BOM Updates Pain Management Rules

The Board of Medicine (BOM) has voted to update its administrative rules regarding appropriate pain management. The new rules, which take effect November 27, 2019, are part of ongoing implementation of the 2018 Opioid Omnibus Legislation that was overwhelmingly passed by the legislature. Extensive stakeholder input on these proposed rules has repeatedly delayed implementation as the board sought to address concerns raised by many in the medical community regarding the impact of these far-reach pain management rules.

Prescription Monitoring Program

The new rules implement a number of legislative mandates, including the requirement that all prescribers register for the prescription monitoring program (PMP) at the time of applying for or renewing their Controlled Substance Act registration with the Board of Pharmacy (BOP). Physicians or their designated agents are also required to check the PMP prior to issuing an opioid prescription. This PMP use mandate does not apply in instances where the patient is in hospice, a long-term care facility, or an in-patient setting. Earlier this year, the BOP updated its PMP rules to remove the previous cap on the number of agents a prescriber may designate to access the PMP on his or her behalf. The rules now allow prescribers to designate as many agents as they deem appropriate.

Electronic Prescribing

The new BOM rules also incorporate the legislative mandate that all prescriptions – controlled and noncontrolled substances – must be electronically prescribed starting January 1, 2020. Over the past several months, we have been telling you about this new eRX mandate. The deadline to apply for exemptions to this mandate has now passed, however, there are a number of standing exceptions including prescriptions for patients in long-term care and in-patient facilities. More information on the eRX mandate is available on the BOP website.

CDC Opioid Prescribing Guidelines

In these updates rules, the BOM also clarifies the role of the CDC Opioid Prescribing Guidelines in helping to guide appropriate pain management for the treatment of patients with chronic pain. Since their release in 2016, many policymakers have viewed the guidelines as a panacea for guiding all opioid prescribing. In crafting these updated rules, the BOM sought to acknowledge that treatment of acute pain is very different than treatment of chronic pain and the CDC prescribing guidelines are not appropriate in many acute settings.

Grounds for Physician Discipline

Finally, the new rules implement a statutory requirement that licensing boards must adopt procedures to discipline practitioners who prescribe excessive levels of opioids. Seeking to account for situations in which it may be appropriate for physicians to prescribe higher levels of opioids, the BOM rules avoid a hard and fast threshold for discipline. Instead, the rules delineate that a physician may be subject to discipline if he or she prescribes opioids in “dosage amounts exceeding what would be prescribed by a reasonably prudent physician in the state of Iowa acting in the same or similar circumstances.”

As with other licensure disciplinary matters, these grounds for discipline will be a complaint-driven process. BOM investigators will review any complaint and licensees will be given the opportunity to articulate why a higher level of opioid prescribing may be appropriate for their individual clinical setting.

The full text of the new administrative rules has been published in the latest Administrative Bulletin. For more information on this issue, please contact Dennis Tibben with the IMS Center for Physician Advocacy.

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