1| SENATE FLOOR VERSION |
| February 16, 2026 |
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3|SENATE BILL NO. 1642 By: Frix of the Senate |
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4| and |
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5| Marti of the House |
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6| |
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7| |
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8| An Act relating to controlled dangerous substances; |
| amending 63 O.S. 2021, Section 2-309I, as amended by |
9| Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp. |
| 2025, Section 2-309I), which relates to prescription |
10| limits and rules for opioid drugs; authorizing |
| divided quantities for certain acute pain |
11| prescriptions; updating statutory language; modifying |
| statutory references; and providing an effective |
12| date. |
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15|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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16| SECTION 1. AMENDATORY 63 O.S. 2021, Section 2-309I, as |
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17|amended by Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp. 2025, |
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18|Section 2-309I), is amended to read as follows: |
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19| Section 2-309I. A. A practitioner shall not issue an initial |
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20|prescription for an opioid drug in a quantity exceeding a seven-day |
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21|supply for treatment of acute pain. Any opioid prescription for |
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22|acute pain shall be for the lowest effective dose of an |
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23|immediate-release drug. |
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1| B. Prior to issuing an initial prescription for an opioid drug |
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2|in a course of treatment for acute or chronic pain, a practitioner |
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3|shall: |
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4| 1. Take and document the results of a thorough medical history, |
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5|including the experience of the patient with nonopioid medication |
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6|and nonpharmacological pain-management approaches and substance |
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7|abuse history; |
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8| 2. Conduct, as appropriate, and document the results of a |
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9|physical examination; |
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10| 3. Develop a treatment plan with particular attention focused |
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11|on determining the cause of pain of the patient; |
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12| 4. Access relevant prescription monitoring information from the |
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13|central repository pursuant to Section 2-309D of this title; |
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14| 5. Limit the supply of any opioid drug prescribed for acute |
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15|pain to a duration of no more than seven (7) days as determined by |
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16|the directed dosage and frequency of dosage; provided, however, upon |
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17|issuing an initial prescription for acute pain pursuant to this |
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18|section, the practitioner may issue one (1) subsequent prescription |
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19|for an opioid drug in a quantity not to exceed seven (7) days if: |
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20| a. the subsequent prescription is due to a major |
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21| surgical procedure or "confined to home" status as |
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22| defined in 42 U.S.C., Section 1395n(a), |
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23| b. the practitioner provides the subsequent prescription |
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24| on the same day as the initial prescription, |
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1| c. the practitioner provides written instructions on the |
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2| subsequent prescription indicating the earliest date |
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3| on which the prescription may be filled, otherwise |
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4| known as a "do not fill until" date, and |
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5| d. the subsequent prescription is dispensed no more than |
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6| five (5) days after the "do not fill until" date |
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7| indicated on the prescription; |
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8| 6. In the case of a patient under the age of eighteen (18) |
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9|years, enter into a patient-provider agreement with a parent or |
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10|guardian of the patient; and |
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11| 7. 6. In the case of a patient who is a pregnant woman, enter |
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12|into a patient-provider agreement with the patient. |
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13| B. 1. A practitioner shall not issue an initial prescription |
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14|for an opioid drug for treatment of acute pain in a quantity |
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15|exceeding a seven-day supply, as determined by the directed dosage |
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16|and frequency of dosage. |
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17| 2. Any initial or subsequent opioid prescription for acute pain |
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18|shall be for the lowest effective dose of an immediate-release drug. |
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19| 3. The practitioner may issue the initial seven-day |
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20|prescription in divided quantities, which shall only count as a |
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21|single prescription for purposes of the requirements of this |
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22|section. |
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23| C. No Except as provided in subsection D of this section, no |
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24|less than seven (7) days after issuing the initial acute pain |
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1|prescription pursuant to subsection A B of this section, the |
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2|practitioner, after consultation with the patient, may issue a |
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3|subsequent acute pain prescription for the opioid drug to the |
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4|patient in a quantity not to exceed seven (7) days, provided that: |
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5| 1. The subsequent prescription would not be deemed an initial |
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6|prescription under this section; |
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7| 2. The practitioner determines the prescription is necessary |
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8|and appropriate to the treatment needs of the patient and documents |
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9|the rationale for the issuance of the subsequent prescription; and |
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10| 3. The practitioner determines that issuance of the subsequent |
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11|prescription does not present an undue risk of abuse, addiction or |
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12|diversion and documents that determination. |
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13| D. 1. The practitioner may issue the subsequent seven-day |
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14|acute pain prescription under subsection C of this section in |
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15|divided quantities, which shall only count as a single prescription |
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16|for purposes of the requirements of this section. |
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17| 2. Notwithstanding the timing and quantity restrictions |
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18|specified in subsection C of this section, upon issuing an initial |
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19|prescription of an opioid drug for acute pain under subsection B of |
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20|this section, the practitioner may simultaneously issue one |
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21|subsequent prescription for an opioid drug in a quantity not to |
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22|exceed seven (7) days if: |
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1| a. the subsequent prescription is due to a major |
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2| surgical procedure or confined to home status as |
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3| described in 42 U.S.C., Section 1395n(a), |
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4| b. the practitioner provides the subsequent prescription |
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5| on the same day as the initial prescription, |
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6| c. the practitioner provides written instructions on the |
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7| subsequent prescription indicating the earliest date |
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8| on which the prescription may be filled, otherwise |
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9| known as a "do not fill until" date, and |
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10| d. the subsequent prescription is dispensed no more than |
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11| five (5) days after the "do not fill until" date |
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12| indicated on the prescription. |
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13| E. Prior to issuing the initial prescription of an opioid drug |
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14|in a course of treatment for acute or chronic pain and again prior |
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15|to issuing the third prescription of the course of treatment, a |
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16|practitioner shall discuss with the patient or the parent or |
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17|guardian of the patient if the patient is under eighteen (18) years |
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18|of age and is not an emancipated minor, the risks associated with |
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19|the drugs being prescribed, including, but not limited to: |
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20| 1. The risks of addiction and overdose associated with opioid |
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21|drugs and the dangers of taking opioid drugs with alcohol, |
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22|benzodiazepines and other central nervous system depressants; |
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23| 2. The reasons why the prescription is necessary; |
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24| 3. Alternative treatments that may be available; and |
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1| 4. Risks associated with the use of the drugs being prescribed, |
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2|specifically that opioids are highly addictive, even when taken as |
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3|prescribed, that there is a risk of developing a physical or |
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4|psychological dependence on the controlled dangerous substance, and |
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5|that the risks of taking more opioids than prescribed or mixing |
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6|sedatives, benzodiazepines or alcohol with opioids can result in |
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7|fatal respiratory depression. |
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8| The practitioner shall include a note in the medical record of |
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9|the patient that the patient or the parent or guardian of the |
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10|patient, as applicable, has discussed with the practitioner the |
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11|risks of developing a physical or psychological dependence on the |
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12|controlled dangerous substance and alternative treatments that may |
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13|be available. The applicable state licensing board of the |
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14|practitioner shall develop and make available to practitioners |
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15|guidelines for the discussion required pursuant to this subsection. |
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16| E. F. At the time of the issuance of the third prescription for |
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17|an opioid drug, the practitioner shall enter into a patient-provider |
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18|agreement with the patient. |
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19| F. G. When an opioid drug is continuously prescribed for three |
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20|(3) months or more for chronic pain, the practitioner shall: |
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21| 1. Review, at a minimum of every three (3) months, the course |
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22|of treatment, any new information about the etiology of the pain, |
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23|and the progress of the patient toward treatment objectives and |
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24|document the results of that review; |
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1| 2. In the first year of the patient-provider agreement, assess |
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2|the patient prior to every renewal to determine whether the patient |
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3|is experiencing problems associated with an opioid use disorder as |
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4|defined by the American Psychiatric Association and document the |
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5|results of that assessment. Following one (1) year of compliance |
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6|with the patient-provider agreement, the practitioner shall assess |
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7|the patient at a minimum of every six (6) months; |
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8| 3. Periodically make reasonable efforts, unless clinically |
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9|contraindicated, to either stop the use of the controlled substance, |
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10|decrease the dosage, or try other drugs or treatment modalities in |
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11|an effort to reduce the potential for abuse or the development of an |
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12|opioid use disorder as defined by the American Psychiatric |
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13|Association and document with specificity the efforts undertaken; |
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14| 4. Review the central repository information in accordance with |
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15|Section 2-309D of this title; and |
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16| 5. Monitor compliance with the patient-provider agreement and |
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17|any recommendations that the patient seek a referral. |
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18| G. H. 1. Any prescription for acute pain pursuant to this |
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19|section shall have the words "acute pain" notated on the face of the |
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20|prescription by the practitioner. |
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21| 2. Any prescription for chronic pain pursuant to this section |
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22|shall have the words "chronic pain" notated on the face of the |
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23|prescription by the practitioner. |
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1| H. I. This section shall not apply to a prescription for a |
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2|patient: |
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3| 1. Who has sickle cell disease; |
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4| 2. Who is in treatment for cancer or receiving aftercare cancer |
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5|treatment; |
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6| 3. Who is receiving hospice care from a licensed hospice; |
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7| 4. Who is receiving palliative care in conjunction with a |
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8|serious illness; |
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9| 5. Who is a resident of a long-term care facility; or |
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10| 6. For any medications that are being prescribed for use in the |
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11|treatment of substance abuse or opioid dependence. |
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12| I. J. Every policy, contract, or plan delivered, issued, |
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13|executed, or renewed in this state, or approved for issuance or |
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14|renewal in this state by the Insurance Commissioner, and every |
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15|contract purchased by the Employees Group Insurance Division of the |
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16|Office of Management and Enterprise Services, on or after November |
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17|1, 2018, that provides coverage for prescription drugs subject to a |
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18|copayment, coinsurance or deductible shall charge a copayment, |
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19|coinsurance, or deductible for an initial prescription of an opioid |
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20|drug prescribed pursuant to this section that is either: |
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21| 1. Proportional between the cost sharing for a thirty-day |
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22|supply and the amount of drugs the patient was prescribed; or |
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23| 2. Equivalent to the cost sharing for a full thirty-day supply |
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24|of the drug, provided that no additional cost sharing may be charged |
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1|for any additional prescriptions for the remainder of the thirty-day |
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2|supply. |
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3| J. K. Any practitioner authorized to prescribe an opioid drug |
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4|shall adopt and maintain a written policy or policies that include |
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5|execution of a written agreement to engage in an informed consent |
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6|process between the prescribing practitioner and qualifying opioid |
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7|therapy patient. For the purposes of this section, "qualifying |
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8|opioid therapy patient" means: |
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9| 1. A patient requiring opioid treatment for more than three (3) |
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10|months; |
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11| 2. A patient who is prescribed benzodiazepines and opioids |
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12|together for more than one twenty-four-hour period; or |
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13| 3. A patient who is prescribed a dose of opioids that exceeds |
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14|one hundred (100) morphine equivalent doses. |
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15| K. L. Nothing in the Anti-Drug Diversion Act this section shall |
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16|be construed to require a practitioner to limit or forcibly taper a |
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17|patient on opioid therapy. The standard of care requires effective |
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18|and individualized treatment for each patient as deemed appropriate |
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19|by the prescribing practitioner without an administrative or |
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20|codified limit on dose or quantity that is more restrictive than |
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21|approved by the Food and Drug Administration (FDA). |
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22| SECTION 2. This act shall become effective November 1, 2026. |
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23|COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES |
|February 16, 2026 - DO PASS |
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