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Sponsor agrees to narrow chiropractic prescribing bill after debate on training and Medicaid costs
Summary
Representatives debated a bill granting chiropractors an elective prescriptive endorsement; opponents raised concerns about training, addictive medications and malpractice costs; sponsor agreed to remove Medicaid coverage and limit allowable drugs in a Senate amendment.
Representative Rob Lander introduced House Bill 500 to allow a license endorsement permitting chiropractors to prescribe a limited class of medications after additional training. The sponsor said the endorsement would be voluntary and subject to board rules on required pharmacology education, storage, and disposal protocols.
Sarah Swanson, commissioner at the Department of Labor and Industry, testified proponentally and described administrative costs: about $10,000 for rule‑making and roughly $10,200 for programming a new endorsement type into the licensing system; revenues would be state special (board) funds. Swanson said the board would set educational qualifications by rule, including initial and ongoing pharmacology hours and protocols for controlled substances management.
Opponents focused on clinical training and patient safety. A chiropractor testified he and colleagues lacked sufficient pharmacology training and feared increased malpractice risk and safety issues. The Montana Medical Association said an amendment in the bill that would allow prescribing of certain addictive medications raises concerns because nonphysician prescribers sometimes have higher rates of prescribing addictive medicines and associated downstream addiction and treatment costs.
Sponsor Lander told the committee an amendment was drafted to limit chiropractors to non‑controlled, non‑scheduled drugs (examples given as NSAIDs and short courses of low‑risk medications) and that he would commit to removing Medicaid coverage for adult beneficiaries in the Senate to address fiscal concerns. He said the endorsement would require documented education and would remain optional for practitioners.
Ending: After extended questioning, the sponsor committed to carry a Senate amendment narrowing the scope of prescriptive authority and removing the Medicaid coverage expansion; the committee recorded a majority vote to advance the bill.
