Okla. Stat. tit. 63, § 63-2-309I

and other insurance requirements – Informed consent process.

A. A practitioner shall not issue an initial prescription for

an opioid drug in a quantity exceeding a seven-day supply for

treatment of acute pain. Any opioid prescription for acute pain

shall be for the lowest effective dose of an immediate-release drug.

B. Prior to issuing an initial prescription for an opioid drug

in a course of treatment for acute or chronic pain, a practitioner

shall:

1. Take and document the results of a thorough medical history,

including the experience of the patient with nonopioid medication

and nonpharmacological pain-management approaches and substance

abuse history;

2. Conduct, as appropriate, and document the results of a

physical examination;

3. Develop a treatment plan with particular attention focused

on determining the cause of pain of the patient;

4. Access relevant prescription monitoring information from the

central repository pursuant to Section 2-309D of this title;

5. Limit the supply of any opioid drug prescribed for acute

pain to a duration of no more than seven (7) days as determined by

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the directed dosage and frequency of dosage; provided, however, upon

issuing an initial prescription for acute pain pursuant to this

section, the practitioner may issue one (1) subsequent prescription

for an opioid drug in a quantity not to exceed seven (7) days if:

a. the subsequent prescription is due to a major surgical

procedure or "confined to home" status as defined in

42 U.S.C., Section 1395n(a),

b. the practitioner provides the subsequent prescription

on the same day as the initial prescription,

c. the practitioner provides written instructions on the

subsequent prescription indicating the earliest date

on which the prescription may be filled, otherwise

known as a "do not fill until" date, and

d. the subsequent prescription is dispensed no more than

five (5) days after the "do not fill until" date

indicated on the prescription;

6. In the case of a patient under the age of eighteen (18)

years, enter into a patient-provider agreement with a parent or

guardian of the patient; and

7. In the case of a patient who is a pregnant woman, enter into

a patient-provider agreement with the patient.

C. No less than seven (7) days after issuing the initial

prescription pursuant to subsection A of this section, the

practitioner, after consultation with the patient, may issue a

subsequent prescription for the drug to the patient in a quantity

not to exceed seven (7) days, provided that:

1. The subsequent prescription would not be deemed an initial

prescription under this section;

2. The practitioner determines the prescription is necessary

and appropriate to the treatment needs of the patient and documents

the rationale for the issuance of the subsequent prescription; and

3. The practitioner determines that issuance of the subsequent

prescription does not present an undue risk of abuse, addiction or

diversion and documents that determination.

D. Prior to issuing the initial prescription of an opioid drug

in a course of treatment for acute or chronic pain and again prior

to issuing the third prescription of the course of treatment, a

practitioner shall discuss with the patient or the parent or

guardian of the patient if the patient is under eighteen (18) years

of age and is not an emancipated minor, the risks associated with

the drugs being prescribed, including but not limited to:

1. The risks of addiction and overdose associated with opioid

drugs and the dangers of taking opioid drugs with alcohol,

benzodiazepines and other central nervous system depressants;

2. The reasons why the prescription is necessary;

3. Alternative treatments that may be available; and

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4. Risks associated with the use of the drugs being prescribed,
iction and overdose associated with opioid

drugs and the dangers of taking opioid drugs with alcohol,

benzodiazepines and other central nervous system depressants;

2. The reasons why the prescription is necessary;

3. Alternative treatments that may be available; and

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4. Risks associated with the use of the drugs being prescribed,

specifically that opioids are highly addictive, even when taken as

prescribed, that there is a risk of developing a physical or

psychological dependence on the controlled dangerous substance, and

that the risks of taking more opioids than prescribed or mixing

sedatives, benzodiazepines or alcohol with opioids can result in

fatal respiratory depression.

The practitioner shall include a note in the medical record of

the patient that the patient or the parent or guardian of the

patient, as applicable, has discussed with the practitioner the

risks of developing a physical or psychological dependence on the

controlled dangerous substance and alternative treatments that may

be available. The applicable state licensing board of the

practitioner shall develop and make available to practitioners

guidelines for the discussion required pursuant to this subsection.

E. At the time of the issuance of the third prescription for an

opioid drug, the practitioner shall enter into a patient-provider

agreement with the patient.

F. When an opioid drug is continuously prescribed for three (3)

months or more for chronic pain, the practitioner shall:

1. Review, at a minimum of every three (3) months, the course

of treatment, any new information about the etiology of the pain,

and the progress of the patient toward treatment objectives and

document the results of that review;

2. In the first year of the patient-provider agreement, assess

the patient prior to every renewal to determine whether the patient

is experiencing problems associated with an opioid use disorder as

defined by the American Psychiatric Association and document the

results of that assessment. Following one (1) year of compliance

with the patient-provider agreement, the practitioner shall assess

the patient at a minimum of every six (6) months;

3. Periodically make reasonable efforts, unless clinically

contraindicated, to either stop the use of the controlled substance,

decrease the dosage, try other drugs or treatment modalities in an

effort to reduce the potential for abuse or the development of an

opioid use disorder as defined by the American Psychiatric

Association and document with specificity the efforts undertaken;

4. Review the central repository information in accordance with

Section 2-309D of this title; and

5. Monitor compliance with the patient-provider agreement and

any recommendations that the patient seek a referral.

G. 1. Any prescription for acute pain pursuant to this section

shall have the words "acute pain" notated on the face of the

prescription by the practitioner.

2. Any prescription for chronic pain pursuant to this section

shall have the words "chronic pain" notated on the face of the

prescription by the practitioner.

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H. This section shall not apply to a prescription for a

patient:

1. Who has sickle cell disease;

2. Who is in treatment for cancer or receiving aftercare cancer

treatment;

3. Who is receiving hospice care from a licensed hospice;

4. Who is receiving palliative care in conjunction with a

serious illness;

5. Who is a resident of a long-term care facility; or

6. For any medications that are being prescribed for use in the

treatment of substance abuse or opioid dependence.

I. Every policy, contract or plan delivered, issued, executed

or renewed in this state, or approved for issuance or renewal in

this state by the Insurance Commissioner, and every contract

purchased by the Employees Group Insurance Division of the Office of
term care facility; or

6. For any medications that are being prescribed for use in the

treatment of substance abuse or opioid dependence.

I. Every policy, contract or plan delivered, issued, executed

or renewed in this state, or approved for issuance or renewal in

this state by the Insurance Commissioner, and every contract

purchased by the Employees Group Insurance Division of the Office of

Management and Enterprise Services, on or after November 1, 2018,

that provides coverage for prescription drugs subject to a

copayment, coinsurance or deductible shall charge a copayment,

coinsurance or deductible for an initial prescription of an opioid

drug prescribed pursuant to this section that is either:

1. Proportional between the cost sharing for a thirty-day

supply and the amount of drugs the patient was prescribed; or

2. Equivalent to the cost sharing for a full thirty-day supply

of the drug, provided that no additional cost sharing may be charged

for any additional prescriptions for the remainder of the thirty-day

supply.

J. Any practitioner authorized to prescribe an opioid drug

shall adopt and maintain a written policy or policies that include

execution of a written agreement to engage in an informed consent

process between the prescribing practitioner and qualifying opioid

therapy patient. For the purposes of this section, "qualifying

opioid therapy patient" means:

1. A patient requiring opioid treatment for more than three (3)

months;

2. A patient who is prescribed benzodiazepines and opioids

together for more than one twenty-four-hour period; or

3. A patient who is prescribed a dose of opioids that exceeds

one hundred (100) morphine equivalent doses.

K. Nothing in the Anti-Drug Diversion Act shall be construed to

require a practitioner to limit or forcibly taper a patient on

opioid therapy. The standard of care requires effective and

individualized treatment for each patient as deemed appropriate by

the prescribing practitioner without an administrative or codified

limit on dose or quantity that is more restrictive than approved by

the Food and Drug Administration (FDA).