July 2019 Regulatory Roundup – Hospice and Palliative Care Industry Updates

DEA Hospice ruling iconEnclara Pharmacia’s Compliance Team works to ensure we are staying abreast of regulatory changes and offering tools and resources to our clients to minimize the impact on patient care. Taking into account the increased regulatory changes impacting the industry, we are committed to keeping the industry informed of the legislative happenings impacting hospice pharmacy practice. John Loxterman, Chief Ethics and Compliance Officer summarizes recent April, May and June happenings below.


Naloxone Co-Prescribing:

Several state legislatures considered bills to require co-prescribing of naloxone when prescribing opioids.

We heard from several clients about the proposed bill in California to exempt hospice patients from the state’s naloxone co-prescribing mandate. There appears to be some confusion among the hospice community about this bill. To be clear the bill (AB 714) is still pending in the legislature and has not been enacted. The bill has passed the assembly and is in committee in the senate. Interested California hospices should contact the California Hospice & Palliative Care Association to get involved on this important issue.

Tennessee enacted a law requiring the commissioner of health to study the circumstances when co-prescribing would be beneficial and report findings to the health care practitioner licensing authorities and the board of pharmacy. The bill was originally introduced as a broad co-prescribing mandate. We are pleased to see the measure transformed into a study bill. Hospice providers in the state should offer the commissioner of health evidence on the danger of co-prescribing naloxone to hospice patients.

Legislators in Illinois introduced a naloxone co-prescribing bill in the house. Enclara Pharmacia worked with clients in Illinois and the Illinois Home Care & Hospice Council to educate legislators on the need to exempt hospice patients from the mandate should they move forward. The bill is currently in committee.


Prescription Monitoring Programs (PMPs):

A bill to exempt prescriptions for hospice and palliative care patients from Florida’s mandate to check the state PMP prior to prescribing or dispensing was passed on June 7, 2019. The bill was championed by the Florida Hospice and Palliative Care Association and is a significant “win” for hospice and palliative care practitioners. The exemption takes effect on July 1, 2019.


State Mandates for Electronic Prescribing:

The map below outlines states with electronic prescribing mandates that have been passed or enacted.


Kentucky enacted a law requiring electronic prescribing for all controlled substances. The effective date is January 1, 2021. The law has several exceptions, including for prescriptions sent to non-resident pharmacies and prescriptions for hospice patients.

South Carolina has enacted a law requiring electronic prescribing of all controlled substances. The law is effective January 1, 2021. The law includes several exemptions, such as for prescriptions for patients in hospice facilities.

Nevada passed a law requiring electronic prescribing of all controlled substances. The law is effective January 1, 2021. The law includes several exemptions, such as for prescriptions dispensed by non-resident pharmacies.

Finally, Florida passed a law that requires prescribers who have an EMR or who practice as an employee or contractor of a health care facility that utilizes an EMR to submit all prescriptions electronically. The bill has several exemptions including for prescriptions for hospice patients. The bill was signed by the governor on June 18 and becomes effective on January 1, 2020.


Automated Dispensing Systems (ADS):

On May 2, 2019 the Massachusetts Board of Pharmacy approved a joint policy statement with the Department of Public Health allowing the use of automated dispensing systems (ADS) in health care facilities without an on-site pharmacy. The policy permits the use of ADS for continuous dosing.

The Board of Pharmacy and the Bureau of Health Care Quality, which licenses hospice inpatient units (IPUs), must issue specific guidance for the use of ADS in hospice IPUs before the agencies will permit such use. The Board expects to issue guidance on this topic in the next two to three months.

We are working closely with the board to secure approval of ADS in hospice IPUs because we believe this technology is safe, secure and provides the most effective and timely option for patients.



Interested in learning more about the regulatory changes impacting hospice pharmacy practice? Please reach out to your designated Account Manager or contact us here. We look forward to continuing the regulatory conversation with you and your hospice.