As of July 2008, 38 states had enacted legislation which required prescription drug monitoring programs: 29 of those programs are currently operating and 9 are in the start-up phase.

The 38 states with prescription drug monitoring programs and/or enacted legislation are: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, New York, North Dakota, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Washington, West Virginia, and Wyoming. Currently, the state of Washington uses their program only for disciplinary purposes, however legislation has been introduced to expand the program statewide.

Eleven additional states are in the process of proposing, preparing, or considering legislation. These states include Arkansas, Delaware, Florida, Georgia, Maryland, Missouri, Montana, Nebraska, New Hampshire, Oregon, and South Dakota.

Program officials state their systems are not used to target subjects for an investigation. Prescription drug monitoring data regarding specific healthcare professionals may be reviewed after an official complaint is received. The PDMP system may also be programmed to highlight significant deviations regarding prescriptions. The states use the data to identify that a problem exists and to determine the extent of the diversion or abuse. The systems are also queried for patients who are found to be "doctor shoppers"--one individual visiting numerous doctors and pharmacies to obtain pharmaceutical controlled substances.

Every prescription drug monitoring program provides safeguards to protect patient confidentiality. Only those individuals who are authorized by statute or regulation can access the controlled substance prescription information.

Each state has legislation that determines who can access the PDMP data. PDMP officials are not privy to information that is not part of the PDMP. The significance of the monitoring programs is to facilitate access to prescription information in a more user friendly format.

The cost of implementing and operating a prescription drug monitoring program differs from state to state because of many variables that exist. The average cost to start a PDMP is approximately $350,000. State annual operating costs for PDMPs range from $100,000 to nearly $1 million. Cost variations are affected by the frequency of data collection (daily, bi-weekly vs. monthly), the use of a third party vendor, the number of prescriptions written/filled in a state, the number of schedules (II-V) collected, and the use of official forms when required.

Historically, investigators needed to visit each location to obtain prescription information for routine pharmacy inspections or investigations. The PDMP database eliminates this tedious process by requiring prescription information be maintained electronically. This allows investigators to obtain pharmacy data from multiple locations without having to visit each and every pharmacy.

Prescription drug monitoring programs are being used to deter and identify illegal activity such as prescription forgery, indiscriminate prescribing and "doctor shopping." Most programs provide patient specific drug information upon request of the patient’s physician or pharmacist. Some state programs proactively notify physicians when their patients are seeing multiple prescribers for the same class of drugs. This assists healthcare professionals in managing patient care. It has been an extremely successful program to thwart diversion in a number of states.

State authorities report that after a prescription drug monitoring program goes into effect, "doctor shopping" patients often move their criminal activities to bordering states that do not have a PDMP. PDMP information can be shared with other states if state statutes and regulations permit it. The National Alliance for Model State Drug Laws has drafted a Model Interstate Compact to assist states in their efforts to share prescription information across state lines. More information on the National Alliance for Model State Drug Laws can be found at www.natlalliance.org

Additionally, the Integrated Justice Information Systems (IJIS) Institute is leading a project funded by the Bureau of Justice Assistance (BJA) to develop a system for the interstate exchange of prescription drug monitoring program data. IJIS created a pilot project between California and Nevada to share state PDMP information. In May 2007, a test of the pilot project was successful with the exchange of information. This is the first time states have exchanged PDMP data in an automated fashion.

Currently, IJIS is working to implement a prototype system that will prove the value of a shared hub server used to centrally facilitate and broker data exchanges. The hub server would provide for a centralized enabling system with which each state PDMP system could communicate more economically than having each and every state manage 49 exchange pipelines on a one-by-one basis. The Ohio Board of Pharmacy has agreed to serve as the host agency that would work under the guidance of the IJIS PDMP Committee to acquire and operate the hub for the duration of the prototype. Ohio, Kentucky, and Nevada have agreed to participate in this phase of the project to exchange data via the hub.

For these projects, IJIS is working closely with the practitioners from the Alliance of States with Prescription Monitoring Programs, the Bureau of Justice Assistance, and the Drug Enforcement Administration. The goal is to provide recommendations on how to implement the data exchanges based on the new open standards emerging from the Global Justice XML Data Model. More information on the IJIS Interstate PDMP exchange project can be found at www.IJIS.org

The majority of pharmacies submit prescription information electronically. States have generally expressed satisfaction with the electronic system since it markedly reduced the paperwork burden that existed when pharmacies manually submitted prescription data.

The Harold Rogers Prescription Drug Monitoring grant program provides financial assistance to state authorities who want to create or enhance a prescription drug monitoring program. Additional information can be found at www.ojp.usdoj.gov/bja

In recognition of the proven effectiveness in curtailing the diversion and abuse of pharmaceutical controlled substances, the DEA has been a long time proponent of prescription drug monitoring programs (PDMPs). Further, it is DEA’s intent to support the best available means to facilitate the establishment or enhancement of PDMPs to ensure prescription data is collected from the largest percentage of controlled substance dispensers in the most efficient, cost-effective manner.

Advantages of a national program may include an enhanced ability to identify and track prescription transactions across state lines. This is particularly important given the growing trend of filling prescriptions through mail order and Internet pharmacies. While several states declare their programs have the capability of generating reports on out-of-state prescribers or patients, they do not routinely disseminate this information to other states.

However, the size and cost of a national database may be prohibitive. The system would be required to annually collect data from over 673 million prescriptions from the nation’s 65,000 DEA-registered pharmacies and respond to requests for information from more than 1.2 million DEA-registered practitioners. Additionally, the system would duplicate the efforts of state programs currently in operation. While only 38 states are currently operating prescriptions drug monitoring programs or have enacted legislation, these states, including those considering or in the process of proposing legislation, cumulatively account for 98 percent of the nation’s DEA-registered pharmacies and 98 percent of all practitioners.

Conversely, because state databases are much smaller than that of a national program, state programs can more readily identify specific trends. In addition, state programs can identify patients who may need drug treatment due to abuse or addiction. State programs also have the ability to assist physicians whose patients may be receiving inadequate pain treatment causing the patient to see multiple physicians in order to obtain additional medication.

Efforts to implement state prescription drug monitoring programs tend to meet with opposition from a variety of groups including medical associations, pharmacy groups, pharmaceutical companies, patient advocacy groups, and civil liberty groups. The creation of a federal program would likely face opposition from those groups as well as from states’ rights groups and from officials in states currently operating their own PDMP. The question arises as to whether a national program would be compatible with existing state programs. States currently operating programs may have to revise existing programs to accommodate a national program.

On August 11, 2005, President Bush signed into law the National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER). The act creates a grant program for states to create prescription drug monitoring databases and enhance existing ones, similar to the Harold Rogers Prescription Monitoring grant program. NASPER authorizes $60 million for the program through fiscal 2010. While the Harold Rogers grant program is placed within the Department of Justice, the NASPER program is placed within the Department of Health and Human Services (HHS).

The NASPER grant program is authorized for $60 million over five years, with $15 million allocated for 2006 and 2007, and $10 million for 2008, 2009, and 2010. However, HHS did not receive an appropriation in its FY2006, FY2007, or FY2008 budget for this program. Funding for NASPER in FY2009 has not yet been determined.

The Harold Rogers grant program, housed in the Department of Justice, allows states to establish their own requirements with regard to Schedules monitored, information sharing, and accessibility/availability to the program data. Harold Rogers encourages the sharing of information and prescription data among states. Harold Rogers encourages the submission of data for prescriptions in Schedules II, III, IV & V. Eligibility for Harold Rogers grant funds has a very simple requirement: States applying for grants must have in place an enabling statute or regulation "that requires submission of controlled substance prescription data to a centralized database administered by an authorized state agency."

The National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER), housed within the Department of Health and Human Services (HHS), requires states to meet requirements in order to receive grant funding. NASPER requires states to collect data for prescriptions in Schedules II, III, and IV. Additionally, NASPER requires states to be capable of sharing information and prescription data among states.

The following chart provides information on the 38 states with legislation enabling a prescription drug monitoring program including the type of program currently being operated, the schedules covered and the year the current version of the program was enacted.

* Program is not currently operational – anticipated start date is listed.