Massachusetts Health and Hospital Advisory March 28, 2018
This Advisory updates previous guidance MHA issued to members regarding the requirement for prescribers to check the Massachusetts Prescription Awareness Tool (MassPAT) for prescriptions provided to patients as part of the discharge planning process from an inpatient facility or following an outpatient visit.
Overview of Exemptions from MassPAT Requirements
In October 2017, DPH promulgated the final version of 105 CMR 700.00, Implementation of MGL C. 94C, which among other provisions, amended the requirements for prescribers to check MassPAT prior to issuing a prescription for applicable drugs.
The final regulations continued the long-standing requirement that all prescribers must check MassPAT prior to prescribing a schedule II or III narcotic drug, a benzodiazepine, or a Schedule IV-VI drug that DPH designates as a controlled substance. (Please note that at this time DPH has not designated any such drugs.) Under the final regulations, DPH also clarified the term “narcotic” by applying the term to any generic drug product, brand name equivalent of a drug product, or derivative of a drug product listed below:
- Codeine (and its derivatives), including
- Fentanyl (and its derivatives);
- Morphine (and its derivatives) including hydromorphone;
- Opium (including DTO); and
It is important to note that section 105 CMR 700.012 (G)(3) provides the following updated circumstances in which prescribers are exempt from checking MassPAT:(a) A registered individual practitioner authorized to prescribe, administer, possess, order, or dispense samples of controlled substances only in Schedule VI;
(b) A registered individual practitioner providing medical, dental, podiatric, pharmaceutical, or nursing care to hospice patients;
(c) A registered individual practitioner treating a patient in an Emergency Department who does not anticipate writing a prescription for a controlled substance in Schedules II through V during that encounter;
(d) An instance in which emergency care is required and in the professional opinion of the prescriber utilization of the prescription monitoring program is likely to result in patient harm;
(e) A registered individual practitioner providing medical, dental, podiatric, pharmaceutical or nursing care to hospital inpatients;
(f) A registered individual practitioner providing medications for immediate treatment in accordance with M.G.L. c. 94C, § 9(b);
(g) An instance in which it is not reasonably possible to utilize the prescription monitoring program, including when the system is not operational due to temporary technological or electrical failure;
(h) A registered individual practitioner examining or treating a patient under 96 months of age;
(i) A registered individual practitioner granted a waiver pursuant to 105 CMR 700.012(I); and
(j) Other exceptions as defined in guidance issued by DPH.
With the issuance of these regulations, prescribers are now required to check MassPAT when they issue to a patient a prescription as part of the discharge planning process from an inpatient facility or following an outpatient procedure/visit, even if it is going to be filled at an outpatient pharmacy on or off of the hospital’s premises. The final regulations also removed a prior exemption for ED physicians who were issuing a prescription for less than a 5-day supply. As a result, all prescriptions issued from the ED must be checked through MassPAT prior to prescribing. Furthermore, given the exemption outlined in subpart (f) above, prescribers who are issuing a medication order for immediate use or a standing order for medications for prolonged use during the course of treatment in inpatient or skilled nursing care would also be exempt from checking MassPAT.
MHA strongly encourages members to also make sure to check the MassPAT website for additional information and resources, including, but not limited to, those related to registering new providers within your facility or system and usage of a prescriber trend report.
As MHA continues to work with DPH to ensure appropriate implementation of the system, including developing connections between the MassPAT data to hospital EMR systems, we are asking members to let us know of specific issues you may be encountering. In addition, if there are further clarifications needed on the current regulations, please let MHA know so we can work with the appropriate DPH staff. Should you have any questions about the regulations or the clarifications above, please contact MHA Manager of Healthcare Policy Janice Peters at firstname.lastname@example.org or (781) 262-6023.
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