Navigating Wisconsin’s Prescription

Drug Monitoring Program and

Controlled Substances Board

WHA Member Forum:

Wednesday, April 27, 2016

10:00 am- 11:30 am CST

Chad Zadrazil, JD

Managing Director,

Controlled Substances Board and PDMP

WISCONSIN HOSPITAL ASSOCIATION WEBINAR

April 27, 2016

Navigating Wisconsin’s Prescription Drug Monitoring Program and Controlled Substances Board

Chad Zadrazil, JDManaging Director

Controlled Substances Board and PDMP

TOPICS

1) History of the Controlled Substances Board

2) Relevant H.O.P.E. Agenda Legislation

3) Current state of the Prescription Drug

Monitoring Program

4) Development of the Enhanced Prescription Drug

Monitoring Program (ePDMP)

History of the Controlled

Substances Board

HISTORY OF THE CSB

• 1970: Dangerous Substances Control Council Created in Department of Health and Family Services• Required to identify dangerous substances

and drugs to recommend to the Legislature

HISTORY OF THE CSB

• 1971: Uniform Controlled Substances Act Enacted• Council recreated as Controlled Substances

Board• Duties:• Modify schedules of controlled substances• Issue special use authorization permits

HISTORY OF THE CSB

• 1981: CSB required to enter into agreements with state and federal agencies to monitor and control the diversion of controlled substances

HISTORY OF THE CSB

• 1995: CSB transferred to the Department of Regulation and Licensing• Required to advise DRL and Boards on CS

issues• New “special” authority for modifying the

schedules of controlled substances based on:• Federal action• Notice from District Attorneys

HISTORY OF THE CSB

• 1995: CSB required to enter into agreements with local, state, and federal agencies• Lead the agencies in:• Improving the identification of diversion• Improve enforcement and compliance

• CSB required to convene periodic meetings of the agencies and to coordinate a state diversion prevention control program

HISTORY OF THE CSB

• 2015 Act 55:• Requires CSB to review and disclose PDMP

data to state agencies and law enforcement when the CSB identifies “critically dangerous conduct or practices of a pharmacy, pharmacist, practitioner, or patient”

HISTORY OF THE CSB

• 2015 Act 55:• Added members to the CSB:• Medical Examining Board Chair• Dental Examining Board Chair• Board of Nursing Chair

• Transferred PDMP oversight from the Pharmacy Examining Board to the CSB

Heroin, Opioid Prevention and

Education (H.O.P.E.) Agenda

Legislation

H.O.P.E. AGENDA LEGISLATION

• 2013 Act 199: Requires individuals to show proper identification when picking up schedule II or III opioid prescription medication

H.O.P.E. AGENDA LEGISLATION

• 2015 Act 266: Changes the PDMP:• Increase data submission frequency from 7 days

to 1 day• Require prescribers to review PDMP data prior to

issuing a prescription order (some exceptions)• Allow law enforcement agencies and

prosecutorial units to request PDMP data without court orders

• Add access for non-prescriber healthcare and substance abuse professionals

H.O.P.E. AGENDA LEGISLATION

• 2015 Act 267: Creates reporting requirements for the CSB to determine the effectiveness of the PDMP and to compare actual outcomes with projected outcomes

H.O.P.E. AGENDA LEGISLATION

• 2015 Act 268: Requires law enforcement agencies to report any of the following to the PDMP for dissemination to PDMP users:• A suspected violation of the CSA involving a

prescription drug• A person who is undergoing or who immediately

prior experienced an opioid-related overdose event• A person who may have died as a result of using a

narcotic drug• A report of a stolen controlled substance

prescription

Current State of the Prescription

Drug Monitoring Program

The PDMP is a tool that provides data that can be used to help address prescription drug abuse, addiction and diversion. The data can help healthcare professionals:• evaluate a patient’s use of monitored prescription drugs

and make more informed decisions

• support access to legitimate medical use of controlled substances

• provide better coordination of care to patients seeing multiple professionals

• identify and treat persons addicted to prescription drugs

• inform public health initiatives

21

PDMP BACKGROUND

1. Pharmacies and other dispensers of monitored prescription drugs collect and submit data to the PDMP.

2. The data is added to a statewide database.

3. Authorized users may obtain PDMP data to verify prescription information.

22

PDMP PROCESS

AK

AL

AR

CA

CO

ID

IL IN

IA

MN

MO

MT

NE

NV

ND

OH

OK

OR

TN

UT

WA

AZ

SD

NM

VA

WYMI

GA

KS

HI

TX

ME

MS

WINY

PA

LA

KY

NC

SC

FL

NH

MA

RI

CT

NJ

DE

MD

VT

WV

States with operational PDMPs

States with enacted PDMP legislation,

but program not yet operational

States with legislation pending

D.C.

PDMP STATUSES

2010 2011 20132012

June 1, 2013PDMP Database is fully operational

24

June 1, 20102009 Act 362 directs the creation of the PDMP

October 1, 2011Administrative rule-

writing process begins

January 1, 2013Administrative rules,

Phar 18, go into effect; dispensers begin collecting data

October 1, 2013WI PDMP Connects

to the PMPi and begins sharing data

with other states

HISTORY OF THE WI PDMP

Prescriber Dispenser Drug Patient

Name Name NDC Number Last Name

DEA Number DEA Number Name, Strength, Form

First Name

NPI Number NPI Number QuantityDispensed

Address

State LicenseNumber

State LicenseNumber

Estimated Days Supply

Date of Birth

Location Location Rx Number Gender

Key:Bold: Submitted by most dispensersGreen: Obtained using submitted dataRed: Beginning April 2017 or after

RefillsAuthorized

PaymentMethod

Dates Prescribed and Dispensed

Name of Person Picking up Rx

25

PDMP DATA

• Over 35 million Rx records in the database since January 1, 2013

• Approximately 1,600 dispensers actively submitting data

• User Registration: Over 14,500 users with query accounts

• Healthcare Queries: Over 2.75 million recipient queries performed since June 1, 2013

• Approximately 90,000 interstate queries performed since October 1, 2013

• Healthcare User Alerts: Approximately 1,600 since July 1, 2013

PDMP STATISTICS

27

Monitored Prescription Drug Doses Dispensed / County Population

July – Sept 2015

Top 15 Monitored Prescription Drug PrescriptionsJuly - September 2015

Drug Name

Nu

mb

er of

Prescrip

tion

s

Percent o

f MP

D

Prescrip

tion

s

HYDROCODONE/ACETAMINOPHEN 451,098 17.01%

DEXTROAMPHETAMINE/AMPHETAMINE 214,259 8.08%

TRAMADOL HCL 204,618 7.72%

OXYCODONE HCL 202,824 7.65%

ALPRAZOLAM 181,209 6.83%

LORAZEPAM 180,161 6.79%

OXYCODONE HCL/ACETAMINOPHEN 162,752 6.14%

ZOLPIDEM TARTRATE 151,559 5.72%

CLONAZEPAM 148,057 5.58%

METHYLPHENIDATE HCL 95,129 3.59%

MORPHINE SULFATE 78,354 2.95%

DIAZEPAM 73,263 2.76%

LISDEXAMFETAMINE DIMESYLATE 60,204 2.27%

ACETAMINOPHEN WITH CODEINE 56,542 2.13%

PREGABALIN 56,333 2.12%

PDMP STATISTICS

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

De

c-1

3

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Average Number of Healthcare Patient Queries Per Day

HEALTHCARE USE

• Number of Agencies with Accounts:

– Federal Law Enforcement/Government: 3

– State Law Enforcement/Government: 3

– County Law Enforcement/DA: 24

– County Coroner/Medical Examiner: 11

– Municipal Law Enforcement: 36

29

PUBLIC SAFETY USE

Development of the Enhanced

Prescription Drug Monitoring

Program (ePDMP)

PROJECT OVERVIEW- GOALS

The primary goals of the project is to develop the Wisconsin Enhanced Prescription Drug Monitoring Program “ePDMP” to maximize the Program’s:

1. Value-added clinical workflow integrations2. Data quality capabilities3. Public health and public safety uses

PROJECT OVERVIEW- SCOPING

• User Feedback since June 2013

• National Best Practices• Pew Charitable Trusts• PDMP Center of Excellence at Brandeis

University• U.S. Bureau of Justice Assistance

• 2014 National Governors Association Policy Academy on Reducing Rx Drug Abuse

PROJECT OVERVIEW- SCOPING

• National Surveys in 2012 and 2015 identified several barriers to use of PDMPs, including:

• Antiquated registration processes• Cumbersome portal designs• Poor data layouts• Limited integration into HIT

PROJECT OVERVIEW- TIMELINE

• 2014 – 2015: Available PDMP solutions investigated

• November 2015: Statement of Work for ePDMP development Approved

• January 2016: Development Sprints began

• January 2017: ePDMP Go Live

PROJECT OVERVIEW- FUNDING

• Project is possible due to federal support and inter-agency collaboration:

• 2014 Harold Rogers PDMP Enhancement Grant

• 2015 Harold Rogers PDMP Enhancement Grant

• 2015 CDC Prescription Drug Overdose Prevention Grant (in partnership with DHS)

PROJECT LOGISTICS

• Iterative Design and Development Process• Modular, user-centered focus

• Continual user input and testing

• Feedback loop with subject matter experts

DEMONSTRATION- REGISTRATION

DEMONSTRATION- LOG IN

DEMONSTRATION- PATIENT REPORT

39

DEMONSTRATION

EMR INTEGRATION CURRENT STATE

PMPi PMP Gateway

Translation of messages

PDMP Environment

Hub Environment

EMREnvironment

EMR INTEGRATION FUTURE STATE

42

PMPi PMP GatewayWI ePDMP

API

PDMP Environment

Hub Environment

EMREnvironment

EMREnvironment

QUESTIONS

Chad ZadrazilManaging Director

608-266-0011chad.zadrazil@wisconsin.gov

pdmp@wisconsin.gov

Additional Resource from WHA

As you may have seen recently in The Valued Voice, the WHA legal and

government relations teams have prepared summaries of new laws (many of

which were championed by WHA) passed during the 2015-16 Wisconsin legislative

session and that impact Wisconsin’s hospitals and health systems. These

summaries provide information to help you and your staff better understand the

newly enacted legislation. Several opioid related bills are summarized. The

summaries are for WHA members only, and will not be generally accessible on

our website.

The summaries are posted to the WHA Member Portal, on the dropdown menu

under the “General” tab. The Member Portal is a secure location and requires a

first-time user to obtain a username and password. If you do not have a member

account, go to members.wha.org and click on “Register” to create an account. For

more information on signing up and logging on to the WHA Member Portal, go to

www.wha.org/data.aspx.

Upcoming Webinar

HCAHPS, Patient Satisfaction & Opioid Prescribing:

Debunking the Myths

Wednesday, June 1 * 12:00-1:00 pm

Visit www.wha.org for more information and to register.

Questions?

Need more information?

Contact: Steve Rush

608-274-1820

srush@wha.org