Authority: IC 25-22.5-2-7; IC 25-22.5-13-3

Affected: IC 25-1-9; IC 25-27.5

Sec. 8. (a) At any time the physician assistant determines that it is medically necessary, whether at the outset of an opioid treatment plan, or any time thereafter, a physician assistant prescribing opioids for a patient shall perform or order a drug monitoring test, which must include a confirmatory test using a method selective enough to differentiate individual drugs within a drug class, on the patient.

(b) In determining whether a drug monitoring test under subsection (a) is medically necessary, the physician assistant shall consider, subject to the provisions of subsection (c), each of the following factors where applicable and reasonably feasible:

1. (1) Whether there is reason to believe a patient is not taking the prescribed opioids or is diverting the opioids.
2. (2) Whether there has been no appreciable impact on the patient's chronic pain despite being prescribed opioids for a period that would generally have an impact.
3. (3) Whether there is reason to believe the patient is taking or using controlled substances other than opioids or other drugs or medications, including illicit street drugs that may produce significant polypharmacological effects or have other detrimental interaction effects.
4. (4) Whether there is reason to believe the patient is taking or using opioids in addition to the opioids being prescribed by the physician assistant and any other treating practitioner.
5. (5) Attempts by the patient to obtain early refills of opioid containing prescriptions.
6. (6) How many times the patient alleges their opioid containing prescription has been lost or stolen.
7. (7) When the patient's INSPECT report provides irregular or inconsistent information.
8. (8) When a previous drug monitoring test conducted on the patient raised concerns about the patient's usage of opioids.
9. (9) The need to verify that the patient no longer has substances in the patient's system that are not appropriate under the patient's treatment plan.
10. (10) When the patient engages in apparent aberrant behaviors or shows apparent intoxication.
11. (11) When the patient's opioid usage shows an unauthorized dose escalation.
12. (12) When the patient is reluctant to change medications or is demanding certain medications.
13. (13) When the patient refuses to participate in or cooperate with a full diagnostic workup or examination.
14. (14) Whether a patient has a history of substance abuse.
15. (15) When the patient has a health status change (e.g., pregnancy).
16. (16) Comorbid psychiatric diagnoses.
17. (17) Other evidence of chronic opioid use, controlled substance abuse or misuse, illegal drug use or addiction, or medication noncompliance.
18. (18) Any other factor the physician assistant believes is relevant to making an informed professional judgment about the medical necessity of a prescription.

(c) It is not considered a violation of this section for a physician assistant to fail to conduct a review of the eighteen (18) factors listed in subsection (b) if the physician assistant reasonably determines, after a review of less than all the factors listed in subsection (b), that a drug monitoring test is medically necessary.

(d) Nothing about subsection (b) may be construed to prohibit the physician assistant from performing or ordering a drug monitoring test at any other time the physician assistant considers appropriate.

(e) If a test performed under subsection (a), or conducted under subsection (d), reveals inconsistent medication use patterns or the presence of illicit substances, a review of the current treatment plan is required. Documentation of the revised treatment plan and discussion with the patient must be recorded in the patient's chart.

(Medical Licensing Board of Indiana; 844 IAC 2.2-3-8; filed Sep 2, 2016, 1:04 p.m.: 20160928-IR-844150420FRA; readopted filed Nov 22, 2016, 12:11 p.m.: 20161221-IR-844160317RFA; readopted filed Nov 22, 2022, 12:22 p.m.: 20221221-IR-844220255RFA; readopted filed Feb 27, 2024, 10:19 a.m.: 20240327-IR-844230772RFA; filed Jun 20, 2025, 3:41 p.m.: 20250716-IR-844240435FRA)