Texas Equine Veterinary Association

www.texasequineva.com • Page 17 supported the veterinary profession to participate in a House floor debate on an amendment to once again remove veterinarians from SB316. Quite unexpectedly and perhaps due to opposition, SB316 never had the chance to make it to the House floor to be debated because the Calendars committee did not set the bill to be heard on the house floor before a key legislative deadline. Next came a movement to amend portions of the now dead SB316 into other bills that were still working their way through the end of the legislative process. TVMA worked to make sure that these proposed amendments did not include mandates on veterinarians. Finally, much of SB316 was successfully amendment onto the Texas State Board of Pharmacy's sunset bill HB2561. WHAT ACTUALLY BECAME LAW The sunset bill for the Texas State Board of Pharmacy, HB2561 contains a number of new laws related to the practice of pharmacy but this article only describes the provisions that may touch veterinary practice as it relates to the Texas Prescription Drug Monitoring Program (PMP). HB2561 requires the Texas State Board of Pharmacy to consult with other listed regulatory agencies (including the Texas State Board of Veterinary Medical Examiners or state veterinary board) to identify harmful prescribing practices, conduct and prescriber or patient activity that may suggest drug diversion or drug abuse. Specifically, each regulatory agency, (including the state veterinary board) is required to promulgate specific guidelines for its own licensees relating to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. Each agency (including the state veterinary board) shall periodically access the information submitted to the PMP to determine whether a prescriber is engaging in potentially harmful prescribing patterns or practices. If, during one of these checks, the regulatory agency finds evidence that a prescriber may be engaging in potentially harmful prescribing patterns or practices, the regulatory agency may notify that prescriber or open a complaint if they believe that there is a violation of the law. Each regulatory agency shall provide the pharmacy board with contact information for each prescriber or dispenser to automatically register the prescriber or dispenser with the PMP system so that they might have access to retrieve information. This will also allow the pharmacy board to send out the required electronic push notifications to licensees and the appropriate regulatory agency if a potentially harmful prescribing pattern or practice or diversion is detected. Prescribers and pharmacists, other than veterinarians who are specifically exempt, are required to lookup patients before prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol. However, a veterinarian may choose to access this information, but if they do so, it may only be for prescriptions dispensed to the animals of an owner and the veterinarian may not consider the personal prescription history of the owner. The bill further creates a joint interim committee composed of three senators appointed by the Lieutenant Governor and three house members appointed by the Speaker of the House to submit a report to the legislature before January 1, 2019. This interim committee has a long list of more than 10 things they are charged with investigating, including three that related specifically to veterinary practice including: - evaluate the existence and scope of diversion of controlled substances by animal owners to whom the substances are dispensed by veterinarians; - explore the best methods for preventing the diversion of controlled substances by animal owners; and - determine how any future reporting by dispensing veterinarians might best be tailored to fit the practice of veterinary medicine. NEW POWERS OF THE TSBVME It's important to note that the sunset bill of the state veterinary board, SB319, also contained some very similar requirements to the ones in the pharmacy boards sunset bill, HB2561. SB319 also required the state veterinary board to periodically check the prescribing and dispensing information submitted to the Texas State Board of Pharmacy to determine whether a veterinarian is engaging in potentially harmful prescribing or dispensing patterns or practices. The board is further required to coordinate with the Texas State Board of Pharmacy to determine conduct that constitutes a "potentially harmful prescribing or dispensing pattern or practice." At a minimum, the board, shall consider the number of times a veterinarian prescribes or dispenses, opioids, benzodiazepines, barbiturates, or carisoprodol. The board shall also consider patterns of prescribing or dispensing combinations of those drugs and other dangerous combinations of drugs identified by the board. If the board suspects that a veterinarian may be engaging in "potentially harmful prescribing or dispensing patterns or practices" they may notify the veterinarian and may initiate a complaint. Since veterinarians are not required to report dispensing information into the PMP, in order to perform the periodic checks required by SB319 and HB2561 regulatory agencies will probably have to look at the information that is submitted to the PMP by pharmacists who fill veterinary prescriptions. The state veterinary board may also develop procedures for reviewing information of this nature during inspections. WHAT'S NEXT FOR VETERINARIANS AND THE PMP The takeaways here are that it took the grassroots work of our TVMA members and a massive lobby effort to ensure that there are no specific PMP mandates on veterinarians. However, this is absolutely not the last that the veterinary profession will hear about the Texas Prescription Drug Monitoring Program. TVMA and the veterinary profession will need to participate in the interim study required by HB2561. Many think it likely that the study will be unable to uncover any widespread evidence of "doctor shopping" in the veterinary profession. Perhaps, the results of the study may not promote the need for additional mandates on the veterinary profession and legislators will lose interest and not attempt to drag veterinarians back into the program during the next legislative session. However, if legislators do seek to revisit the veterinary portion of this issue next session the profession may be in a much better position to fight another battle because it will not be under the specter of sunset review and a must pass bill. It's also possible that fixes can be made to the PMP program that more specifically tailor it to the practice of veterinary medicine and make it less burdensome for veterinarians. Regardless, the Texas State Board of Veterinary Medical Examiners now possesses more regulatory authority in the realm of prescribing and dispensing controlled drugs than ever before. Many of the new laws described will require the agency to pass administrative rules to properly implement this power. However, when the time comes to write and implement the rules, the majority of the state veterinary board members and staff will be new. The board will need to seek assistance from the veterinary profession because they may lack much of the expertise needed to fully visualize all of the important factors that must be considered to properly draft some of the necessary administrative rules. For example, what is a "potentially harmful prescribing or dispensing patterns or practice" in each and every practice type. The veterinary profession will need to be on guard to make sure that the state board does not inadvertently ban appropriate and necessary practices because they may not fully understand them. When the state board does propose rules, TVMA will guide practicing veterinarians in responding and making public comments to the board. All in all, it's in everyone best interest that the upcoming actions by the state veterinary board are well reasoned, fair, non-disruptive to veterinary practice, and defensible in future reviews by the sunset commission. If you have any questions, please contact TVMA Director of Government Relations/General Counsel Elizabeth Choate, JD, at echoate@tvma.org or 512/452-4224.

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