Amends TCA Title 33; Title 53; Title 63 and Title 68.

ON APRIL 17, 2019, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 656, AS AMENDED.<br /> <br /> AMENDMENT #1 rewrites this bill. Under present law, only licensed physicians are authorized to prescribe any buprenorphine product for any federal food and drug administration approved use in recovery or medication-assisted treatment. Other healthcare providers who are otherwise permitted to prescribe Schedule II or Ill drugs are prohibited from prescribing any buprenorphine product for treatment of opioid dependence, but may participate in the assessment and management of patients with an opiate addiction.<br /> <br /> This amendment revises the above provisions to authorize nonphysician healthcare providers who are otherwise permitted to prescribe Schedule II or III drugs to also prescribe a buprenorphine product for the treatment of opioid use disorder if the healthcare provider:<br /> <br /> (A) Is licensed and has practiced as a family, adult, or psychiatric nurse practitioner or physician assistant in this state;<br /> (B) Has had no limitations or conditions imposed on the provider's license by the provider's licensing authority within the previous three years;<br /> (C) Is employed by a community mental health center or a federally qualified health center that employs one or more physicians and has adopted clinical protocols for medication-assisted treatment;<br /> (D) Works under the supervision of a physician who holds a waiver registration from the federal drug enforcement agency that authorizes the physician to prescribe buprenorphine products;<br /> (E) Obtains a waiver registration from the federal drug enforcement agency that authorizes the provider to prescribe buprenorphine products under federal law;<br /> (F) Prescribes buprenorphine products only to patients who are treated through the organization that employs the provider; and<br /> (G) Writes prescriptions that can only be dispensed by a licensed pharmacy to ensure entry into the controlled substance database.<br /> <br /> ON JUNE 11, 2020, THE SENATE SUBSTITUTED HOUSE BILL 656 FOR SENATE BILL 1060, ADOPTED AMENDMENT #1, AND PASSED HOUSE BILL 656, AS AMENDED.<br /> <br /> AMENDMENT #1 incorporates the changes described in the Summary for House Amendment #1, adds several additional requirements that a non-physician prescriber must meet in order to dispense a buprenorphine product under this bill, and changes the effective date from July 1, 2019, to July 1, 2020.<br /> <br /> This amendment adds to the physician oversight requirement described in (D) of the Summary for House Amendment #1 by requiring that, in addition to holding an FDA waiver to prescribe buprenorphine products, the supervising physician must also be actively treating patients with such products for recovery or medication-assisted treatment.<br /> <br /> This amendment adds that, in addition to meeting the requirements added by House Amendment #1, a non-physician prescriber must meet the following in order to dispense a buprenorphine product under this bill:<br /> (1) Be employed at a facility at which healthcare providers are contracted and credentialed with TennCare and TennCare's MCOs to treat opioid use disorder with buprenorphine products for use in recovery or medication-assisted treatment;<br /> (2) Be employed at a facility at which healthcare providers are accepting new TennCare enrollees or patients for treatment of opiate addiction;<br /> (3) Be employed by a facility that requires patients to verify identification;<br /> (4) Not write any prescription for a buprenorphine product that exceeds a sixteen-milligram daily equivalent;<br /> (5) Not prescribe or dispense a mono product or buprenorphine without naloxone;<br /> (6) Be supervised by or collaborate with a physician who is limited to the supervision of, or collaboration for, a maximum of four licensed nurse practitioners or physician assistants;<br /> (7) Be supervised by or collaborates with a physician who reviews one 100 percent of the charts of the patients being prescribed a buprenorphine product;<br /> (8) Weigh the risk of relapse with the benefit of tapering down or off of buprenorphine, and initiate and lead discussion regarding patient readiness to taper down or taper off treatment medications with each patient at any time upon the patient's request but no later than one year after initiating treatment and then every six months thereafter; and<br /> (9) Write prescriptions of buprenorphine products to 50 or fewer patients at any given time.<br /> <br />