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The “Partial Fills” Legislation; The Best Solution Against Over-Prescription?

A state senator from Quincy has presented a bill seeking to grant patients the authority to request that narcotic prescriptions be filled in lower quantities and then pay lower sliding-scale co-payments. This legislation tabled by Sen. John Keenan has received massive support from doctors but vehemently opposed by an insurance industry group who termed it afoul of the federal law. The senator, under the bill and with reference to the state’s current struggles with painkiller prescription addiction, said that the legislation will allow one to ask for a reduction in the 30-day supply to a 15-day or even a 5-day.

Appearing before the Mental and Substance Abuse Committee, he said that individuals sometimes don’t feel obliged to open up concerning their prescription requirements with their doctors. The central idea advocated by the senator is to allow every patient a space of freedom, what the opposing group is against.

The group made up of 17 insurance associations, the Massachusetts Association of Health Plans (MAHP) argued against the Bill. They noted that pharmacists don’t require informing their insurers or even their benefits managers of their partially-filled prescription forms, citing chances of confusion in their testimony to lawmakers. The testimony further raised concerns over the decision to throw out the prescriber’s decision from the information obtained during the time of prescription.

The lawmakers who supported the 2014 landmark law with a motive of creating a clearer path to substance abuse appeared leaning towards accepting these extra measures in addressing opiate use. In what seemed to highlight their mission, Committee member Rep. Carole Fiola of Fall River cited some cases of what she called “Absurd” and even those moments when people are afraid to challenge a prescription with an example of individuals who have been mistakenly over-prescribed "benzos," or benzodiazepines, calling them "zombies."

In support of the senator’s appeal, an assistant counsel at the "Massachusetts Medical Society" (Society), Brendan Abel saying that the initial dose should be so minimum that it can achieve its desired use without much side effects, what the society typically advocates on the opioid therapies. The society, however, termed “the minimum effective dosage” a moving target, what Abel said that the partial fills law will help determine with ease.

The medical society meanwhile hopes for an amendment for the validity of the “partially filled” situation to avoid follow-ups to get the remainder of the prescription. Speaking to the News Service, Abel further disclosed that the legislation includes a language or communication requirement between a pharmacist and a physician about if the patient got less than the full quantity of the prescription.

The group, through their testimony further added that excessive prescriptions can lead to opioid misuse and even addiction. Additionally, up to 80% of persons abusing opioids, according to the Centers for Disease Control and Prevention, didn’t get them from a valid prescription. Partial filling, therefore, will reduce the number of drugs available to potential abusers.

The association wrote that the remaining drugs should be pharmacists duty to inform the physician while the pending balance is forfeited. They even argued that their systems aren’t designed to pro-rate co-pays, and any changes are “complex.”

MAHP, however, termed educating the prescriber a "much more sensible approach," while acknowledging Gov. Charlie Baker's Opioid Working Group partial refills on all payers together with a single-time co-payment.
Sen. Keenan is collaborating with the medical society on a prescribing protocol bill (S 1041), what he said are similar to the Blue Cross Blue Shield of Massachusetts’ efforts.

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