Prescription Drug Monitoring Programs - PDMP Center of Excellence

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Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 46Current adoption status: A small but growing number of states statutorily require or recommend thatprescribers, pharmacists, and/or addiction treatment providers consult their PDMPs, sometimes only inspecific circumstances (NAMSDL, 2012b). In Nevada, statute NRS 639.23507 states that prescribers“shall” obtain a PDMP report when first prescribing a controlled substance for a new patient who theysuspect might be doctor shopping, and for patients for whom they have not prescribed controlledsubstances in the last year. In Oklahoma, prescribers must consult the PDMP when prescribingmethadone for treating pain. Recently passed legislation in Ohio requires its medical and pharmacylicensing boards to adopt rules mandating use of its PDMP, which they have done (Ohio AdministrativeCode Sections 4731-‐11-‐11 and 4729-‐5-‐20). In Louisiana, medical directors of pain clinics are nowresponsible for joining and querying the PDMP to help ensure compliance with a patient’s treatmentagreement. West Virginia requires that opioid addiction treatment programs access the PDMP whenbeginning treatment and at 90-‐day intervals, and Vermont requires use of its PDMP data by physicianswho treat patients for opioid dependence with buprenorphine (Office Based Opioid Treatment, orOBOT). Kentucky, Massachusetts, New York, and Tennessee have passed laws in 2012 requiring use ofthe PDMP by prescribers (NAMSDL, 2012b, communication with Massachusetts PDMP).Barriers to adoption: Monitoring required prescriber use of its system by a PDMP requires staff timeand resources that may be unavailable to some PDMPs, presenting a barrier to assuring that prescribersadopt this practice. Other potential barriers include resistance to mandates by providers and enactmentof the required legislative or regulatory changes. However, should findings from existing initiatives provepositive, other states could be encouraged to undertake the necessary legislative and regulatorychanges to mandate utilization, and make resources available to implement utilization requirements.See Section V. Summary and Recommendations for a recommendation to study the efficacy ofmandates in comparison to voluntary approaches with regards to increasing PDMP utilization.SummaryRationale: Mandating utilization may improve prescribing, patient safety, drug treatment, and licensingboard monitoring.Evidence of effectiveness: Accumulated experience, key stakeholder perceptions.Current adoption status: Several states mandate utilization by different categories of end users undervarying circumstances.Barriers to adoption: Provider resistance to mandates, need for legislative and/or regulatory reform,lack of program resources to monitor compliance.5. Institute financial incentivesRationale and evidence for effectiveness: Greater utilization of the PDMP by prescribers could perhapsbe encouraged by financial incentives, but little data exist on such approaches. One suggestion is tomake lower medical malpractice insurance premiums contingent on regular use of PDMP data. There isa need for studies examining whether prescriber use of PDMP data reduces the number of patient-‐‐initiated lawsuits stemming from alleged mis-‐prescribing of controlled substances; such findings couldhelp establish the rationale for charging PDMP-‐using prescribers lower insurance premiums. Similarly,
Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 47health insurance carriers providing somewhat higher office visit fees to prescribers who consult thePDMP through pay for performance initiatives might also incentivize greater use. Investigation is neededto determine whether any states or agencies have implemented financial incentives to encourage PDMPuse, and if they have, what impact they may have had on utilization, prescribing practices, doctorshopping, and other forms of drug diversion.Current adoption status: As of this writing, we know of no examples of financial incentive programsdesigned to elicit greater PDMP utilization.Barriers to adoption: No precedent exists for adopting this practice, so pilot programs should beconsidered.SummaryRationale: Financial incentives may increase PDMP utilization.Evidence of effectiveness: Key stakeholder perceptions.Current adoption status: None.Barriers to adoption: Lack of evidence for effectiveness, lack of precedents.6. Delegate accessRationale and evidence for effectiveness: Allowing prescribers to delegate access to PDMP records byoffice staff (sometimes called “sub-‐accounts”), may help increase utilization of PDMP data to detectpatients at risk and improve prescribing. However, the extent to which delegate accounts increasePDMP utilization is unknown.Current adoption status: Twelve states permit prescribers to delegate access to PDMP records (NAMSDL,2011b), and statutes adopted in 2012 in Kentucky, New York, and Tennessee authorize use of delegates.Some PDMPs permit prescribers to delegate only licensed health care professionals, e.g., nurses, whileothers allow non-‐licensed administrative staff to be delegated. New York’s new statute requires thedelegates to be employees of the same practice as the prescriber. Methods to allow prescribers toestablish sub-‐accounts for delegates and to oversee and supervise their data acquisition, as well asmethods to hold prescribers accountable for their delegates’ activities, are not standardized. The specificpolicies and procedures governing delegates, their relative security, and the extent to which theyincrease the legitimate use of PDMP data in a practice need study. A first step would be to survey states’current policies, followed by a comparative analysis of their impact on utilization.Barriers to adoption: Increasing staff access to PDMP data has raised concerns about maintainingpatient privacy and confidentiality. Those concerns must be addressed by each state in order fordelegate accounts to gain acceptance. Master account holders may find monitoring of sub-‐accounts forwhich they are responsible burdensome.
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