Jonathon Kimes 5-13

Corporate Takeover Revisited

In September, I wrote an article about the potential for an overwhelming corporate takeover of all industries, including dentistry. It must have struck a nerve, because I have received more comments on that article than all my other editorials combined. Read more

Jonathon Kimes 5-13

Ghosts, Goblins, and Tooth Fairies

For as long as I’ve been editor of this prestigious newsletter/journal, I’ve wanted to write something more lighthearted, and mainly out of my own curiosity. Read more

Jonathon Kimes 5-13

Is Corporate Takeover Inevitable?

As a part of organized dentistry you often hear debates, and more often complaints, about the rise of corporate dentistry and the effect that the numerous Dental Support Organizations (DSOs) are having on association membership as well as the local economy.  Read more

Jonathon Kimes 5-13

Prescription Monitoring Requirements

With the recent flurry of activity regarding our Sunset Bill, as well as the passage of the Pharmacy Board Sunset Bill, there has been some confusion as to the requirements for dentists and the Prescription Monitoring Program (PMP). The PMP actually has been in place for some time. From the Pharmacy Board website:

The Texas Prescription Monitoring Program (PMP) collects prescription data on ALL Schedule II, III, IV and V controlled substances dispensed by a pharmacy in Texas or to a Texas resident from a pharmacy located in another state. The Texas Prescription Program (TPP) was created by the 67th Texas Legislature in 1981 becoming effective January 1, 1982, to monitor Schedule II controlled substance prescriptions. Effective September 1, 2008, the Texas Legislature expanded the TPP to include the monitoring of Schedule III through V controlled substance prescriptions. Beginning September 1, 2016, the PMP transferred from the Texas Department of Public Safety to the Texas State Board of Pharmacy. Although controlled substances have valid medical uses, they also have potential for abuse and addiction. Diversion of prescription drugs is a significant abuse problem, and this program was created to be an efficient, cost effective tool for investing and preventing drug diversion. Federal controls monitor the substances from manufacture through distribution to retail facilities. The program seeks to educate and control misuse by following controlled substances to the ultimate user. The PMP may be used by practitioners and pharmacists to verify their own records and inquire about patients. In addition, the program may be used to generate and disseminate information regarding prescription trends. Pharmacies that dispense Schedule II, III, IV, and V are required to report the information directly to the Texas State Board of Pharmacy’s contracted vendor, APPRISS. Prescription data is reported by the prescriber’s Federal (DEA) number. Prescribers and pharmacies are required by statute to have a current Federal (DEA) registration in order to possess, administer, prescribe or dispense controlled substances. Pharmacies are required to submit data to the PMP no later than the 7th day after the prescription is completely filled. However, pharmacies may submit more frequently. Pharmacies, who fail to report, are subject to an administrative, civil, or criminal penalty. Access to the prescription data is statutorily restricted. The information is available to practitioners and pharmacies who are inquiring about their own prescribing or dispensing history on their patients. State regulatory boards have access as well. A person who knowingly gives, permits or obtains unauthorized access to this information, is subject to criminal penalty.

The initial recommendation from the Sunset Committee was to require dentists to use PMP to query each patient, each time, a controlled substance is prescribed to help curb opioid abuse tendencies. This language was never introduced into the Dental Board Sunset Bill, but it WAS PASSED with the Pharmacy Board Sunset Bill. According to HB 2561 (Pharmacy Board Sunset Bill) Sec.481.0764 of the Texas Health and Safety Code shall be amended to read:

 

DUTIES OF PRESCRIBERS, PHARMACISTS, AND RELATED HEALTH CARE PRACTITIONERS.

(a) A person authorized to receive information under Section 481.076(a)(5), other than a veterinarian, shall access that information with respect to the patient before prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol.

(b)A person authorized to receive information under Section 481.076(a)(5) may access that information with respect to the patient before prescribing or dispensing any controlled substance.

This “person” the new law refers to is you. The language is slightly vague, as it doesn’t specifically mention the PMP, but the intent is clear. If you write a prescription for the above-mentioned drugs, you will be required to use the PMP to query the patient for each RX. The good news is the implementation of this new law has been pushed back to September 1, 2019. One thing that merits mention; the information contained in the PMP database is sensitive and not public record, therefore you must use the information only as intended or you could face criminal penalty. DO NOT get nosy and search for the prescription patterns of your ex, your neighbor, your children’s teacher, etc. Although we have access to this information, this would be considered misuse…the fall out could be severe.
There are some recent TSBDE rule changes that are currently in effect as of December 2016

Texas Administrative Code, Title 22, Part 5, Chapter 111

Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall complete every three years a minimum of two hours of continuing education in the abuse and misuse of controlled substances, opioid prescription practices, and/or pharmacology. This continuing education may be utilized to fill the continuing education requirements of annual renewal.

Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall annually conduct a minimum of one self-query regarding the issuance of controlled substance through the Prescription Monitoring Program of the Texas State Board of Pharmacy.

Access to the PMP is available through the Pharmacy Board website (https://www.pharmacy.texas.gov/PMP/)

By Jonathon R. Kimes, DDS
Editor, CADS

Jonathon Kimes 5-13

Sine Die Sunset

We made it. On May 29, Governor Abbott signed into law SB 313, the Texas State Board of Dental Examiners Sunset Bill, giving a sigh of relief and a promising sunrise to our profession until 2029. Read more

Jonathon Kimes 5-13

Report on TDA Governance

Article Objectives: one, update you on what is happening in the TDA; two, explain the most important and fundamental reason to be a member; and three, convince you to donate (more) to DENPAC. Read more

Jonathon Kimes 5-13

Editor’s Corner May 2017

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Jonathon Kimes 5-13

Editor’s Corner February 2017

Jonathon Kimes 5-13Regulatory Update

As the 85th Texas Legislature is now in session, you will soon be deluged with information about the legislative session and the State Board of Dental Examiners Sunset Bill.  There are still a few interesting things going on outside of downtown Austin though.

Buda Re-Fluoridates its Community Water Supply

During the November 2015 elections, San Marcos residents voted to stop the fluoridation of their community water supply.  Some surrounding communities were also inadvertently affected.  The City of Buda, for example, buys about half of its water from the same San Marcos plant that stopped fluoridation.  Buda has taken the issue up on its own and will begin fluoridating its water again.  The city has been working with the Texas Fluoridation program since 2015, in preparation for the need.  There was some initial resistance from one Buda City Council member, but his efforts were overcome.  A win for the dental health of the people of Buda!

The EPA has Announced a Final Rule on Amalgam Separators

With the purpose of reducing the amount of environmental mercury contamination, the EPA has announced their final rule, which will require dental offices to have amalgam separators in place within the next 3 years.  The rule also requires submission of a one-time compliance report (not available as of press time) as well as implementation of two ADA best management practices, one that prohibits the discharge of scrap amalgam, and the other which prohibits the use of line cleaners that may lead to the dissolution of solid mercury when cleaning chair-side traps and vacuum lines.  The rule does not apply to mobile units or offices where the practice of dentistry consists only of the following dental specialties: oral pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics, periodontics, or prosthodontics.  For more information, visit www.epa.gov/eg/dental-effluent-guidelines

Class Action Lawsuit against Major Dental Suppliers Moves Forward

Early last year, a class action lawsuit was filed against Henry Schein, Patterson, Burkhart, and Benco Dental Suppliers with claims of price-fixing and violation of anti-trust regulations.  More recently, a federal judge refused to dismiss the case, and the prosecution has asked for a jury trial.  Allegations against the dental suppliers are that they have been “illegally engaging in a conspiracy to boycott competitor dental product distributors and other entities that do business with such competitors, in order to allow Defendants to maintain and extend their dominant collective market power in the market for the distribution of dental supplies and dental equipment (collectively, ‘dental supplies’) in the United States.”  The companies are also accused of blocking the entry and expansion of “lower-margin, lower-priced, rival dental distributors into the market” by engaging in a “concerted and collusive effort that involved threats to boycott collectively, and actual group boycotts of, dental supply and equipment manufacturers, state dental trade associations, dental practices, and other industry participants that chose to deal with or sell to lower-priced dental distributors.”  No trial date has been set.

By Jonathon R. Kimes, DDS

Jonathon Kimes 5-13

Editor’s Corner January 2017

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Editor’s Corner November 2016

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