Mandatory Use of Prescription Drug Monitoring Programs

Mandatory Use of Prescription Drug Monitoring Programs Peggy Kelley Wed, 10/24/2018 - 03:26 PM EDT

Description

Mandatory use of prescription drug monitoring programs (PDMPs) is a legal mandate by the state for prescribers (and, in some states, dispensers) to register with and/or use the state PDMP when prescribing (or dispensing) a Schedule II drug or other controlled drug. A PDMP is a statewide electronic database that collects designated data on substances dispensed in the state. The PDMP is housed by a specified statewide regulatory, administrative, or law enforcement agency, which distributes data to professionals who are authorized under state law to receive this information (National Alliance for Model State Drug Laws [NAMSDL], 2009).

Objective(s)

To limit the over-prescription of opioids and other controlled substances by increasing prescribers’ and dispensers’ use of PDMPs

Typical Elements

State requirements regarding who must register with the PDMP and whether registrants are then required to use it vary (PDMP Center of Excellence [COE], 2014). States can require:

  • Only prescribers to register with a PDMP
  • Both prescribers and dispensers to register with the PDMP
  • Only certain prescribers to register with the PDMP, for example, those at pain management practices (National Alliance for Model State Drug Laws [NAMSDL], 2013)
  • Potential prescribers to register with the PDMP before they can prescribe controlled substances (NAMSDL, 2013)
  • Both prescribers and dispensers to actively use the PDMP
  • Prescribers to use the PDMP only under certain circumstances
    • Note: For example, in Nevada, prescribers must use the PDMP only when they suspect that a patient may seek the medicine for a reason other than treatment of a medical condition. In Oklahoma, use of the PDMP is required only when prescribing methadone (PDMP COE, 2014).
    • The status of PDMPs changes rapidly, and these examples may no longer be current. NAMSDL catalogs PDMP laws by state and is the best source for up-to-the-minute information.

When instituting mandatory use of PDMPs, states can require the following of prescribers:

  • Acquisition of licensed prescriber and pharmacist files from appropriate licensure boards (PDMP COE, 2014)
  • An online registration process for licensed prescribers and pharmacists that, based on licensee files, allows for automated verification of the applicant’s driver’s license number, prescriber or pharmacist license number, and DEA license number (PDMP COE, 2014)
  • A social marketing campaign to persuade medical professionals that the required use of the PDMP is in the best interests of patients and providers; the campaign should include evidence that PDMPs can help improve clinical decision-making without burdening medical workflow (PDMP COE, 2014)
  • Development and delivery of a Web-based training module on the use and benefits of PDMP data for prescribers and dispensers (PDMP COE, 2013)
  • Dedicated staff and resources to handle the increase in demand on the PDMP system (PDMP COE, 2014)
  • Stipulations on whether to make prescribers immune from liability for checking or failing to check the PDMP, to encourage use (Haffajee, Jena, & Weiner, 2015)
  • Guidance-based available evidence, and regular and rigorous evaluation of the requirements (Haffajee, Jena, & Weiner, 2015)
    • Note: Haffajee et al. (2015) recommend that policymakers “seriously explore and evaluate more positive approaches [to improving PDMP use], including pay-for-performance, malpractice discounts, or immunity from liability for prescribers who diligently use the systems” (p. 892). The authors note that while PDMP mandates can be effective, they should apply only to clinically appropriate circumstances.

Populations

Prescribers, dispensers, and users of controlled substances

Outcomes

Mandatory use of PDMPs has been linked to the following:

  • Lower incidence of doctor shopping in Tennessee and New York (PDMP COE, 2014)
  • A 35% growth in prescribers active on Utah’s PDMP (NAMSDL, 2013)
  • Increased use of the PDMP in Kentucky, New York, Tennessee, and Ohio (PDMP COE, 2014)
  • Fewer individuals with an opioid prescription and fewer prescriptions for all opioids in Tennessee and New York (PDMP COE, 2014)
  • A reduction in the overall dispensing of controlled substances in Kentucky (PDMP COE, 2014)

Guidelines

Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States. 

Mandating PDMP Participation by Medical Providers: Current Status and Experience in Kentucky. 

State Advocacy Guide to Prescription Drug Monitoring Program Legislation and Regulations. 

Kentucky Meets Gold Standard for Prescription Drug Monitoring Programs. 

Acknowledged by

National Conference of Insurance Legislators. Best Practices to Address Opioid Abuse, Misuse and Diversion. 

References

Haffajee, R. L., Jena, A. B., & Weiner, S. G. (2015, March 3). Mandatory use of prescription drug monitoring programs. Journal of the American Medical Association, 313(9), 891–892. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2107540

National Alliance for Model State Drug Laws. (2013, September 25). Emerging PMP issues: Legal analysis. Presentation at the Harold Rogers PDMP National Meeting, Washington, D.C. Retrieved from http://www.pdmpassist.org/pdf/PPTs/National2013/26-9-A%20Green.pdf

National Alliance for Model State Drug Laws. (2009, August). Prescription Drug Monitoring Programs: A Brief Overview. Retrieved from  https://namsdl.org/wp-content/uploads/Prescription-Drug-Monitoring-Programs-PMPs-and-Health-Insurance-Portability-and-Accountability-Act-HIPAA-Brief-Overview.pdf

PDMP Center of Excellence. (2013). Mandating PDMP participation by medical providers: Current status and experience in Kentucky. Waltham, MA: Brandeis University. Retrieved from https://olis.leg.state.or.us/liz/2015R1/Downloads/CommitteeMeetingDocument/51774

PDMP Center of Excellence. (2014). Mandating PDMP participation by medical providers: Current status and experience in selected states. Waltham, MA: Brandeis University. Retrieved from https://docplayer.net/20900402-Mandating-pdmp-participation-by-medical-providers-current-status-and-experience-in-selected-states.html