Reminder: CURES duty-to-consult takes effect October 2, 2018 Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload. On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018. Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient. Save the Date: CURES webinar with DOJ on 8/22 CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Register today at cmadocs.org/events. For More Information CURES website: oag.ca.gov/cures CURES FAQ: oag.ca.gov/cures/faqs Medical Board CURES webpage: mbc.ca.gov/cures CMA CURES webpage: cmadocs.org/cures CMA Safe Prescribing webpage: cmadocs.org/safe-prescribing July 24, 2018 General Drug Prescribing/Dispensing, CURES 0 0 Comment Read More »
Are You Ready for CURES! Effective October 2, 2018, physicians must consult California’s prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, or CURES) – prior to prescribing Schedule II, III or IV controlled substances. All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate must be registered to use CURES. Because of the critical importance of adequate technical support for physicians who will have to rely on CURES as a part of their prescribing workflow, the California Medical Association (CMA) negotiated into the final legislation a requirement that the mandate could not take effect until the California Department of Justice (DOJ) certified that the database was ready for statewide use and that the department had adequate staff to handle the related technical and administrative workload. On April 2, 2018—two years after the law was enacted—DOJ finally certified that CURES was ready for statewide use. The certification began a six-month transition period, with the duty-to-consult taking full effect on October 2, 2018. What Physicians Need to Know Under the new mandate, physicians must consult the database prior to prescribing controlled substances to a patient for the first time, and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient. The law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions, so long as the quantity of the controlled substance does not exceed a five-day supply. Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: Admitted to a facility for use while on the premises; In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or Receiving hospice care. In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician. CMA Fights for CURES Protections CMA worked closely with the bill's author and other stakeholders to reach mutually agreeable language, which was reflected in the final version of the bill (SB 482, Lara). Among the negotiated amendments are liability protections related to the duty to consult the database and changes to ensure that health care providers can meet the requirements under state and federal law to provide patients with their own medical information without penalty. The bill also clarifies that health care providers sharing the information within the parameters of HIPAA and the Confidential Medical Information Act, including adding the CURES report to the patient’s medical record, are not out of compliance with the CURES statute. Save the Date: CURES webinar with DOJ on 8/22 CMA will be cohosting a live CURES webinar with DOJ on August 22, 2018. The webinar will be free to all interested parties. Registration will open soon at cmanet.org/events. For More Information For more information, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES).” On-Call documents are free to members in CMA's online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page. Additional Resources: CURES website: oag.ca.gov/cures CURES FAQ: oag.ca.gov/cures/faqs Medical Board CURES webpage: mbc.ca.gov/cures CMA CURES webpage: cmanet.org/cures CMA Safe Prescribing webpage: cmanet.org/safe-prescribing CMA will continue to provide educational resources and work with DOJ to ensure a smooth implementation of the new requirement. Physicians who experience problems with the CURES database should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov. Sidebar 1: CMA publishes safe prescribing resources for physicians The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The page includes two CMA white papers on opioid prescribing, links to CMA’s health law library resources on the topic, the Medical Board of California’s "Guidelines on Prescribing Controlled Substances for Pain," a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state's prescription drug monitoring database. Members can find the page at cmanet.org/safe-prescribing. Sidebar 2: New report shows California’s progress addressing opioid crisis The American Medical Association (AMA) recently issued a new report documenting how California’s physician leadership is advancing the fight against the opioid crisis. The report found a statewide decrease in opioid prescribing, as well as an increase in the use of California’s Controlled Substance Utilization Review and Evaluation System (CURES) database, number of physicians trained and certified to provide patients with buprenorphine for the treatment of opioid us disorder, and naloxone access. California also saw two consecutive years of decreases in prescription-related opioid deaths and surpassed the national average for prescription decreases between 2014 and 2017. “This report demonstrates that California physicians have made significant strides against the opioid crisis by expanding access to effective treatments for substance use disorders,” said California Medical Association (CMA) President Theodore M. Mazer, M.D. “CMA will continue to lead the nation in implementing effective solutions to reduce opioid abuse and ensure that patients have timely access to medically necessary treatment.” For more details on the report visit end-opioid-epidemic.org. By Katherine Boroski is Senior Director of Communications for the California Medical Association. June 26, 2018 General CURES 0 0 Comment Read More »
DOJ certifies CURES: Physicians must check database prior to prescribing effective October 2, 2018 The California Department of Justice (DOJ) has certified that as of April 2, 2018, the Controlled Substance Utilization and Evaluation System (CURES) – California’s prescription drug monitoring database – is ready for statewide use. The certification starts a six-month implementation period for the duty to consult requirements enacted by the Legislature in SB 482 (Lara, 2016). Effective October 2, 2018, physicians must consult CURES prior to prescribing Schedule II, III or IV controlled substances to a patient for the first time and at least once every four months thereafter if that substance remains part of the patient’s treatment. Physicians must consult CURES no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient. This law provides, however, that the requirement to consult CURES would not apply if doing so would result in the patient’s inability to obtain a prescription in a timely manner and adversely impact the patient’s conditions so long as the quantity of the controlled substance does not exceed a five-day supply. Physicians are also not held to this duty to consult when prescribing controlled substances to patients who are: Admitted to a facility for use while on the premises; In the emergency department of a general acute care hospital, so long as the quantity of the controlled substance does not exceed a seven-day supply; As part of a surgical procedure in a clinic, outpatient setting, health facility or dental office, so long as the quantity of the controlled substance does not exceed a five-day supply; or Receiving hospice care. In addition, there are exceptions to the duty to consult when access to CURES is not reasonably possible, CURES is not operational or the database cannot be accessed because of technological limitations that are beyond the control of the physician. As of July 1, 2016, the law mandates that all California licensed physicians authorized to prescribe scheduled drugs and registered with the Drug Enforcement Administration be registered to access CURES. For more information on CURES and the upcoming duty to consult, see CMA On-Call document #3212, “California’s Prescription Drug Monitoring Program: The Controlled Substance Utilization Review and Evaluation System (CURES)” or visit the DOJ’s website and CURES user guide. CMA will continue to provide educational resources and work with the DOJ to ensure a smooth implementation of the new requirement. April 9, 2018 General Department of Justice, DOJ, Drug Prescribing, CURES 0 0 Comment Read More »
Court hears oral arguments in Oregon prescription drug monitoring database case The Ninth Circuit Court of Appeals heard oral arguments earlier this month in a patient privacy case involving law enforcement access to Oregon’s Prescription Drug Monitoring Program (PDMP). The California Medical Association (CMA) joined the American Medical Association and other western state medical associations in 2015 to file an amicus brief with the appeals court challenging the authority of the U.S. Drug Enforcement Administration (DEA) to obtain patients' private prescription records without a court order. In this case, the DEA sought patient-specific information from Oregon’s PDMP through the use of a federal administrative subpoena, which does not involve judicial review or a showing of probable cause. The Oregon PDMP, however, refused to comply with the DEA’s subpoena on the ground that doing so would violate Oregon state law, which requires a court order based on probable cause before patient data in the PDMP can be disclosed to any federal, state or local law enforcement agency. A coalition of plaintiffs that include Oregon’s PDMP, the American Civil Liberties Union (ACLU), patients and physicians filed a lawsuit in federal court against the DEA challenging the use of administrative subpoenas to access PDMP information. The plaintiffs argued that information in the PDMP is protected under the Fourth Amendment of the U.S. Constitution and that the DEA must show probable cause and obtain a warrant prior to accessing such information. The federal trial court sided with the State of Oregon and concluded that the Fourth Amendment prohibits the DEA from issuing administrative subpoenas for the database records. The court held that patients have an expectation of privacy in their prescription information contained in the PDMP stating that it “is difficult to conceive of information that is more private or more deserving of Fourth Amendment protections.” The DEA appealed this ruling to the Ninth Circuit Court of Appeals, whose jurisdiction includes California. The brief filed by the medical associations urges the court to recognize the profound interests that this case places at issue in the areas of patient privacy and the integrity of the patient-physician relationship. The protection of patient privacy “is essential for a patient-physician relationship built on trust … so that patients will seek care and so that doctors may provide the most efficacious health care for the patient’s benefit,” the brief states. It advocates for the strongest possible protections for patient prescription data collected by state prescription drug monitoring programs so that data is used by doctors and pharmacists for responsible treatment and prescription practices and to protect public health and safety, not for the enhancement of federal law enforcement without stringent legal safeguards. Click here to read the medical associations’ brief. A decision from the Ninth Circuit is expected in early 2017. Contact: CMA legal information line, (800) 786-4262 or legalinfo@cmanet.org. November 28, 2016 CMA, General CURES, Drug Prescribing, Privacy 0 0 Comment Read More »
UC Davis and CDPH conduct survey of physicians on CURES The opioid overdose epidemic in California has brought with it heightened interest in California’s Controlled Substance Utilization Review and Evaluation System (CURES). Now, a new effort to understand CURES usage and controlled substance prescribing in California has begun under two multi-year grants to improve CURES and prevent prescription drug overdoses. As part of the grant project, the University of California, Davis, and the California Department of Public Health – in collaboration with the Medical Board of California – are conducting a physician survey to provide insight and information regarding the prescribing of controlled substances in California. The information will also be used to help guide efforts to make CURES more user-friendly and to improve patient care and safety. Physician participation is voluntary. The information will be analyzed only by the research team at UC Davis, and the findings will be presented only in aggregate. No personal or identifying information will be shared with payors or other parties, and individual responses will not be shared with the medical board. Individual responses will NOT be reported to the medical board or to any other state agency. The survey has been approved by the UC Davis Institutional Review Board. If you have any questions about this survey, you can contact the project leader, Stephen Henry, M.D., at (916) 734-2177. Physicians whose licenses expire November 30, 2016, are eligible to participate in the survey. To take the survey, click here. September 22, 2016 General CURES 0 0 Comment Read More »
Deadline to register for CURES is July 1, 2016 Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must register to use the Controlled Substance Utilization Review and Evaluation System (CURES) by July 1, 2016. The California Medical Association (CMA) has compiled a list of educational materials to familiarize physicians with the registration process and key features of the newly upgraded system, CURES 2.0. These resources are available at www.cmanet.org/cures. Among the resources is an on-demand recording of CMA's webinar, cohosted with the Department of Justice (DOJ), to help physicians navigate the CURES 2.0 registration process. The webinar provides an overview of key user features of the updated system and tips on how to avoid technical issues. This webinar is available in CMA's online resource library and is free to all interested parties. Physicians who experience problems with the new system should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or memberservice@cmanet.org. June 8, 2016 General Important Deadline, Webinars, CURES 0 0 Comment Read More »
Opioids: CMA publishes safe prescribing resources for physicians The California Medical Association (CMA) has published a members-only resource page to provide physicians with the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. The page includes both of CMA’s white papers on prescribing opioids, links to CMA’s health law library resources on the topic, the Medical Board of California’s "Guidelines on Prescribing Controlled Substances for Pain," a listing of continuing medical education courses and webinars on pain management and safe prescribing, as well as the latest information on the state's prescription drug monitoring database (the Controlled Substance Utilization Review and Evaluation System, also known as CURES). Members can find the page at www.cmanet.org/safe-prescribing. June 8, 2016 General Drug Prescribing, Opioids, CURES, Drug Abuse, PDMP, Prescription Drugs 0 0 Comment Read More »
Reminder: Deadline to register for CURES is July 1, 2016 Under California law, all individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) must register to use the Controlled Substance Utilization Review and Evaluation System (CURES) by July 1, 2016. The California Medical Association (CMA) has compiled a list of educational materials to familiarize physicians with the registration process and key features of the newly upgraded system, CURES 2.0. These resources are available at www.cmanet.org/cures. Physicians who experience problems with the new system should contact the DOJ CURES Help Desk at (916) 227-3843 or cures@doj.ca.gov. Providers are also encouraged to report these technical issues to CMA's member service center at (800) 786-4262 or memberservice@cmanet.org. The California Medical Association (CMA) recently cohosted a webinar with the Department of Justice to help physicians navigate the CURES 2.0 registration process. The webinar provides an overview of key user features of the updated system and tips on how to avoid technical issues. This webinar is now available on demand in CMA's online resource library and is free to all interested parties. April 18, 2016 General Webinars, CURES, Drug Prescribing 0 0 Comment Read More »
CMA tells California Supreme Court it must protect patient data in CURES The California Medical Association (CMA) has filed an amicus brief with the California Supreme Court asking that it give meaningful privacy protection to patient data contained in the Controlled Substance Utilization Review and Evaluation System (CURES) database. CMA was joined on the brief by the American Medical Association, California Psychiatric Association, California Dental Association and the American Dental Association. This case, Lewis v. Superior Court (Medical Board), examines the constitutionality of the Medical Board of California's practice of routinely data mining the confidential prescription records of California patients. In response to a patient complaint—a complaint that had nothing to do with Dr. Lewis's prescribing practices—the medical board investigator accessed from CURES the prescribing records of every single one of Dr. Lewis's patients during a three-year period. In addition, it obtained three years of confidential prescription records for all medications, including non-controlled substances, dispensed to Dr. Lewis's patients from the corporate headquarters of CVS Pharmacy. The information obtained identified patients by name and included details about medications prescribed to them. The medical board did not obtain any patient authorizations, warrants or issue subpoenas prior to accessing this patient data. CMA’s amicus brief underscores the importance of confidentiality of medical information as an indispensable component of quality medical care. It explains the importance of recognizing that patients have a privacy interest in their medical information maintained in CURES, despite the government’s arguments that patients have a diminished expectation of privacy in their prescription data. The brief shows how prescription records can reveal sensitive information about an individual’s medical condition and argues that the medical board’s routine, unfettered and indiscriminate access to prescription data from CURES circumvents existing laws protecting the confidentiality of medical records. The brief also addresses the heightened importance of protecting patient privacy rights in the digital age where technology has facilitated the government’s ability to store and mine large amounts of data. The ACLU of California and the Electronic Frontier Foundation also filed amicus briefs in this case in support of Dr. Lewis. The California Supreme Court will likely schedule oral arguments in this case in 2016. Click here to read CMA's brief. Contact: CMA's Center for Legal Affairs, (800) 786-4262 or legalinfo@cmanet.org. November 9, 2015 General CMA Legal Case List, CURES, Amicus Briefs, California Supreme Court 0 0 Comment Read More »
Governor signs bill to extend CURES registration deadline for prescribers and dispensers In the final days of the legislative session, the California Medical Association (CMA) worked to pass Assembly Bill 679 to extend by six months the registration deadline for the Controlled Substance Utilization Review and Evaluation System (CURES). All individuals practicing in California who possess both a state regulatory board license authorized to prescribe, dispense, furnish or order controlled substances and a Drug Enforcement Administration Controlled Substance Registration Certificate (DEA Certificate) now have until July 1, 2016, to register to use CURES. In 2013, Senate Bill 809 required the California Department of Justice (DOJ) to identify and implement a streamlined application and approval process for CURES registration. Currently, the registration process remains highly manual, requiring notarization of documents and reportedly six to eight weeks to process applications. A streamlined process was seen as essential to meeting the January 1, 2016, registration deadline. DOJ has not issued a definite date for when streamlined registration will be available, and so CMA pursued an extension. The bill was signed into law on October 11. CMA will continue to monitor the situation, communicate with DOJ and update members on progress. CMA recommends that any physicians who need access to CURES not wait for streamlined registration and begin the process for registration as soon as possible. October 14, 2015 General Advocacy, CURES, Legislation, Prescription Drugs 0 0 Comment Read More »
