prescription monitoring program 612x300
Issue Background

Prescription Monitoring Programs

SPPAN Position

As PMPs have developed, a number of key features have emerged as considerations for policymakers intent on optimizing their PMPs. Some of these include:

Housing entities:  Early PMPs were housed in law enforcement agencies; most of the newer programs are run by state boards of pharmacy, state health departments, or other entities within the healthcare delivery sphere.

Controlled substances schedules monitored: Most PMPs now monitor medications in schedules II, III, and IV; a few are more limited, and a few also include schedule V medications. Some also have added “drugs of concern” that can be designated by regulation to capture non-scheduled medications that may be subject to abuse.

Frequency of reporting: Most now require data to be reported at least weekly by dispensers. The trend is toward requiring daily reporting, and one state, Oklahoma, has instituted point-of-sale reporting.

Access to the data: Recently, states have begun expanding access to include drug abuse counselors, coroners, probation and parole officers, and others, including patients, judged to have legitimate need for the information.

Unsolicited reporting: Many PMPs now regularly analyze their data to identify individuals who use multiple prescribers and pharmacies, and who may be engaging in inappropriate “doctor shopping” activities. When such individuals are identified, the program automatically notifies all prescribers and dispensers involved, intending that those individuals take steps to intervene if and when they encounter the individual again.

Advisory Councils: A minority of PMPs use multidisciplinary advisory councils composed of key stakeholders as a source of additional oversight and ideas to improve the effectiveness of the programs.

Integration with electronic health records (EHRs) and health information exchanges (HIEs): The most recent development in PMP characteristics has been integration of PMP data with EHRs and HIEs. Such integration is thought to improve provider utilization as it streamlines the workflow and increases the visibility of PMP data.

Background

A prescription monitoring program (PMP) utilizes a centralized database to collect and analyze information about prescriptions for controlled substances. Information such as the identity of the patient, the doctor, the pharmacist, and the medication, is entered when the prescription is dispensed at the pharmacy.

PMPs are intended primarily to be a source of information for prescribers and pharmacists to use in the care of patients, as well as a tool to help deter, detect, and respond appropriately to drug abuse and diversion. PMP data can help providers feel confident in prescribing for the treatment of pain, and can help them diagnose and refer for appropriate treatment those patients who have a substance use disorder. A PMP is not intended to prevent patients from obtaining needed medications.

At present, 49 states, the District of Columbia, and the territory of Guam have passed legislation to establish a PMP; two states are in the process of initiating their programs, leaving 47 fully operational PMPs. With nearly every state having an established program, the focus now is on implementing sustainable funding for PMPs and on identifying and instituting key characteristics of PMPs that maximize their effectiveness.

SPPAN’s member organizations have identified PMP policy as a key policy priority and SPPAN is taking the lead in efforts to address their needs.  In 2014, SPPAN created a short-term, ad hoc group, Improving the Effectiveness of PMPs as Healthcare Delivery Tools.  The group members had robust discussions and productive meetings during its 8-month timeframe; in 2015, this group will continue to meet and focus on its deliverables, as a SPPAN PMP Resource Group.

Map: State PMP Status, January 2015

Map: Status of Interstate Data Sharing, January 2015

Policy brief on PMPs, created with PAINS.

NASCSA’s PMP information

ACS-CAN How Do You Measure Up? (See pages 45-46)

SPPAN/ACS/PPSG model PMP legislation

NAMSDL-PMP State Law and Policy Profiles, June 2014

Frequently overlooked in the discussion of PMPs is their usefulness as healthcare delivery tools. By far, the most common use of PMPs is by healthcare providers. Policies should support this use of PMPs.