Publisher’s Window: September/October 2014
<!–– PDMPs: Are They Working? ––>
PDMP stands for prescription drug monitoring program. Forty-nine states now have PDMPs in place requiring pharmacies to report controlled substances that have been dispensed. I recently had the opportunity to attend a meeting on the topic in Washington, D.C., sponsored by the Bureau of Justice Assistance. What I heard is that these programs are turning out to be quite effective in addressing abuse and diversion of highly addictive drugs.
Contributing to this is that more and more states are now requiring physicians to not only register with the state’s program but to also check what’s been reported to the program for a particular patient before prescribing certain controlled substances. In years past, while the information on controlled substances was being reported to the states, there was very limited use of the data. Moreover, many states now send out what are referred to as unsolicited reports to physicians and pharmacists when a patient hits a threshold for triggering such a report. These thresholds could be five or more physicians and five or more pharmacies in 90 days, as in Florida, for example, or they could be five and five in 30 days, as is the case in New York.
Let me give you a few facts to support the positive impact PDMPs are having. In a recent paper on PDMP effectiveness published by the PDMP Center of Excellence at Brandeis University, using Florida and New York again as examples, Florida was shown to have a 51% decline in doctor shopping in a one-year period from Oct. 1, 2011, to Sept. 30, 2012, which was attributed to prescribers and pharmacists making queries to its database on a person of interest. In New York, when the mandate went into effect for prescribers to check the state’s database before prescribing specific controlled substances such as opioids, the number of individuals meeting New York’s threshold decreased close to 75% from the fourth quarter of 2012 to the fourth quarter of 2013.
Because doctor shoppers have a tendency to try to game the system by crossing state lines to have prescriptions written and filled, the National Association of Boards of Pharmacy (NABP) launched NABP InterConnect in 2011. The purpose was to enable data exchange among states. This program has met with great success, with 28 states now participating in InterConnect. It opens up the opportunity for prescribers and pharmacists to not only query their state’s database, but those of neighboring states as well.
Efforts are now underway to make it easier to query a state’s database on a person of interest by bringing this functionality into the workflow of a physician practice and a pharmacy. The American Society for Automation in Pharmacy (ASAP) took the lead back in 1995 in developing the first reporting standard used by pharmacies. Over the years ASAP, working with PDMPs, drug chains, and system vendors, enhanced the standard in order to improve the quality of the data being reported. For example, method of payment was a data element added that the state programs felt was important to have reported (doctor shoppers typically pay cash for their prescriptions).
ASAP took the lead again last year in developing a Web service standard to query a PDMP right from an electronic health record system or pharmacy system.
Prescription drug monitoring programs may never completely erase the abuse and diversion problem we have in this country, but these programs are gaining the traction needed to dramatically reduce the problem. CT
Bill Lockwood, chairman/publisher, can be reached at firstname.lastname@example.org.