as members of ASAPA and despite the negativity and sometimes divisive language she has faced from PAs who hinder rather than help the cause, she helped us all prevail in Arizona. Onward and forward to new horizons!
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