Montana and Wyoming enact opioid prescribing limits

April 3, 2019 · Policy Matters team

Montana and Wyoming have enacted opioid prescribing limits focused on “opioid-naïve” patients by amending existing prescribing laws.

Montana limitations
Montana law defines an opioid-naïve patient as a patient who has not been prescribed a medication containing an opioid in the 90 days prior to the acute event or surgery for which an opioid is prescribed. When a medical practitioner or a naturopathic physician prescribes an opioid to an opioid-naive patient, on an outpatient basis, the prescription may not be for more than a seven-day supply.

Montana exceptions
This limitation does not apply if in the professional medical judgment of the prescriber, a prescription for more than a seven-day supply is necessary to treat chronic pain, pain associated with cancer, pain experienced while the patient is in palliative care; or if the opioid being prescribed is for the treatment of opioid abuse or dependence. The new restriction takes effect on October 1, 2019.

Wyoming limitations
Wyoming law defines an opioid-naïve patient as a patient who has not had an active opioid prescription in the preceding 45-day period. The new law states that no practitioner is to prescribe, nor any person dispense, any opioid or combination of opioids for acute pain to an opioid-naive patient for more than a seven-day supply in a seven-day period.

Wyoming exceptions forthcoming
The Wyoming State Board of Pharmacy is required to, by rule, establish reasonable exceptions, consulting with other professional licensing boards, and include exceptions for chronic pain, cancer treatment, palliative care and other clinically appropriate exceptions. The restriction is effective July 1, 2019.

States’ opioid legislation trend and impact on workers’ compensation
These two recent examples continue the trend of states limiting initial opioid prescriptions to lessen the potential for opioid over-utilization, dependence and other related concerns. It is important to note that these types of laws are focused on the actual prescribing and/or dispensing of these medications and not on payment for these medications by insurers or employers. Consequently, issues such as insurer authorization, coverage and reimbursement are usually not addressed.