Sponsored by:
Assemblyman JOHN ARMATO
District 2 (Atlantic)
Assemblywoman CAROL A. MURPHY
District 7 (Burlington)
SYNOPSIS
Requires that pharmacists, prescribers, and hospice programs furnish patients with information and products to safely dispose of unused prescription drugs and medications when issuing or dispensing certain prescriptions.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning prescription medications, supplementing Title 24 and Title 45 of the Revised Statutes, and amending P.L.2017, c.135.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) a. A health care professional authorized to issue prescriptions shall, when issuing any prescription for a drug or medication which is a controlled dangerous substance, and when issuing a prescription for any other prescription drug or medication as may be designated by the Commissioner of Health by regulation:
(1) provide the patient with oral instructions and written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:
(a) there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient's household;
(b) children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;
(c) when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and
(d) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;
(2) offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and
(3) provide the patient with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, providing instructions concerning the use of a nontoxic composition furnished to the patient pursuant to paragraph (2) of this subsection, and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take-back programs.
The requirements of this subsection shall apply to each prescription issued by the health care professional, regardless of whether the prescription is being issued to a new or existing patient, regardless of whether the prescription is for a new drug or medication or renews or refills a current prescription, and regardless of the health care setting in which the prescription is issued.
b. At such time as any change is made to a patient's course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, the health care professional providing care or treatment to the patient shall:
(1) provide the patient with oral instructions and written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:
(a) there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient's household;
(b) children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;
(c) when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and
(d) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;
(2) offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and
(3) provide the patient with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, providing instructions concerning the use of a nontoxic composition furnished to the patient pursuant to paragraph (2) of this subsection, and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.
The requirements of this subsection shall apply to any change to a patient's course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, regardless of whether the patient is a new or existing patient, and regardless of the health care setting in which the care or treatment is provided.
2. (New section) a. A pharmacy practice site or health care professional that dispenses prescription drugs, other than a long-term care pharmacy, shall, when dispensing to an individual located in this State a prescription drug or medication which is a controlled dangerous substance, and when dispensing any other prescription drug or medication as may be designated by the Commissioner of Health by regulation:
(1) provide the patient with oral instructions and written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:
(a) there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient's household;
(b) children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;
(c) when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and
(d) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;
(2) offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and
(3) provide the patient with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, providing instructions concerning the use of a nontoxic composition furnished to the patient pursuant to paragraph (2) of this subsection, and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.
b. The requirements of subsection a. of this section shall apply regardless of whether the prescription is an initial prescription or a renewal or refill of an existing prescription, and regardless of whether the patient is a new or returning customer at the pharmacy practice site or is a new or existing patient of the health care professional.
3. Section 1 of P.L.2017, c.135 (C.26:2H-81.1) is amended to read as follows:
1. a. As used in this section:
"Family member" means a hospice care patient's spouse, parent, adult sibling, adult child, or adult grandchild.
"Health care representative" means a person, including a member of the patient's family, who is authorized to make health care decisions on behalf of a hospice care patient.
"Hospice care patient" means a person currently receiving hospice care services in a private home or an assisted living facility through a licensed hospice care program.
"Third party caregiver" means a person who:
(1) is 18 years of age or older;
(2) provides care or assistance to a hospice care patient; and
(3) is not the patient's health care representative, a family member of the patient, or employed by the patient's hospice care program.
b. A hospice care program licensed pursuant to P.L.1997, c.78 (C.26:2H-79 et seq.) may choose, but shall not be required, to accept for disposal, at such time as a hospice care patient ceases to use the drug or medication or ceases to receive hospice care services through the program, the hospice care patient's unused prescription drugs and medications. A hospice care program that chooses to accept unused prescription drugs and medications for disposal pursuant to this section shall:
(1) Establish a written policy setting forth procedures for accepting and disposing of unused prescription drugs and medications;
(2) Furnish a copy of the written policy to each patient, and to the patient's health care representative, at the time the patient is enrolled in the hospice care program, and designate a program representative who shall discuss the procedures and requirements for surrendering unused prescription drugs and medications with the patient and the patient's health care representative;
(3) Accept drugs and medications prescribed and dispensed to the patient pursuant to the patient's hospice care plan, as well as any other prescription drugs and medications that the patient, or the patient's health care representative, chooses to surrender to the program;
(4) Not accept any drug or medication for surrender except at such time as the patient ceases to use the drug or medication or ceases to receive hospice care services through the program; [and]
(5) Obtain any certifications, authorizations, or waivers as may be required under State or federal law in order to accept and dispose of unused prescription drugs and medications pursuant to this section; and
(6) (a) at the time the patient is enrolled in the hospice care program, at such time as any change is made to the patient's course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, and at such time as the patient ceases to receive hospice care services through the program, provide the patient or the patient's health care representative with oral instructions and written informational materials advising that when unused, unwanted, or expired drugs and medications are not properly, safely, and promptly disposed of:
(i) there is a risk that the drug or medication can be stolen, diverted, abused, misused, or accidentally ingested, which can pose a risk to the health and safety of the patient and other members of the patient's household;
(ii) children are particularly at risk of accidentally ingesting unused, unwanted, and expired medications that have not been properly, safely, and promptly disposed of;
(iii) when drugs or medications are disposed of in the household trash or flushed down the drain, the drugs and medications can leak into the ecosystem, which can have a potentially adverse or harmful effect on the environment; and
(iv) when drugs or medications are disposed of in the household trash without the drug or medication having been rendered deactivated, inaccessible, or otherwise unpalatable, the drug or medication may be stolen by individuals seeking to divert, abuse, or misuse the drug or medication;
(b) offer to make available for purchase, or furnish at no cost to the patient, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications; and
(c) provide the patient with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but shall not be limited to, providing instructions concerning the use of a nontoxic composition furnished to the patient pursuant to subparagraph (b) of this paragraph, and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.
c. At the time a hospice care patient ceases to receive hospice care services, a program representative shall provide a written request for surrender of unused [medication] drugs and medications to the patient or the patient's health care representative, which shall:
(1) request that the patient or the patient's health care representative surrender any unused prescription drugs or medications that were prescribed and dispensed to the patient pursuant to the patient's hospice care plan;
(2) offer to accept and dispose of any other prescription drug or medication which the patient will not use; and
(3) urge that the patient or the patient's health care representative dispose of any unused prescription drug or medication that is not surrendered to the program in a safe and legal manner, so as to avoid the risk of theft, diversion, or accidental ingestion.
d. No hospice care program may accept and dispose of an unused prescription drug or medication pursuant to this section unless the patient or the patient's health care representative authorizes, in writing, the surrender of the unused prescription drug or medication to the program; except that, if the patient is unable to provide written authorization and the patient does not have a health care representative, a third party caregiver may provide written authorization for the surrender. A hospice care program shall not accept an unused prescription drug or medication unless the drug or medication is identified for inclusion in the authorization for surrender.
e. (1) Unused prescription drugs and medications surrendered to a hospice care program pursuant to this section shall be surrendered to a registered professional nurse or a licensed practical nurse employed by the program.
(2) A nurse accepting the surrender of unused prescription [medication] drugs or medications pursuant to this section shall dispose of the drugs or medications at the site where hospice care was provided; in no case shall the nurse transport the unused prescription medications off-site for disposal or for any other purpose. The nurse may dispose of the unused drugs or medications using a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications.
(3) A nurse who accepts and disposes of an unused prescription drug or medication pursuant to this section shall document:
(a) the name and quantity of each drug or medication surrendered;
(b) the name of the person authorizing the surrender, and the relationship of the person to the patient;
(c) the date and method of disposal; and
(d) the quantity and type of any unused prescription drug or medication, of which the nurse is aware, that was prescribed and dispensed to the patient pursuant to the patient's hospice care plan, but was not surrendered to the program or otherwise disposed of by another person in the nurse's presence.
(4) The person authorizing the surrender of a drug or medication shall be provided with the opportunity to review, verify, and sign the documentation required under paragraph (3) of this subsection.
f. Nothing in this section shall prohibit any person from disposing of an unused prescription drug or medication by any means authorized by law, including, but not limited to, disposing of the drug or medication using a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications or surrendering the medication at a secure prescription medication drop-off receptacle.
g. No person shall be subject to civil or criminal liability or professional disciplinary action for any act or omission undertaken in good faith consistent with the requirements of this section.
(cf: P.L.2017, c.135, s.1)
4. This act shall take effect 30 days after the date of enactment.
STATEMENT
This bill requires that patients be provided with certain information concerning safe drug disposal and the opportunity to receive a nontoxic composition that can be used for the safe disposal of unused, unwanted, and expired drugs and medications under certain circumstances.
Specifically, patients are to be provided with the information and offer of a nontoxic composition:
· When a health care professional issues any prescription for a drug or medication which a controlled dangerous substance, and a prescription for any other prescription drug or medication as may be designated by the Commissioner of Health by regulation to a patient, regardless of whether the prescription is being issued to a new or existing patient, regardless of whether the prescription is for a new drug or medication or continues a current prescription, and regardless of the health care setting in which the prescription is issued;
· When a change is made to a patient's course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, regardless of whether the patient is a new or existing patient, and regardless of the health care setting in which the care or treatment is provided;
· When a pharmacy practice site or health care professional that dispenses prescription drugs, other than a long-term care pharmacy, dispenses a prescription drug or medication which is a controlled dangerous substance, or any other prescription drug or medication as may be designated by the Commissioner of Health by regulation, regardless of whether the prescription is an initial prescription or a renewal or refill of an existing prescription, and regardless of whether the patient is a new or returning customer at the pharmacy practice site or is a new or existing patient of the health care professional; and
· When a patient is first enrolled in a hospice care program that has elected to take back unused drugs and medications, any time when a change is made to a patient's course of treatment that results in a change in the drugs or medications prescribed for the patient, or in the patient discontinuing the use of a prescription drug or medication, and when the patient ceases to receive hospice care through the program.
The informational materials are to include oral instructions and written information advising the patient of the risks of theft, diversion, abuse, misuse, and accidental ingestion when unused, unwanted, and expired drugs and medications are not properly, promptly, and safely disposed of, and that improperly disposing of drugs and medications presents a risk of harm to both individuals and the environment.
The patient is additionally to be offered, either for purchase or at no cost, a nontoxic composition that can be used to permanently sequester or deactivate unused, unwanted, or expired drugs and medications for the purpose of safely disposing of the drugs and medications. The patient is also to be provided with oral and written instructions on how to properly, safely, and promptly dispose of unused, unwanted, or expired drugs and medications, which may include, but will not be limited to, providing instructions concerning the use of any nontoxic composition furnished to the patient and advising the patient of the availability of secure prescription medication drop-off receptacles and prescription medication take back programs.
In the case of a patient enrolled in a hospice care program, the informational materials, offer of a nontoxic composition, and instructions may be provided to the patient or to the patient's health care representative.