I've been tracking the progress of HB 4 (now HB 1 in the special session) in the Kentucky state legislature for a few weeks now. The bill aims to strengthen Kentucky's ability to monitor prescription drugs and force pill mills out of business. In a state where the prescription drug abuse epidemic is particularly bad, such a measure appears to make sense and should enjoy across-the-board support.
Not so fast.
The Kentuck Medical Association has issued a "call to action" for its members to lobby for changes to the bill. They claim the bill will lead to malicious prosecution of doctors and will interfere with a doctor's ability to practice medicine in a professional manner.
So let's examine the core tenets of the bill:
- Physicians will be required to register in KASPER (only one-third of docs are registered today).
- Physicians running pain clinics would have to be on-site treating patients at least 50% of the time the clinic is open.
- Clinics will have to accept insurance vs. only cash payments.
- Physicians will be required to consult KASPER (Kentucky's PDMP - Kentucky All Schedule Prescription Electronic Reporting system) before prescribing schedule II and III drugs.
- Doctors will be restricted from dispensing more than a 48-hour supply of schedule II and II drugs.
- Move management of the database from Health and Family Services to the Attorney General's office.
- Doctors might have to pay a $50 annual fee to support the administration of the KASPER database.
I'll grant that the $50 annual fee is a bit of an annoyance and I would suggest the state legislature find a different financing mechanism. That being said, the requirement to consult the database and the restriction on physician dispensing are logical, high impact measures that will have virtually zero negative impact on the vast majority of doctors in the state of Kentucky. Some doctors are concerned about the AG's office managing the database... but if you're a good doc doing the right thing, this shouldn't be a concern (particularly because hospice and emergency care are excluded).
Governor Beshear has called a special session of the state legislature in which this bill will be addressed. The House has already passed the bill (again). Now it's up to the Senate where the bill failed during the general session mostly due to the efforts of the Kentucky Medical Association.
Other states are watching. I hope Kentucky does the right thing.
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