By Phil Walls, RPh, Chief Clinical and Compliance Officer, myMatrixx
As stated last week, as the only state that does not have a prescription drug monitoring program (PDMP) in place, Missouri runs the risk of becoming the nation’s next pill mill.
Although PDMPs are the best tool currently available to combat fraud, waste and abuse of prescription drugs, they still have their limitations. Each state has its own regulations and reporting requirements, making it easy for individuals to “doctor shop” simply by crossing state lines—until the National Association of Boards of Pharmacy (NABP) got involved.
The NABP has led the way in breaking down some of the interstate barriers by developing a highly secure exchange platform that allows for the transmission of prescription monitoring program (PMP) data across state lines. The NABP’s PMP InterConnect system does not house any data but does ensure that each state’s data access rules are enforced. Currently 24 states are using PMP Interconnect, and many others are in discussion with NABP. (See the PMP InterConnect map for details).
Neither PMP Interconnect nor any of the individual state PDMPs interferes with the legitimate prescribing of controlled substances. Their sole purpose is to help fight drug diversion and abuse, and PMP Interconnect could make this possible on a national scale–provided that Missouri launches their own PDMP program and that all states participate in PMP Interconnect.
Brandeis University has also been very active in evaluating PDMPs, and through its PDMP Center of Excellence (COE), has released information on two very significant projects. The first project is a Prescription Behavior Surveillance System (PBSS) which uses de-identified data provided on a voluntary basis by various states’ PDMP databases. The primary goal of this project is to create an “early warning surveillance system” by measuring trends in controlled substance prescribing. A secondary goal is to use the data to evaluate the effectiveness of educational activities directed at prescribers. As of last September, 20 states had been invited to participate and five states had already submitted two to three years’ worth of data. The activities of the PBSS are driven by an oversight committee comprised of members from the Centers for Disease Control, the Food and Drug Administration, the Bureau of Justice Assistance, the Substance Abuse and Mental Health Services Administration, the Integrated Justice Information Systems Institute, the COE, the PDMP Training and Technical Assistance Center at Brandeis, and the participating PDMPs. These activities will include development of a periodic report to measure:
- Overall usage within drug classes and selected individual drugs
- Daily dosage
- Overlapping prescriptions within each drug class, across the opioid and benzodiazepine classes, and across dosage forms of opioid analgesics (i.e., immediate vs. extended release)
- Questionable activity within a class or classes
- Indicators of possible pill mills
- Inappropriate prescribing measures
- Pharmacy-based measures of possible inappropriate dispensing
- Payment sources
Reporting on “payment sources” is especially valuable! This will be the only report that has been able to capture all sources of controlled substance prescriptions–group health, Medicaid, Medicare, workers’ compensation, cash, etc. The only missing data will be those states that do not require dispensing physicians to submit data to a PDMP.
The second project from the COE is called the Third Party Payers Project. A severe limitation of PDMPs is the lack of access by insurance companies or other payers as well as clinical pharmacists not directly involved in dispensing. The project began by directly examining this limitation and others by convening a meeting of 77 participants invited from insurance companies, the Centers for Medicare and Medicaid Services, workers’ compensation organizations, and other state and federal government agencies. The consensus of this meeting: PDMP data should be made available to various payers. Look for an upcoming report from the COE on the expected outcome of sharing this data, namely, improved patient care, evaluation of prescriber and pharmacy performance, and a reduction in claims that result from inappropriate prescribing.
Both the NABP and the PDMP COE have contributed significantly to improve the use of PDMP data. However, there are two areas that will have to come from the states: 1) all state PDMPs should make reporting mandatory for all dispensers, and 2) the Missouri legislature needs to pass the PDMP bills this session!
About Phil Walls
Phil Walls is the Chief Clinical and Compliance Officer for myMatrixx®, a leading pharmacy and ancillary benefit management firm focused on workers’ compensation. Phil oversees all aspects of myMatrixx’s clinical program and the corporately owned and operated mail service pharmacy. He is a clinical pharmacist with over 35 years of experience in pharmacy benefits management, healthcare informatics and workers’ compensation. Phil has particular expertise in pain management, side effects of medications and managing overutilization. He is a published author, frequent speaker and regular contributor to the myMatrixx Blog covering work comp topics. Phil received the 2011 Dorland Health People Pharmacist Award, a national honor of excellence presented to healthcare professionals. Additionally, he is a member of several industry organizations including the American Pharmacists Association and the National Council for Prescription Drug Programs. Phil received his Bachelor in Science in Pharmacy from Mercer University School of Pharmacy and was awarded Doctoral Candidate status in Pharmacology at Ohio State University.
myMatrixx® is a full-service pharmacy and ancillary benefit management company focused on the workers’ compensation market. By combining advanced technology, clinical expertise and comprehensive reporting, myMatrixx simplifies the management of claims. Our results driven solutions deliver reduced costs for our clients and improve outcomes for their injured workers.
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