Edna McKnight Advocates for Tennessee Residents in State Senate

State Senate.png

Earlier this year, McKnight Advisory Group, Inc. began a new chapter in its nearly 30-year history – a jump into legislature. Edna McKnight, R.N. was invited by Senator Shane Reeves to testify before the Tennessee State Senate about (Senate Bill) SB0810. This bill will make various minor changes to the current law, which was passed last fall, concerning opioids.

Mrs. McKnight testified before the State Senate’s Health and Welfare Committee on March 13, 2019. She opened her testimony by saying, “I am here as an advocate for the patient: our fellow Tennessee residents.” She believes that the current restrictions prevent patients from receiving the legitimate, effective pain-management medications.

Edna, a Registered Nurse, is the Director of Case Management and Compliance at McKnight Advisory Group. She became interested in the legislature concerning prescription distribution, especially when and where prescriptions for opioids can be filled by patients, after her husband Edwin’s knee surgery. Edna is the co-owner of McKnight Advisory Group, Inc.

Opioid addiction is a major topic in the United States with almost daily news coverage of the overdose epidemic. According to the U.S. Department of Health and Human Services, 130 people die every day from opioid overdose and 11.4 million people have misused prescription opioids (hhs.gov). It is no wonder that lawmakers are paying close attention to how and to whom prescription opioids are being distributed.

While the current law’s intentions are valid, Edna believes that there are several aspects of the law that do not keep the patients’ best interest in the forefront. According to Senator Shane Reeves, who sponsored the bill, the original legislation had “unintended consequences” which prevented many Tennesseans from adequately accessing vital pain medication. Senator Reeves felt it was important to have someone personally affected by the law to testify. “We were able to reach out and find someone like Edwin or Edna [McKnight] to actually come in and share testimony of what happened to their family over the holidays and the members of the committee could hear the impact that it had on them and how frustrating it was.”

Following Edna’s testimony SB0810 passed unanimously in both houses. It has progressed to the desk of Governor Bill Lee, who signed it into law. The amendments will become effective July 1, 2019. Senator Reeves said of Edna’s involvement with the bill, “Her testimony was very powerful and there’s no question about it, it played a big role in actually helping this bill to pass unanimously.”

This bill and the amendments it brings to current legislature will have a positive impact on Tennessee residents seeking pain management after surgery. The McKnight team is proud of Edna’s commitment in researching this topic and her dedication to her fellow citizens. We would also like to thank Senator Shane Reeves for his hard work in sponsoring this bill.

For more information on the Opioid Crisis, please visit the U.S. Department of Health and Human Services website http://www.hhs.gov

Please contact Senator Shane Reeves for more information about SB0810 or Representative Cameron Sexton for HB08

To learn more about the legislature concerning SB0810, contact Senator Shane Reeves or visit the Tennessee State Senate website. To learn more about the legislature concerning HB0843, contact Representative Cameron Sexton or visit the Tennessee State House website. All State Congressperson contact information and bill summaries are listed on the TN General Assembly Website, http://www.capitol.tn.gov

The current restrictions on opioids have several unintended consequences. For example, the current laws do not distinguish between major and minor surgery. This means that if you have a major hip, shoulder, or knee replacement surgery, your pain management medication would have to follow the same guidelines as someone who had a minor appendectomy.

In addition to this, opioid prescriptions are required to have an IDC-10 diagnosis code listed. A simple diagnosis code cannot adequately express the amount of pain a patient may be experiencing or any other factors that might be influencing the amount of pain a patient may be experiencing. Other factors that may contribute to pain level are the location of the surgery or injury, the amount of swelling experienced, any prior surgeries to the same area, or the length of time the patient experienced disability before undergoing surgery.

The current “half-fill” requirement on opioid prescriptions imparts several challenges to patients and their caregivers due to unforeseen consequences of this restriction. Under the current law, for example, patients must fill the second half of their prescription within 24-hours of running out of the first half. Pharmacies are not allowed to dispense opioid medication early for any reason, including closures for holidays or inclement weather. This is a problem because patients who need to fill the second half of their prescription during a 24-hour period when they cannot get a pharmacy may not be able to obtain their medication.

There has been much confusion and lack of communication between physician’s offices, pharmacies, and insurance companies over the half-fill requirements. According to Mrs. McKnight, “Some pharmacies did not proactively tell patients they could even obtain the second portion of their prescription.” Medicare’s Part D drug coverage involvement in the half-fill law is of particular interest to the McKnight team. Many Medicare prescription insurance companies are national companies. Therefore, they do not recognize Tennessee’s “half-fill” provisions. Under these circumstances Part D insurance company providers will only pay for the first half of an opioid prescription. The pharmacy will dispense the second half to the patient, but they will have to pay out-of-pocket.

Another major issue with the current legislature in Tennessee is the fact that “not all pharmacies have the software in place to dispense the half-fill requirements,” Edna explained. Two major pharmacy retailers here in Tennessee currently do not have this capacity.

In addition to this, it may be a challenge for rural residents of the state to even receive their prescription. Edna went into more detail saying, “Many of our providers do not have the electronic means to send prescriptions to the pharmacy, forcing the caregiver to go and physically pick up and deliver the written prescription to the pharmacy. Our large surgical practices service many smaller rural communities.” This places a burden on our rural Tennessee residents.

These facts were bolstered by Edna’s personal experiences in helping her husband Edwin recover from total knee surgery. When she inquired about the half-fill procedure at her own pharmacy, they “confirmed that while they may dispense the second half, there is no guarantee they will have it available for you when you return due to possible shortages.”

We applaud the current law’s approach in suggesting alternative, non-opioid pain management strategies. However many over-the-counter pain management medications are contraindicated, meaning they cannot be used in the case of surgery. Often, over-the-counter medications are already mixed with an opioid in the prescription (and thus cannot be taken in conjunction with the prescription for additional pain management) or cannot be taken with a “blood thinner” which is typically ordered following surgery. Non-drug pain management, such as portable icepack machines, massage therapy, or TENS units are usually not covered by insurance and can be expensive for some of our Tennessee residents to pay for out-of-pocket.

Opioids are still the main option for patients dealing with intense pain. They should only be used as indicated for the least amount of time to be effective for each individual patient. No one wants Tennessee residents to become addicted to opioid medications and have to endure the consequences that can follow. While precautions need to be taken, the current law with its restrictions makes it difficult for patients to receive adequate, effective pain management.

The amendments to the law presented in SB0810 sponsored by Senator Shane Reeves have remedied many of the above concerns.