A New Generation of Prescription Monitoring Programs:Kentucky Is Adopting Best Practices

University of KentuckyLexington, KY

Thursday, January 24, 2013

Why Is a New Generation of PMPs Needed?

The Prescription Drug Abuse Epidemic is Increasing

The New Generation of PMPs

THE PARADIGM SHIFT:In addition to responding to others’ requests, PMPs need to proactively confront the Epidemic.

White Paper on PDMP Best Practices

Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best PracticesSeptember 20, 1012

• at www.pdmpexcellence.org

• Developed with BJA and Pew Charitable Trusts

KASPER -- moving toward the Next Generation

2012 Legislation – HB1 - has catapulted the KASPER system forward

In the following slides: items in Blue are Best Practices authorized by HB1

Data Collection : Standardize and Speed Up

• Collect prescription data within 24 hours of dispensing - as of 1/1/2013

Being done:• Collect all schedules II to V• Use most recent data submission standard, e.g. ASAP version

4.0 or higher. • For each Rx, collect data on method of payment

ID Person Picking Up PrescriptionTo be done:• Require pharmacies to submit ID information on who picks-up

each prescription -- so PMP knows who actually has the drug • Require pharmacies to check photo ID check before

dispensing a controlled substance to verify who has the drug.• MA PMP mandates reporting and positive ID for Schedule II

prescriptions - since 1/2/2009• Found 38% of the persons who dropped off or picked up the Rx are

not the patient• Now MA requires reporting and positive ID for all Schedule II to V

prescriptions - As of 1/1/2011.

Keep Current with Technology To be done:• Integrate electronic prescribing with PMP data

• Modify PMPs to incorporate electronic prescribing

To explore:• Utilize state-issued prescription forms

• serialized • single copy

Maintain Data QualityBeing done:• Verify data quality

• Take action to require non-reporting pharmacies do report• Require pharmacies to make corrections

To be done:• PMPs should check for obvious anomalies, e.g.:

• Prescribers who have died • Prescribers whose licenses/registrations are suspended or revoked • Prescriptions dispensed when pads were stolen, counterfeited or

forged.• Take action to stop illegal activities

Data LinkingBeing done:• Software link prescription records for the same individual:

• To allow all users to see full prescription histories• To identify probable doctor shoppers• For interstate data sharing• For aggregate reports to Governors, Legislatures and BJA • To make data analysis and reporting feasible• For researchers to evaluate and assess data

To be done:• Link when persons using aliases are identified

User Access and Report DisseminationBeing done:• Provide online access and automated reports - 24/7• Allow prescribers to review their own records • Allow law enforcement, including prosecutors to have

access.To be done:• Develop batch requesting for prescribers to screen an entire

day’s calendar of appointments • Integrate PMP reports with health information exchanges

(HIE) and electronic health records (EHR).

Increase Recruitment of Users

Being done:• Mandate prescriber enrollment in PMP – August 2012

• Enable access for appropriate users, e.g.

• State Medicaid Agencies• Medical examiners and coroners• Drug courts, probation officers and prisons• Drug treatment professionals and agencies

Increasing utilization - IBeing done:• Mandate prescribers use data for patients meeting criteria

• First C-II or C-III hydrocodone prescription or change in drug• Continued prescribing of these Rx at three mo• Average weekday requests to KASPER:

Before mandate -- 2,900 After mandate -- 19,000

• Authorize delegates to access data:• Allow users to create sub-accounts for persons delegated to request

PMP data• Principal users – responsible for delegate supervision • Principal users retain accountability for delegates’ data use

Increasing utilization - IIBeing done:• Education of all users• Prescriber training:

• Proper use of controlled substances • How to use PMP data• Methods of education: on-line training, tool-kits, medical schools,

continuing education, academic detailing,

To do:• Use PMP to monitor to assure training requirements are met• Use data to identify potential high impact users

• The 30% who prescribe 90% of Rx• Prescribers with high volume of doctor shoppers

•

Wider application of PMP data Being done:• Interstate PMP data sharing should be fully implemented

To be done:• PMPs should proactively request data from other PMPs to

identify doctor shopping or other criminal behavior across borders.

Unsolicited Reports and Alerts - ITo be explored:• PMP data -- vigorously analyze to identify potential misuse

and diversion, e.g.:• Potential doctor shopping, • Organized drug rings, • Prescription forgery• Pill Mills• Fraudulent sales of prescriptions by prescribers

• Send analyzed data rapidly to those who can intervene• Prescribers and Pharmacists• Law Enforcement • Health Professional Licensing Agencies

Wider application of PMP data Being done:• KY – Participating in National Governors Association

(NGA)Policy Academy to reduce prescription drug abuse.

• KY – Participating in Association of State and Territorial Health Officers (ASTHO) initiative with OH, TN and WV

• KY – Participating in Prescription Behavior Surveillance System with PDMP Center of Excellence / CDC, FDA and BJA project.

Other Data Analyses To be done with PBSS:• Analyze to ID geographical areas for intervention• Provide reports to:

• State Department of Health and county health agencies• State and Community Substance Abuse Prevention organizations• Drug Treatment Programs• Drug Take Back Programs

• PMP Data should be used as an Early Warning System• Doctor shopping patterns can detect where overdose and deaths will

increase, allowing interventions

Rates of Doctor Shopping Associated with OxyContin in MA, 1996

Rates per 100 of doctor shopping, by quintile00 - 88 - 14.2914.29 - 4040 - 100

"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"

Rates of Doctor Shopping Associated with OxyContin in MA, 1998

Rates of doctor shopping x 100, per quintile00 - 1.691.69 - 3.193.19 - 8.118.11 - 73.33

"Source: Massachusetts Dept. of Public Health in partnership with Brandeis University"

2005 Opioid-related Health ProblemsRate per 100,000 by Town

Rate per 100,000 Quintiles00.01 - 19.8219.82 - 37.537.5 - 56.9256.92 - 225.51

Overdose

2005 Prescriptions Associated with Questionable Activity(Rates per 100,000 Prescriptions) by Pharmacy Town

Questionable activity rates01 - 10951096 - 18971898 - 28822883 - 14184

Idaho: Rate of Doctor Shopping (Prescriptions)by Zip Code, January 2010

Percent of Prescriptions Associatedwith Doctor Shopping, by Quintiles

00 - 16.6716.67 - 28.5728.57 - 54.5554.55 - 99

Idaho: Zip Codes with at Least 100 Patients in 2010and Doctor Shopping Rate of at Least 10% in January 2010

Zip Codes Meeting the Criteria01

Collaboration with other agenciesTo be done:• Indian Health Service • Department of Veterans Affairs• Department of Defense

• DOD Facilities• Tricare

• Medicaid and Medicare• Private third party payers

• Health insurers• Workers Compensation

PDMPs & Third Party Payers – First MeetingDecember 2012

• PDMPs • PBMs • Privately Funded 3rd Party Payers • Publicly Funded 3rd Party Payers• Workers Compensation• Federal Agencies – ONDCP, BJA, CDC, CMS, DEA, FDA, NIDA,

SAMHSA • National Organizations• Researchers

PDMPs & Third Party Payers – First Meeting

Workgroup Recommendations:• PDMPs should share patient Rx histories with all 3rd Party Payers• Safeguards to protect PDMP data and assure proper use are

needed and are possible• Challenges to sharing require collaborative work• PDMPs should provide data to health care systems’ and facilities

quality assurance programs• Data regarding questionable providers should be shared • 3rd Party Payers should support PDMPs• PDMPs & 3rd Party Payers should help providers to identify and

refer persons to substance abuse treatment

Prescription Drug Monitoring Program Center of Excellence at Brandeis University

Funded by federal Bureau of Justice Assistance (BJA)and by Center for Disease Control and Food and Drug Administration through agreement with BJA

Began operation February 2010

www.pmpexcellence.org

Contact Information

John Eadie, MPADirector

PDMP Center of ExcellenceBrandeis University

518-429-6397jeadie@Brandeis.edu

Website: www.pmpexcellence.org