Q&A's > Prescription
Drug Monitoring Programs
STATE PRESCRIPTION DRUG MONITORING
PROGRAMS
Updated November 2008
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Which states have
prescription drug monitoring programs (PDMPs)?
-
Are other states
planning to implement prescription monitoring programs?
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Has monitoring program
data been used to target potential subjects of investigation?
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Is the accessibility
to controlled substance prescription data a violation of patient
confidentiality?
-
Who is authorized to
review the data and once the data is collected, what is done with it?
-
What are the annual
costs to operate a prescription drug monitoring program?
-
What are some of the
beneficial uses of prescription drug monitoring programs?
-
What impact do
monitoring programs have on bordering states that do not operate a
monitoring program?
-
What additional time,
if any, is required to submit prescription data to state authorities?
-
How can a state
initiate a prescription drug monitoring program?
-
Which states have
received a Harold Rogers Drug Prescription Monitoring grant?
-
Should there be a
federal mandate for states to establish prescription monitoring
programs or should states be encouraged to establish individual
programs?
-
What is NASPER?
-
What are the differences between the Harold
Rogers Prescription Drug Monitoring grant Program and NASPER?
1. Which states have drug prescription monitoring programs
(PDMPs)?
As of November 2008, 38 states had enacted legislation that required
prescription drug monitoring programs: 32 of those programs are currently
operating and 6 are in the start-up phase.
The 32 states that have operational PDMPs (capacity to receive and
distribute PDMP information to authorized users) are: Alabama, Arizona,
California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Indiana,
Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Nevada,
New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma,
Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah,
Virginia, Washington, West Virginia, and Wyoming. The 6 states that have
legislation in place but are not yet operational are: Alaska, Iowa, Kansas,
Minnesota, New Jersey, and Vermont. Currently, the state of Washington uses
their program only for disciplinary purposes, however legislation has been
introduced to expand the program statewide.
2. Are other states planning to implement prescription drug
monitoring programs?
Eleven 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.
Only one state (Wisconsin) and the District of Columbia have done nothing
to implement a program.
3. Has monitoring program data been used to target
potential subjects of investigations?
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.
4. Is the accessibility to controlled substance
prescription data a violation of patient confidentiality?
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.
5. Who is authorized to review the data and once the data
is collected, what is done with it?
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.
6. What are the annual costs to operate a prescription drug
monitoring program?
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.
7. What are some of the beneficial uses of prescription
drug monitoring programs?
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.
8. What impact do monitoring programs have on bordering
states that do not operate a monitoring program?
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
9. What additional time, if any, is required to submit
prescription data to state authorities?
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.
10. How can a state initiate a prescription drug monitoring
program?
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
11. What states have received a Harold Rogers Prescription
Monitoring grant?
In FY2002, Congress allocated $2 million for the Harold Rogers grant
program. Sixteen states applied to receive grants and 9 grants were awarded.
Ohio, Pennsylvania, Virginia and West Virginia received grants to start a
new state monitoring program. California, Kentucky, Massachusetts, Nevada,
and Utah received grants to enhance their existing state monitoring
programs.
In FY2003, Congress allocated $7 million for the Harold Rogers grant
program. Nine states applied to receive new or enhancement grants and a
technical assistance grant was awarded to the National Alliance for Model
State Drug Laws. Florida, Maine, Alabama, New Mexico and Wyoming received
grants to start new programs in their states. California, Idaho, New York
and Nevada received enhancement grants. Additional funding was set aside in
FY2003 for an evaluation of the effectiveness of the existing programs.
In FY2004, Congress appropriated another $7 million for the Harold Rogers
grant program. Twenty-seven states applied to receive new, enhancement or
planning grants and a total of 23 grants were awarded. Iowa, Mississippi,
New Jersey, Oregon, and South Carolina received grants to start new
programs. Alabama, Hawaii, Indiana, Kentucky, Massachusetts, Maine, New
York, Nevada, Oklahoma, Pennsylvania, Virginia, and West Virginia received
enhancement grants. Kansas, Colorado, Connecticut, North Carolina,
Tennessee, and Washington received planning grants.
In FY2005, the Harold Rogers Prescription Drug Monitoring Program
received $10 million in funding. Twenty-two states were awarded grants.
Alabama, California, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine,
Massachusetts, Michigan, Mississippi, New York, Nevada, Oklahoma, and
Virginia received enhancement grants. Missouri, Ohio, Tennessee, and Vermont
received implementation grants. Arizona, Louisiana, and New Hampshire
received planning grants.
In FY2006, the Harold Rogers Prescription Drug Monitoring Program
received $7.5 million in funding. Eighteen states were awarded grant funds:
Alabama, California, Colorado, Connecticut, Idaho, Illinois, Indiana,
Kentucky, Louisiana, Maine, Mississippi, New York, North Carolina, North
Dakota, Ohio, Oklahoma, Texas, and Virginia.
In FY2007, the Harold Rogers Prescription Drug Monitoring Program
received $7.5 million in funding. Eighteen states were awarded grant funds:
Alabama, Alaska, Arizona, California, Connecticut, Hawaii, Illinois,
Indiana, Kentucky, Massachusetts, Montana, Nevada, New York, Ohio, Oklahoma,
Texas, Vermont and Virginia.
In FY2008, the Harold Rogers Prescription Drug Monitoring Program
received $7.05 million in funding. Twenty-seven grant applications for
financial assistance were received from states to create, enhance, or plan
PDMPs. Funding was recommended for 3 planning grants (Florida, Georgia, and
Missouri), 2 implementation grants (Guam and Minnesota), and 11 enhancement
grants (Alabama, Colorado, Illinois, Indiana, Kentucky, Maine,
Massachusetts, North Dakota, Ohio, Rhode Island, and West Virginia). It
should be noted that two states and one U.S. territory (Rhode Island,
Minnesota, and Guam) received grants for the first time through this
program. Also, one state (Minnesota) and one U.S. territory (Guam) will
implement new PDMPs with this funding. A total of $5,261,905 from FY08 funds
was provided.
Since the creation of the Harold Rogers grant program in FY2002, the
number of states with PDMPs or legislation to initiate PDMPs (38) has
increased by 171%. Prior to Harold Rogers funding in 2001, only 14 states
had operational PDMPs. This represented only 40 percent of DEA-registered
pharmacies and 44 percent of DEA registered-practitioners.
12. Should there be a federal mandate for states to
establish prescription monitoring programs or should states be encouraged to
establish individual programs?
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.
13. What is NASPER?
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.
14. What are the differences between the Harold Rogers
Prescription Drug Monitoring grant program and NASPER?
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.
|
STATE |
PROGRAM TYPE |
SCHEDULES COVERED |
YEAR ENACTED |
DATA COLLECTION Started |
1 |
AL |
Electronic |
C II-V |
2004 |
April 2006 |
2 |
AK* |
Electronic |
C I-V |
2008 |
|
3 |
AZ |
Electronic |
C II-IV 2008 |
2007 |
October 2008 |
4 |
CA |
Single copy serialized, Electronic |
C II-IV |
2005 |
January 2007 (1939) |
5 |
CO |
Electronic |
C II-V |
2005 |
July 2007 |
6 |
CT |
Electronic |
C II-V 2008 |
2007 |
July 2008 |
7 |
HI |
Electronic |
C II-V |
2002 |
July 1999 (1992 –II only) |
8 |
ID |
Electronic |
C II-V |
2001 |
Oct 1997 |
9 |
IL |
Electronic |
C II-V |
1999 |
April 2000/ Jan 2008 |
10 |
IN |
Electronic |
C II-V |
2004 |
January 2005 |
11 |
IA* |
Electronic |
C II-IV 2008 |
2006 |
|
12 |
KY |
Electronic |
C II-V |
1998 |
January 1999 |
13 |
KS* |
Electronic |
C II-IV |
2008 |
|
14 |
LA |
Electronic |
C II-V |
2006 |
November 2008 |
15 |
ME |
Electronic |
C II-IV |
2003 |
July 2004 |
16 |
MA |
Electronic |
C II |
1992 |
April 2002 |
17 |
MI |
Electronic |
C II-V |
2002 |
January 2003 |
18 |
MS |
Electronic |
C II-V |
2005 |
May 2006 |
19 |
MN* |
Electronic |
C II-III Jan 2009 |
2007 |
|
20 |
NV |
Electronic |
C II-V |
1995 |
January 1997 |
21 |
NJ* |
Electronic |
C II-IV |
2008 |
|
22 |
NM |
Electronic |
C II-IV |
2004 |
July 2005 |
23 |
NY |
Single copy, serialized/ Electronic (state issued) |
C II, Benzos |
1998 |
July 1982 |
24 |
NC |
Electronic |
C II-V |
2005 |
July 2007 |
25 |
ND |
Electronic |
C II-V |
2005 |
September 2007 |
26 |
OH |
Electronic |
C II-V |
2005 |
May 2006 |
27 |
OK |
Electronic |
C II-V |
1990 |
July 2006 |
28 |
PA |
Electronic |
C II |
1972 |
Late 2002 |
29 |
RI |
Electronic |
C II-III |
1997 |
July 1997 |
30 |
SC |
Electronic |
C II-IV |
2006 |
January 2008 |
31 |
TN |
Electronic |
C II-IV |
2002 |
December 2006 |
32 |
TX |
Single copy, serialized/ Electronic (state issued) |
CII
II-V Sept 2008 |
1997 |
July 1982 |
33 |
UT |
Electronic |
C II-V |
1995 |
January 1997 |
34 |
VT* |
Electronic |
C II-IV Jan 2009 |
2006 |
|
35 |
VA |
Electronic |
C II-IV |
2002 |
June 2006 |
36 |
WA |
Electronic |
Limited Triplicate |
1984 |
Limited program |
37 |
WV |
Electronic |
C II-IV |
1995 |
December 2002 |
38 |
WY |
Electronic |
C II-IV |
2004 |
July 2004 |
* Program is not currently operational – anticipated start date is
listed.
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