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Policy Statement

Policy Statement 2018-04: Naloxone Dispensing via Standing Order

Date: 06/07/2018
Organization: Board of Registration in Pharmacy
Referenced Sources: An Act for Prevention and Access to Appropriate Care and Treatment of Addiction (Chapter 208 of the Acts of 2018)
M.G.L. c. 94C

On August 9, 2018, Governor Baker signed into law chapter 208 of the acts of 2018, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. The law makes important strides in our work as a state to combat the opioid epidemic, including thorough updates to M.G.L. c. 94C section 19B to expand access to naloxone through a statewide standing order for this life-saving medication. The statewide standing order preserves the ability of pharmacies to dispense the opioid antagonist without a prescription to any person at risk of experiencing an opioid-related overdose, as well as by family members, friends or other persons in a position to assist individuals at risk of experiencing an opioid-related overdose, while lifting the current requirement that each pharmacy in the Commonwealth have its own pharmacy-specific standing order for dispensing naloxone.

In the face of this ongoing opioid crisis, the Board, through collaboration with the Department of Public Health’s Bureau of Substance Addiction Services, has determined that, compared to the national average, all areas of Massachusetts experience high incidences of opioid-related overdoses or deaths thereby requiring all pharmacies to stock naloxone in accordance with M.G.L. c. 94C section 19C.

All retail pharmacies located in Massachusetts and licensed by the Board of Pharmacy must maintain a continuous, sufficient supply of naloxone rescue kits, or other approved opioid antagonist medication, to meet the needs of the community. Additionally, as required by M.G.L. c. 94C section 19B, each pharmacy must annually report the number of naloxone doses dispensed.

There is no limit to the amount of naloxone that may be dispensed to an individual. Massachusetts state law specifically allows for an individual to obtain naloxone with the intention to administer it to another person. A pharmacy may dispense naloxone either pursuant to a patient-specific prescription or via the statewide standing order.

A copy of the statewide standing order is attached to this Policy.

Table of Contents

Dispensing Naloxone

Naloxone should be dispensed in accordance with the following protocol:

  • Naloxone rescue kits must be labeled with the expiration date of the included naloxone unit.
  • In place of the name and address, “Naloxone Rescue Kit,” may be used to create a patient profile and prescription label.
  • The pharmacy must counsel the individual and distribute an Opioid Antagonist Information Pamphlet such as the one found here: https://www.mass.gov/files/documents/2018/05/10/oend-information-sheet-english.pdf
  • In accordance with the Massachusetts Controlled Substances Act, unless the purchaser requests otherwise, the pharmacy must make a reasonable effort to determine if the purchaser’s insurance covers naloxone.
  • When an individual presents to the pharmacy to obtain naloxone, the order should be processed under the statewide standing order.
  • For insurance billing and cost-sharing purposes, the pharmacy must treat the transaction as the dispensing of a prescription to the person purchasing naloxone.
  • Annually, by January 15th, each pharmacy must submit a report via email to naloxonestandingorders@MassMail.State.MA.US, including the following information for the previous calendar year:
    • The name and zip code of the pharmacy;
    • The total number of naloxone doses (not prescriptions or manufacturer-supplied units) dispensed; and
    • The total number of those doses paid for with insurance.

      While not required, the Board encourages pharmacies to also submit information for each dispensing event that includes the following:
    • The number of doses dispensed;
    • The date dispensed;
    • The zip code of residence for the individual to whom the naloxone is dispensed; and
    • Whether the naloxone was paid for with insurance.
  • The pharmacy should consider advertisements or signage to inform the public that naloxone kits are available.

Downloads for 2018-04: Naloxone Dispensing via Standing Order

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