DOPL Warns Prescribers About Mandatory Checking of Idaho Prescription Drug Monitoring Process Deadline

The Idaho Department of Occupational and Professional Licenses (DOPL) sent a letter to Controlled Substances Registrants about Idaho Code 37-2722 that went into effect October 1, 2020. The law was designed initially for educational purposes. However, now the law mandates that prescribers check the Prescription Drug Monitoring Process (PDMP) database, which the Idaho Board of Pharmacy administers.

The letter states, "The period of enforcement discretion ends March 31, 2023. Those prescribers not checking the PDMP prior to prescribing opioid analgesic or benzodiazepine in accordance with Idaho Code 37-2722 are in violation of the law and subject to disciplinary action."

Prescription drug monitoring programs (PDMP's) were designed and continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk. Although, a PDMP is only helpful to health care providers if they check the system before prescribing.

To make integration of the PMDP smoother, the process has been streamlined with incorporation into electronic health record (EHR) systems using the Idaho Statewide Gateway integration, which will eliminate providers having to log in separately to do the PDMP. More information is available at: PDMP Gateway-Welcome Kit.

You may direct any questions to: pdmp@dopl.idaho.gov

You can also view a list of FAQ's at: www.BOP.idaho.gov

Click the button below to view the Mandatory Checking of the Prescription Drug Monitoring Program (PDMP) letter from DOPL.

Idaho's House Bill 71 Would Make it Harder for Parents to Give Children the Best Chance to Thrive

by Neil Ragan, MD and Jessie Duvall, MD

Being a parent is hard. Everyone can agree on that. Every day we, as health care providers, bear witness to parents dealing with really hard things, trying to do the best they can for their kids. Everyone wants their kids to be happy, to contribute meaningfully to their family and community, and to thrive. That’s what we want for our own kids. And we became providers who care for kids because we want that for all children.

House Bill 71 would make it harder for parents to give their children the best chance to thrive. This bill targets transgender youth and their families by taking away their right to evidence-based, life-saving health care. It doesn’t help kids. It doesn’t help parents. And it doesn’t help our community.

Medically and socially, there is no one way to treat a transgender kid. The path every family chooses is different. It is a highly individualized, months- to years-long process that begins with getting to know the child, the caregivers, and their hopes for the future.



Gender affirming care is about how we talk to our patients. It’s honoring someone’s whole self while recognizing the inherent risk of not feeling at home in one’s own body. This care is long term. Decisions are made slowly and revisited frequently. We know families who have chosen to do no medical treatments because that’s the right thing for them. We also know kids who would not be alive without the medical treatment they’re receiving right now.

When used, medical treatment often begins with puberty blockers. These drugs are well studied. We know they are safe, reversible and do not cause infertility. They are a “pause” that gives families more time to decide on the best course of treatment for their child. Sometimes that course involves starting hormones. Sometimes it means focusing on transitioning socially. What it doesn’t include is surgery. In Idaho, like much of the world, treatment of gender dysphoria in minors never involves surgery – this is not the standard of care.

We know that this thoughtful, individualized care reduces depression and suicide. This is why all the major medical societies in America and Idaho support evidence-based, comprehensive gender affirming care. 

House Bill 71 criminalizes doctors for doing our job, providing our patients with the standard of care. If doctors have to choose between failing their patients and going to jail, they will leave Idaho and we will not be able to replace them. And this won’t just impact trans children. The doctors who provide gender affirming care are the same doctors who provide care for Type 1 diabetes, thyroid disorders and urological problems. They are also the doctors who provide primary care in rural places.

House Bill 71 sets a precedent that complex, highly personal medical decisions can be legislated. That the government knows kids better than their parents do. This is not the Idaho we know and love.

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Drug Management and Key Information Driving Medical Decision Making

By Nicole Benson, Gill Compliance Solutions

Over the years, the AMA and payors have continued to clarify and refine drug management as a part of the medical decision-making risk. In the 2023 guidelines, in column three of the medical complexity tables, there are three separate areas addressing prescription drug management (categorized as moderate-risk), drug therapy requiring intensive monitoring for toxicity, and parenteral controlled substance (both categorized as high-risk). So, what is the difference between these drug management, and when is the intensive drug therapy monitoring supported? Here are some definitions and tips from the AMA and industry research on these risk categories.

Prescription drug management is based on documented evidence that the provider has evaluated the patient's medications as part of a service versus simply listing medications or refills. This may be a prescription being considered, written, discontinued, or the decision to maintain a current medication/dosage. Documentation should include evidence of these medication considerations, as well as appropriateness and any interaction concerns. Prescription drug management differs from "drug therapy requiring intensive monitoring for toxicity." Here is the defining list of the AMA 2021 Technical Corrections that can be found in the current year CPT E/M guidelines for meeting this high-risk category.

• A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death
• The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy
• The monitoring should be that which is generally accepted practice for the drug agent but may be patient-specific in some cases
• Intensive monitoring may be long-term or short-term
• Long-term intensive monitoring is not less than quarterly
• The monitoring may be by a lab test, a physiologic test, or imaging
• Monitoring by history or examination does not qualify
• The monitoring affects the level of medical decision-making in an encounter in which it is considered in the management of the patient

CMS has not provided a list of high-risk drugs that would typically require intensive monitoring. Yet, several Medicare contractors, including Palmetto GBA, has published the AMA guidelines and a limited list of higher-risk medications. One such example is the monitoring for a cytopenia in the use of an antineoplastic agent between dose cycles or the short-term intensive monitoring of electrolytes and renal function in a patient undergoing diuresis. A non-qualifying example would be monitoring glucose levels during insulin therapy as the primary reason is the therapeutic effect (even if hypoglycemia is a concern); or annual electrolytes and renal function for a patient on a diuretic as the frequency does not meet the threshold of intensive monitoring defined above.

A parenteral controlled substance is given by a route other than the alimentary canal or oral, and may include subcutaneous, intramuscular, intravenous, or intrathecal administered medications and is categorized under the schedule of controlled drugs. While initiating parenteral controlled medications may represent high-risk, once they have reached a therapeutic effect and/or stabilized, they may not continue to represent high-risk in complexity, as cited by Dr. Holman during the 2022 AMA Symposium. Some parenteral administration may even be safer than oral medications in terms of ongoing opiate use. It is always important to specify in the documentation the overall risk of any medications, considerations, and monitoring, as the ownness is up to the provider to support and define these drug management areas in terms of the risk complexity.