BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
SB 1258 (DeSaulnier) - Controlled substances: prescriptions:
reporting.
Amended: April 23, 2014 Policy Vote: B&P 7-2, PS 5-1
Urgency: No Mandate: No
Hearing Date: May 12, 2014 Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1258 would make several changes to the ways
that controlled substances are prescribed and tracked. The bill
would require medical providers to use electronic prescribing
systems, require additional reporting of controlled substance
prescribing to the state, and place additional restrictions on
the prescribing of controlled substances.
Fiscal Impact:
Unknown increase in costs for health information technology
upgrades by the Department of State Hospitals (General
Fund). The Department is in the early stages of a process to
implement electronic health records, which will include an
electronic prescribing function. However, the new system is
not scheduled to be complete by the deadline for electronic
prescribing in this bill. If it is feasible for the
Department to accelerate its electronic health record
implementation, this bill will likely increase the costs to
do so by shortening the available time. The cost to
accelerate the project is unknown at this time.
Unknown additional costs to the Medi-Cal program (General
Fund and federal funds). By imposing a mandate to use
electronic prescribing on medical providers, the bill is
likely to increase operational costs to those providers that
have not yet adopted electronic health records and
electronic prescribing. To the extent that this bill
increases costs to Medi-Cal providers, such providers may
seek and be granted increased rates for Medi-Cal services.
While the Medi-Cal program does not generally pay providers
directly based on their costs to provide services,
substantial increases in costs to providers may result in
upward pressure on Medi-Cal rates.
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Potentially significant information technology and staff
costs for increased utilization of the CURES system by the
Department of Justice (General Fund). By adding Schedule V
drugs to CURES the bill is likely to significantly increase
the number of reported prescriptions. Given the recent
problems with CURES, it is not known whether the system
(even with recent increases in funding) will be able to
handle increased workload without additional resources.
Background: Under current law, the California Department of
Justice manages the Controlled Substances Utilization Review and
Evaluation System (CURES). This system is used to track
prescriptions of Schedule II, III, and IV drugs. Pharmacies are
required to submit information on those prescriptions when they
are dispensed. Prescribers (such as physicians), law enforcement
personnel, and regulatory agencies are authorized to access
CURES. For example, a physician (who has been approved by the
Department of Justice) can access CURES to review whether a
patient has already been prescribed controlled substances before
issuing a new prescription.
The 2011 Budget Act eliminated General Fund support for CURES.
To date, the Department of Justice has received funding from
licensing boards to maintain the system. According to the
Department of Justice, the current CURES computer system is slow
and prone to delays in providing reports. In addition, limited
staff availability mean that requests from providers or law
enforcement often take several weeks to get a response from the
Department. About 9,000 prescribers have signed up for access to
CURES, which is about only 4% of the eligible licensed providers
in the state. SB 809 (DeSaulnier, Statutes of 2013) raised
licensing fees on health care providers by $6 to fund the CURES
system and requires health care providers who can prescribe or
furnish controlled substances to apply for access to the CURES
system by January 1, 2016. In addition, CURES is currently being
upgraded to address shortcomings in usability and reliability,
at a cost of $3.4 million.
Under current federal law and regulation, health care providers
who use electronic prescribing systems (typically as part of a
larger electronic health record system) are required to meet
stringent standards set by the Drug Enforcement Agency.
According to a provider of electronic prescription applications,
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about 35 percent of prescriptions in the state were sent
electronically in 2013.
Proposed Law: SB 1258 would make several changes to the ways
that controlled substances are prescribed and tracked.
Specific provisions of the bill would:
Authorize a Schedule II controlled substance to be orally
or electronically transmitted by a prescriber's agent;
Limit the prescribing or furnishing of a controlled
substance for specified conditions to a 90-day supply;
Limit prescriptions and refills of Schedule III or IV
controlled substances to a total of a 120-day supply;
Prohibit a the prescription or dispensing of a controlled
substance within 30 days of the issuance of a previous
prescription until the user has exhausted all but a
seven-day supply remaining from the previous prescription;
Generally require prescriptions for Schedule II, III, IV,
or V controlled substances to be made by an electronic
prescription that complies with federal Drug Enforcement
Agency regulations by January 1, 2016;
Require medical practices with two or fewer physicians or
providers in certain underserved rural areas to comply with
electronic prescribing requirements by January 1, 2017;
Require prescribing and dispensing of Schedule V controlled
substance to be reported to CURES;
Allow limited oral or written prescribing of controlled
substances under certain circumstances (such a when there is
a technological failure or the pharmacists is outside
California);
Require hospitals and pharmacies to accept electronic
prescriptions;
Authorize Department of Consumer Affairs investigators to
access CURES data with probable cause;
Prohibit the prescribing or dispensing of a controlled
substance in a quantity that is more than a 30-day supply,
with specified exceptions.
Related Legislation: SB 500 (Lieu) would require the Medical
Board to update prescriber standards for controlled substances
periodically. That bill is pending in the Assembly.
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