Prescription Drug Monitoring Programs: Effects on Opioid ...
Prescription Monitoring Programs Ohio’s Experience
Transcript of Prescription Monitoring Programs Ohio’s Experience
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Prescription Monitoring ProgramsPrescription Monitoring ProgramsOhio’s ExperienceOhio’s Experience
Danna E Droz, RPh, JDDanna E Droz, RPh, JDAdministratorAdministrator
Prescription Monitoring Program Prescription Monitoring Program Ohio Board of PharmacyOhio Board of Pharmacy
National Conference of State Legislators National Conference of State Legislators San Antonio, TXSan Antonio, TX
December 6, 2006December 6, 2006
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WA
ORMT
ID WY
ND
SDMN
IANE
WI MI
CO KS MOIL INUTNV
CA
AZ NM OK
TXAK
AR
LA
TNKY
MS AL GASC
NC
OHVA
PANY
MEVT
CT
NH
NJ
MD
RI
DC
DE
HI
VW
FL
MA
States with current PMP Law
Operational
Enacted
Pending
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Data Collection / Investigation Data Collection / Investigation without a PMPwithout a PMP
W a lg r e e n ’ s
R i t e A i dP h a r m a c y
R i t e A idP h a r m a c y
W a l g r e e n ’ s
L e w i s & C l a r k D r u g s # 1
J o e ’ sP h a r m a c y
A r e a D r u gT a s k F o r c e
D P HD r u g C o n t r o l B r a n c h
M e d i c a lB o a r dD e n ta l
B o a r d
C i t yP o l i c e
K S PP o s t
P h a r m a c yB o a r d
C o u n tyP o l i c e
W a l M a r tP h a r m a c y
S m i t h ’ sD r u g
L e w is & C la r kD r u g s # 2
P a t ’ s P h a r m a c y
W a lM a r tC e n t r a lO f f i c e
W a lM a r tP h a r m a c y
R i t e A idC e n t r a lO f f i c e
W a l g r e e n ’ sR e g io n a lO f f i c e
C i t yP o l i c e
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Data Collection / Investigation Data Collection / Investigation after a PMPafter a PMP
Walgreen’s
Rite AidPharmacy
Rite AidPharmacy
Walgreen’s
Lewis & Clark Drugs #1
Joe’sPharmacy
Area DrugTask Force
DPHDrug Control Branch
MedicalBoard
DentalBoard
CityPolice
KSPPost
PharmacyBoard
CountyPolice
WalMartPharmacy
Smith’sDrug
Lewis & ClarkDrugs #2
Pat’s Pharmacy
WalMartCentralOffice
WalMartPharmacy
Rite AidCentralOffice
Walgreen’sRegionalOffice
CityPolice
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
Confidentiality & SecurityConfidentiality & Security
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Goals ofGoals of PMPsPMPs
♥♥ Education & informationEducation & information
♥♥ Public Health InitiativesPublic Health Initiatives
♥♥ Early intervention & PreventionEarly intervention & Prevention
♥♥ Investigation & law enforcementInvestigation & law enforcement
♥♥ Protection of confidentialityProtection of confidentiality
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Goals of a PMPGoals of a PMP
•• Prevent people from getting Prevent people from getting
drugsdrugs
•• “Cut them off”“Cut them off”
•• To decrease the number of To decrease the number of
pills dispensedpills dispensed
NOTNOT
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Decision PointsDecision PointsGoalsGoals
Where will data come from?Where will data come from?Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Confidentiality & SecurityConfidentiality & Security
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
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DispensersDispensers•• PharmaciesPharmacies•• PractitionersPractitioners
OfficeOfficeEmergency RoomEmergency Room
Inpatients?Inpatients?•• Hospital/nursing homeHospital/nursing home•• JailJail•• Assisted LivingAssisted Living
EE--prescriptions: preprescriptions: pre--dispensing???dispensing???
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to include?Drugs to include?Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Confidentiality & SecurityConfidentiality & Security
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
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WA
ORMT
ID WY
ND
SDMN
IANE
WI MI
CO KS MOIL IN
UTNVCA
AZ NM OK
TXAK
AR
LA
TNKY
MS AL GASC
NC
OHVA
PANY
MEVT
CT
NH
NJ
MD
RI
DC
DE
HI
VW
FL
MA
C-II onlyC-II, IIIC-II, III, IVC-II, III, IV, VUnknown
Schedules Reported
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate program?Agency to operate program?Who can obtain informationWho can obtain information
Confidentiality & SecurityConfidentiality & Security
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
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WA
ORMT
ID WY
ND
SDMN
IANE
WI MI
CO KS MOIL INUTNV
CA
AZ NM OK
TXAK
AR
LA
TNKY
MS AL GASC
NC
OHVA
PANY
MEVT
CT
NH
NJ
MD
RI
DC
DE
HI
VW
FL
MA
Pharm Bd/ Licensing agencyHealth/Pub Health /Subst AbuseLaw EnfUnknown
Agencies That Operate the PMP
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can access information?Who can access information?Confidentiality & SecurityConfidentiality & Security
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
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NO NEW ACCESS!NO NEW ACCESS!
Entities already Entities already had access to had access to patient’s medical patient’s medical records and records and prescriptionsprescriptions
Rx records in Rx records in one placeone place
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Who can access the data?Who can access the data?
Prescriber Prescriber -- own patientown patient
Pharmacist Pharmacist –– own patientown patient
Licensing Board Licensing Board -- own licenseeown licensee
Law Enforcement Law Enforcement –– active active investigation investigation –– drug relateddrug related
??Grand Jury Subpoena??Grand Jury Subpoena
??Individual ??Individual –– own informationown information
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WA
ORMT
ID WY
ND
SDMN
IANE
WI MI
CO KS MOIL INUTNV
CA
AZ NM OK
TXAK
AR
LA
TNKY
MS AL GASC
NC
OHVA
PANY
MEVT
CT
NH
NJ
MD
RI
DC
DE
HI
VW
FL
MA
LE/ Licensing AgenciesPharmacists/PharmaciesPhysiciansUnknown
-PMP Data-Primary Clients
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PMP IssuesPMP Issues
Profiling/ Fishing/ Targeting Profiling/ Fishing/ Targeting PhysiciansPhysicians•• Express purpose limitations in Express purpose limitations in
statutestatute•• Double signature each LE Double signature each LE
request request –– KY, OHKY, OH
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Liability for providers?Liability for providers?Funds to operate programFunds to operate program
Confidentiality & SecurityConfidentiality & Security
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Liability for Health Care Liability for Health Care PractitionersPractitioners
Statutory protection on pointStatutory protection on point
•• OH, OK, ALOH, OK, AL
Open to interpretation Open to interpretation
•• ID, IN, ID, IN,
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate programConfidentiality & SecurityConfidentiality & Security
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PMPsPMPs are funded through:are funded through:
Federal grants Federal grants ––•• Hal Rogers GrantsHal Rogers Grants
•• NASPER GrantsNASPER Grants
State funds:State funds:•• Controlled substance license feesControlled substance license fees
•• General tax revenueGeneral tax revenue
•• Professional license feesProfessional license fees
•• Fines and forfeituresFines and forfeitures
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Decision PointsDecision PointsGoalsGoals
Where will data come fromWhere will data come from
Drugs to includeDrugs to include
Agency to operate programAgency to operate program
Who can obtain informationWho can obtain information
Liability for Health Care providersLiability for Health Care providers
Funds to operate programFunds to operate program
Confidentiality & SecurityConfidentiality & Security•• Separate presentationSeparate presentation
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OHIOOHIO PrePre--LegislationLegislation
2001 2001 -- Agency supports PMP Agency supports PMP conceptconcept
May 2001 Obtain sponsor for May 2001 Obtain sponsor for PMP legislationPMP legislation•• Sponsor met with BOP + LE Sponsor met with BOP + LE
officersofficers
•• Discussed other state lawsDiscussed other state laws
Draft PMP legislationDraft PMP legislation
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OHIOOHIO PrePre--Legislation, cont.Legislation, cont.
Medical Medical -- Board Board and Associationand Association
Pharmacy Pharmacy --Board and Board and AssociationAssociation
Nursing Nursing -- Board Board and Associationand Association
Dental Board Dental Board
Retail MerchantsRetail Merchants
Law Enforcement Law Enforcement (State and Local)(State and Local)
PhRMAPhRMA rep. rep.
Fall 2001 Fall 2001 -- Seek input from Seek input from stakeholdersstakeholders
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OHIOOHIO LegislationLegislation
Jan 2002 Jan 2002 -- Legislation introduced Legislation introduced in Housein House
May 2002 May 2002 –– Passed House Health Passed House Health CommitteeCommittee
May 2002 May 2002 –– Passed HousePassed House
November 2002 November 2002 –– Senate HearingsSenate Hearings
December 2002 December 2002 –– Died at end of Died at end of legislative sessionlegislative session
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OHIOOHIO Legislation, cont.Legislation, cont.
Jan 2004 Jan 2004 –– Legislation reLegislation re--introduced in Houseintroduced in House
May 2004 May 2004 –– Passed House Health Passed House Health CommitteeCommittee
May 2004 May 2004 –– Passed HousePassed House
November 2004 November 2004 –– Passed Senate Passed Senate Health CommitteeHealth Committee
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OHIOOHIO Legislation, cont.Legislation, cont.
December 2004 December 2004 –– Passed SenatePassed Senate
Dec 2004 Dec 2004 –– House concurred with House concurred with amendmentsamendments
Feb 2005 Feb 2005 -- Governor signedGovernor signed
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Ohio Automated RxOhio Automated RxReporting ProgramReporting Program
OAOA℞℞RSRS
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OAOA℞℞RSRS ImplementationImplementation
Summer Summer –– Fall 2005 Drafted RulesFall 2005 Drafted Rules
October 2005 October 2005 –– Hired AdministratorHired Administrator
Jan 2006 Jan 2006 -- Ohio Rules effectiveOhio Rules effective
Feb Feb –– Apr 2006Apr 2006•• Purchase equipmentPurchase equipment
•• Hire additional staff as neededHire additional staff as needed
•• Communicate with stakeholdersCommunicate with stakeholders
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OAOA℞℞RSRS ImplementationImplementation
May 2006 May 2006 –– Initial Rx data Initial Rx data reportingreporting
July, August 2006 July, August 2006 –– Internal Internal testingtesting
September 2006 September 2006 –– Pilot/external Pilot/external testingtesting
October 2006 October 2006 –– Full Full implementationimplementation
NovNov--Dec 2006 RefinementsDec 2006 Refinements
2007 Enhancements2007 Enhancements
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OAOA℞℞RSRS
Sales DatabaseSales Database Rx DatabaseRx Database
Manufacturers Manufacturers WholesalersWholesalers
PharmaciesPharmacies
Law EnforcementLaw Enforcement
PrescribersPrescribers& &
PharmacistsPharmacistsRegReg BoardsBoards
IndividualsIndividualsGrand JuryGrand Jury
OSBPOSBP--
PMPPMP
VendorVendor
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OAOA℞℞RSRSControlled substances CControlled substances C--II, III, IV, and VII, III, IV, and VCarisoprodol (Soma®)Carisoprodol (Soma®)Tramadol (Tramadol (UltramUltram®)®)Sales to prescribers by Sales to prescribers by pharmacies or wholesalerspharmacies or wholesalers
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OAOA℞℞RSRS
Statute requirementsStatute requirements
Pharmacies and wholesalers Pharmacies and wholesalers submit datasubmit data
OSBP staff collect, monitor & OSBP staff collect, monitor & review datareview data
OSBPOSBP--PMP releases data as PMP releases data as authorized by statuteauthorized by statute
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OAOA℞℞RSRS BudgetBudget
$180,000 $180,000 -- 2003 Hal Rodgers Grant2003 Hal Rodgers Grant
$350,000 $350,000 -- 2005 Hal Rodgers Grant2005 Hal Rodgers Grant
$400,000 $400,000 -- 2006 Hal Rodgers Grant2006 Hal Rodgers Grant
$ ? $ ? -- Supplemental FundsSupplemental Funds
Cannot charge pharmacist, Cannot charge pharmacist, pharmacy, or prescriber to support pharmacy, or prescriber to support OAOA℞℞RSRS
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OAOA℞℞RSRS BudgetBudget
Future FundingFuture Funding
•• Grants Grants
•• State Appropriations State Appropriations
•• Medicaid?Medicaid?
••Workers’ Compensation?Workers’ Compensation?
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OAOA℞℞RSRS
Board is required to:Board is required to:
Review data for potential law Review data for potential law violationsviolations
Notify LE agency or licensing Notify LE agency or licensing board of potential violationsboard of potential violations
Keep records of every requestKeep records of every request
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NASPERNASPER
Grant RequirementsGrant Requirements••Weekly reportingWeekly reporting
•• Minimum data fieldsMinimum data fields
•• Electronic formatElectronic format
•• InteroperabilityInteroperability
•• Criteria for use/disclosureCriteria for use/disclosure
•• Client authenticationClient authentication
•• Penalties for unauthorized Penalties for unauthorized disclosuredisclosure
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WA
ORMT
ID WY
ND
SDMN
IANE
WI MI
CO KS MOIL INUTNV
CA
AZ NM OK
TXAK
AR
LA
TNKY
MS AL GASC
NC
OHVA
PANY
MEVT
CT
NH
NJ
MD
RI
DC
DE
HI
VW
FL
MA
30 days15 days7 daysDaily - plannedUnknown
Pharmacy Reporting Frequency
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NASPERNASPER
Data available to Data available to
•• Practitioner/Pharmacist for Practitioner/Pharmacist for treating/evaluating a patienttreating/evaluating a patient
•• LE/Licensing Agency in LE/Licensing Agency in furtherance of investigation of furtherance of investigation of diversion/misuse of a schedule II, diversion/misuse of a schedule II, III, or IV drug.III, or IV drug.
•• PMP of another statePMP of another state
•• HHS, DEA, Medicaid for researchHHS, DEA, Medicaid for research
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NASPERNASPER
Stick:Stick:•• Preference for Preference for
treatment $$ if treatment $$ if state has a state has a NASPER grantNASPER grant
Carrot:Carrot:$$ to $$ to implement or implement or enhance PMPenhance PMP
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RECOMMENDATIONSRECOMMENDATIONS••Allow data to be shared with Allow data to be shared with
outout--ofof--state entities, subject to state entities, subject to same criteria and penalties as same criteria and penalties as inin--state entitiesstate entities
••Plan for trainingPlan for training
PhysiciansPhysicians
PharmacistsPharmacists
law enforcementlaw enforcement
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Data from a PMP is Data from a PMP is NOT evidence!NOT evidence!
Investigation is still Investigation is still required. required.
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www.nascsa.orgClick on “Alliance of States WithPrescription Monitoring Programs”
www.deadiversion.usdoj.govClick on “Publications”, then “Program Reports”
ResourcesResources
www.natlalliance.orgClick on “Prescription Drug Monitoring Project”
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OAOA℞℞RSRS
Contact infoContact info
Phone: 614Phone: 614--466466--41434143
OAOA℞℞RSRS Fax: 614Fax: 614--644644--85568556
EE--mail: mail: [email protected]@ohiopmp.gov
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