Drug Monitoring Programs Offer Step Toward Limiting Opioid Abuse
By: Stephanie Goldberg, Business Insurance, July 2015
At least 10 states require health care providers to access a prescription drug monitoring program before prescribing opioids, but workers compensation payers in all states should request providers do so to curb overprescribing, drug monitoring advocates say.
Connecticut is the latest state to require that health care providers check a patient’s history in the state’s prescription drug monitoring program before prescribing controlled substances. The requirements, which include checking the database before prescribing more than a 72-hour supply of any controlled substance and at least every 90 days for “continuous or prolonged treatment,” will take effect in October.
Prescription drug monitoring programs “give a holistic picture of the drug regimen for patients,” said Mark Pew, senior vice president of product development at Prium, a Duluth, Georgia-based medical management company. “A pharmacy benefit manager in workers compensation only has access to the drugs that are prescribed and dispensed for workers compensation … (The database) has every single drug that’s prescribed regardless of the payer.”
New York, Massachusetts and Tennessee are among states that also require health care providers to access databases before prescribing opioids.
“More and more states are going to be requiring it,” said Thomas W. Clark, clearinghouse manager at the PDMP Center of Excellence and research associate with the Heller School for Social Policy and Management at Brandeis University in Waltham, Massachusetts. “It’s critical for good patient care. If you don’t know what your patient is getting prescribed, it could contribute to addiction or diversion.”
Obstacles abound
Pennsylvania and Missouri are the only two states without prescription drug monitoring programs that health care providers can access.
Pennsylvania was expected to make its database available to all health care providers and pharmacists in June, but the process was delayed due to a lack of funds. Once the vendor that will create the monitoring program is identified, “we will have a better sense of the timeline,” a spokeswoman for the state’s Department of Health said in an email.
Meanwhile, Missouri H.B. 130, which would enact a statewide prescription drug monitoring program, passed the state House in February. A public hearing was held in April by the Senate, but no updates have been issued since.
When speaking with treating or prescribing physicians, the reviewing physicians at Prium always ask whether they’re accessing the prescription drug monitoring program, Mr. Pew said. “If the answer is no,” he added, “that to us is an immediate red flag that the prescriber isn’t doing the level of due diligence that they should in order to understand everything that’s going on with the patient.”
The follow-up is asking that they check the database. Payers in most states should get in the habit of asking workers comp physicians if they’re accessing prescription drug monitoring programs, Pew said.
One of the biggest concerns for health care providers is the amount of time it takes to check the database, Mr. Pew said, noting that it could take up to 10 minutes per patient.
“I personally see no issue with reimbursing physicians for time spent” if it’s going to increase adoption, Mr. Pew said. “Is it more cost effective to pay a doctor a fee to look at the PDMP and make better decisions, make sure the patient has right drug, or is it more cost effective to not do that and give patients inappropriate drugs that then become addiction or dependence issues and create ongoing health issues?”
While prescription drug monitoring programs are one of the best tools to curb overprescribing, they are state specific, sources said.
Though, Mr. Clark said some states are sharing data, which is important since “crossing state lines to doctor shop is a good way to avoid detection — especially with smaller states or states with lots of borders.”
Mr. Pew and Mr. Clark said there’s a push by some legislators, workers comp payers and other PDMP advocates for a national prescription drug monitoring program, but it’s not currently feasible from a technical standpoint.
