BILL ANALYSIS
AB 2018
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Date of Hearing: May 17, 2000
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Carole Migden, Chairwoman
AB 2018 (Thomson) - As Amended: May 3, 2000
Policy Committee: Public
SafetyVote: 5-0
Health 14-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill repeals the requirement that Schedule II controlled
substances be written on an official prescription form known as
the "triplicate form" issued by the Department of Justice (DOJ),
and repeals the July 1, 2003 sunset of the electronic
prescription tracking pilot project (CURES), thereby making the
program permanent. Specifically, this bill:
FISCAL EFFECT
Ongoing costs to operate CURES of about $300,000 per year (GF).
(Current CURES funding, from a $1 million appropriation from the
Pharmacy Board Contingent Fund, expires in 2000-01.)
In addition to the $300,000 in contract and operating costs, the
DOJ contends it will need auditors to check prescriptions
against the CURES database. Four auditors cost about $300,000
(GF) annually.
COMMENT
1)Rationale . According to the author, California is one of only
eight states that require a government-issued prescription for
Schedule II drugs. Triplicate prescription is widely viewed by
the medical and patient community as a barrier to pain
management. Studies indicate that cancer-related pain could be
well controlled in 80% to 90% of affected patients, but recent
findings indicate more than 40% of cancer patients receive
inadequate pain relief. Many patients with chronic pain are
not treated effectively or appropriately. Some physicians
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simply refuse to use triplicates. AB 2018 does not end
Schedule II monitoring, - it simply eliminates the
government-issued prescription required and makes electronic
monitoring permanent.
The 1994 California Pain Summit included a recommendation:
'Replace the requirement for a special, state-issued
prescription form (triplicate system) with electronic
monitoring of controlled substances prescription that can
foster better, more effective pain management and better
diversion detection.' AB 2018 implements that recommendation.
2)Current law regarding triplicate prescriptions:
a)Requires each prescription for a controlled substance
classified in Schedule II to be written in the handwriting
of the prescriber on an official prescription form, in
triplicate, issued by DOJ.
b)Requires the original and duplicate of the prescription to
be delivered to the pharmacist and requires the duplicate
to be retained by the pharmacist and the original to be
transmitted to DOJ at the end of the month in which the
prescription was filled.
c)Requires triplicate prescription blanks to be issued by DOJ
in serially numbered groups of not more than 100 and
requires prescription blanks to bear the preprinted name,
address, and category of licensure of the practitioner, and
the federal registry number for controlled substances.
d)Requires the prescriber to maintain a prescription book
containing copies of issued prescriptions for three years
and permits DOJ to charge a fee for the prescription blanks
sufficient to reimburse the department for the actual costs
associated with the preparation and processing of the
forms.
e) Exempts Schedule II prescriptions from the triplicate
procedure when prescribed for use by a patient who has a
terminal illness, defined in part as an illness that will,
in the judgment of the physician, bring about the death of
the patient within a period of one year. (Migden, AB
2693,1999)
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3)The CURES Pilot Project within DOJ for electronic monitoring
of the prescribing and dispensing of Schedule II controlled
substances, was created in 1996 (AB 3042, Takasugi). AB 3042
was sponsored by Attorney General Dan Lundgren, whose DOJ
noted at the time that "the information captured on the
current system is not complete and therefore not useful in
identifying and investigating those suspected of abusing the
prescribing and dispensing process?.By integrating existing
systems, virtually 100% of the data could be captured at the
point of sale, and the information made accessible to law
enforcement."
According to the 1999 CURES Report, CURES has been implemented
in a timely and cost-effective manner. The report also notes
that the triplicate program reached its peak production level
in 1995 by manually entering data from 256,303 triplicate
prescription forms into the computer system. Since 1995,
productivity has steadily declined, and in 1998 only 39,945
triplicate prescription forms, representing 1.7% of the total,
were manually entered into the system. The report states that
CURES has solved the data entry backlog problem experience by
the triplicate program. Through CURES, DOJ and medical-related
licensing boards have ready access to up-to-date information
on Schedule II drug prescriptions.
The report made several recommendations, including making CURES
permanent, and reclassifying current triplicate prescription
program staff to classifications more suitable to the
investigative and analytical duties they will perform for
CURES.
4)Support . The bill's sponsor, the Pharmacy Board, contends
CURES has clearly established electronic monitoring as a
superior alternative to collecting the more than 2 million
paper prescriptions written each year. The board argues that
CURES makes identifying patterns of abuse and diversion of
prescription drugs into illicit markets easier because all
data is readily available for analysis. The triplicate
prescription process has out-lived its utility as demonstrated
by the small percentage of forms actually being entered into
the database.
The American Cancer Society (ACS) states that research indicates
less than half of cancer patients get adequate pain relief,
even though the means to relieve almost all cancer pain
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currently exist. The ACS contends that CURES best addresses
the conflict between the effort to restrict controlled
substances and compassionately treat patients experiencing
pain.
The California Medical Association sites survey data indicating
54% of physicians modify pain prescriptions based on concerns
of regulatory oversight, and that physicians continually
express concerns over restrictive regulations, feeling
threatened, and fearing harassment and/or prosecution by
enforcement authorities.
5)Opposition . Law enforcement contends electronic monitoring,
unaccompanied by triplicate forms, is inadequate to safeguard
against forgery and counterfeiting of prescriptions, and that
serialized forms provide for self-monitoring before
prescribing, while CURES provides monitoring after the fact.
The DOJ states that CURES alone is insufficient to monitor
illegal diversion. Triplicate forms provide evidence in the
prosecution of diversion cases, since each prescription is
assigned to a specific, individual practitioner. Moreover, the
original document is required as evidence in a prosecution
because computer printouts are not admissible and present
substantial issues regarding authentication and reliability of
the record.
Analysis Prepared by : Geoff Long / APPR. / (916)319-2081