The successes and challenges of state prescription drug monitoring programs
The United States is in the midst of a prescription drug abuse epidemic as addiction, overdoses and deaths associated with non-medical drug use have risen dramatically over the last decade.1 In 2009, U.S. drug overdose deaths outnumbered motor vehicle accident deaths for the first time.1 To help combat this alarming trend, Prescription Drug Monitoring Programs are being utilized in states to identify prescription fraud, forgeries, doctor shopping and improper prescribing. These programs are used by prescribers and third party payers to provide good clinical medical care and promote patient safety.
The use of PDMPs has been found to positively influence the prescribing practices of medical practitioners.1 PDMPs can also be used by workers compensation entities, Medicaid departments, emergency providers and drug courts. Since states with proactive PDMPs typically have lower rates of treatment admissions, it is clear the use of PDMPs can have an impact on reducing overall healthcare treatment costs.1
One problem limiting the positive impact of these programs is underutilization. Prescriber registration rates vary from state to state, with a median registration rate at 35%.2 A major obstacle to increased prescriber and dispenser participation in PDMPs is the disruption of workflow involved in retrieving this information. The use of standalone web portals in the existing PDMPs that don’t integrate via physician and pharmacy practice management systems is another deterrent to usage.
A second obstacle within the current PDMP system is the lack of interoperability between the respective PDMPs. Without a federal mandate, states are developing unique systems that will make the exchange of data across state lines complex. The Department of Health and Human Services issued a report to Congress in September 2013, which suggested that states should require dispensers and prescribers to register with the state PDMP. HHS also recommended that real time access to the PDMP data should be enabled, and that PDMP activity be reported within minutes of a prescription being dispensed.1
It appears that the states are responding to the HHS recommendations. In 2014, 30% of the states crafted legislation that would adjust the requirements for PDMPs. New York and Kentucky had previously passed laws mandating registration and use of the state PDMPs. In the 2014 legislative session, Pennsylvania and New Jersey introduced bills mandating registration and use by both practitioner and prescriber with penalties and/or licensure consequences for violators. In addition, Colorado, Iowa, and Oklahoma debated whether PDMP data sharing with bordering states should be permitted.
Since pharmacies operate primarily with real time transactions, standard data sets would benefit PDMP utilization, as well as efficient patient care. The development of model state legislation, model interstate compacts and model contracts would also promote uniformity among the states. Other potentially beneficial steps would be the adoption of Federal uniform standards and incorporation of that data into EHR systems to improve utilization.
This article provides just a small example of the need for improvements in healthcare IT and interoperability, while opening the door for those in the healthcare IT industry that are ready to deliver solutions to remedy these issues.
1http://www.healthit.gov/sites/default/files/fdasia1141report_final.pdf. 2 Prescription Drug Monitoring Program Center of Excellence, Brandeis University. Bureau of Justice Assistance: Prescription Drug Monitoring Program Performance Measures Report: January 2009 through June 2012. 2013.
As the Emdeon Pharmacy Services director of government product development and manager of government affairs, Wendy Cloe focuses on supporting sales, operations and product teams with legislative and regulatory analysis. With 14 years of state and federal government relations experience, she has assisted in educating her employers and clients regarding policy changes in the healthcare insurance and PBM industries. Cloe is a graduate of the University of Indianapolis and an AHIP certified managed healthcare professional. She served on the Colorado All Payer Claims Database Advisory Committee, the Legislative Committee on the Colorado Association of Health Plans, Self-Insurance Institute of America Government Relations Committee and the Colorado Association of Commerce and Industry Legislative Committee.
One often overlooked problem with the PMP's is the healthcare professional's ability to validate a drivers license with the state's BMV. With today's technology.. a grade schooler could produce a passable fake driver's license. The only people that are being caught by the PMP or those that are too lazy, cheap or stupid to get a fake driver's license.. those people who are in the business to divert drugs knows this weak link in the system. Now that hackers are getting into medical records http://www.reuters.com/article/2014/09/24/us-cybersecurity-hospitals-idUSKCN0HJ21I20140924?feedType=RSS&feedName=healthNews we should expect to see more and more insurance fraud... because we will have one less red flag.. of paying cash for Rxs.
Congressional Dietary Supplement Caucus hosts luncheon celebrating DSHEA
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NACDS members, HHS Secretary meet as 2015 health insurance enrollment nears
ARLINGTON, Va. — With open enrollment for the 2015 health insurance plan year set to begin on Nov. 15, National Association of Chain Drug Stores members were invited by Secretary of Health and Human Services Sylvia Burwell to participate in a pharmacy issues meeting on Friday with the secretary, HHS officials and pharmacy stakeholders at HHS headquarters in Washington, D.C.
NACDS president and CEO Steve Anderson released the following statement regarding NACDS’ engagement in the meeting:
“We appreciate the opportunity to participate in the pharmacy issues meeting with Secretary Burwell today. Patients rely on their pharmacies as trusted sources of information on healthcare topics, so NACDS again will make it a priority to work on a collaborative basis to help present clear and accurate information to patients — to empower their healthcare decisions in the still-new health exchange landscape. NACDS also has appreciated the opportunity to comment formally to the Centers for Medicare and Medicaid Services and to make recommendations intended to create a smooth start for new exchange enrollees seeking prescription drug coverage in the 2015 plan year.
“This is similar to pharmacy’s patient-focused collaboration in the lead-up to the January 2014 roll-out of exchange-based insurance. It also reflects pharmacy’s similar work in the roll out of Medicare Part D, in the response to H1N1, in vaccination-awareness efforts, and in providing necessary goods and services during natural disasters.
“NACDS members also valued the chance today to continue the discussion of opportunities to leverage the value of pharmacy in other areas. These include familiar and important functions like the dispensing of medication and helping patients take their medications correctly, as well as opportunities to make new and better use of the extensive education of pharmacists for the good of patient care.
“We took the opportunity to urge continued vigilance in the ongoing effort to create a fair and accurate pharmacy reimbursement structure to help ensure medication access for Medicaid beneficiaries.
“We also took the opportunity to discuss medication therapy management, which uses face-to-face interaction with a pharmacist to help patients take medications as prescribed. We are pleased that the HHS proposed rule issued earlier this year included an expansion of MTM services within the Medicare Part D program, indicating support for reforms to help pharmacy better serve its patients.
“Pharmacists are widely trusted and extremely valued by patients in the greatest need. Pending bipartisan legislation illustrates the strong support for leveraging pharmacy services to help care for the nation’s most vulnerable patients. With 116 cosponsors, H.R. 4190 would designate pharmacists as healthcare providers under Medicare Part B, to empower them to provide services in medically underserved communities, as allowed by state laws.
“NACDS appreciates the growing recognition of the importance of pharmacies as the face of neighborhood healthcare, and looks forward to continuing to expand partnerships designed to foster patient education and quality patient care.”
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