§ 65-05-39 — Chronic opioid therapy coverage and monitoring

1. As used in this section, "chronic opioid therapy" is opioid treatment extending beyond
ninety days from initiation which is for the treatment of pain resulting from a
nonmalignant, compensable condition or therapies for another nonterminal
compensable condition.
2. In order to qualify for payment for chronic opioid therapy:
a. Chronic opioid therapy must result in an increase in function, enable an injured
employee to resume working, or improve pain control without debilitating side
effects;
b. Chronic opioid therapy must treat an injured employee:
(1) Who has been nonresponsive to non-opioid treatment;
(2) Who is not using illegal substances or abusing alcohol; and
(3) Who is compliant with the treatment protocol; and
c. The prescriber of chronic opioid therapy shall provide to the organization:
(1) At least every ninety days, documentation of the effectiveness of the chronic
opioid therapy, including documentation of improvements in function or
improvements in pain control without debilitating side effects; and
(2) A treatment agreement between the injured employee and the prescriber
which restricts treatment access and limits prescriptions to one identified
single prescriber. This paragraph does not preclude temporary coverage
within a single clinic by an identified prescriber when the prescriber of record
is unavailable and does not preclude a referral to a pain specialist.
3. At the prescriber's or organization's request, an injured employee on chronic opioid
therapy is subject to random drug testing for the presence of prescribed and illicit

substances. Failure of the test or of timely compliance with the request may result in
termination of chronic opioid therapy coverage.
4. Failure to comply with any of the conditions under this section may result in the
termination of coverage for chronic opioid therapy.