What’s a Prescription Monitoring Program and why you should care

Prescription Monitoring Programs are state-based electronic information systems that collect and deliver information about the drugs dispensed to patients, the prescribers thereof, and the pharmacies that do the dispensing.
Each state now has legislation enabling a PMP, with New Hampshire just added to the list. Not all are operational, and even among those that are there is wide variation among and between PMPs. Some are mandatory – that is, they require physicians and/or pharmacies to check them before prescribing or dispensing certain drugs. Others are optional – not surprisingly, usage in mandatory states is much higher than in those states where usage is optional.
What drugs are entered into the system also varies, with some states requiring much broader lists of drugs be tracked via their PMP – typically Schedule II – V Others only require tracking for the most potent Scheduled drugs.
PMPs can identify likely doctor-shopping and patients getting multiple fills for the same script, prevent duplicate fills, guard against dangerous drug-drug interactions, help law enforcement identify potentially fraudulent or criminal activity, and help physicians assess the risk in prescribing narcotics.
There have been some significant results. This from Brandeis’ University’s PMP Center of Excellence:
• Ohio – emergency department medical providers found that 41% of those given PMP data altered their prescribing for patients receiving multiple simultaneous narcotics prescriptions. Of these providers, 63% prescribed no narcotics or fewer narcotics than originally planned, while 39% prescribed more.
• California – 74% of physician responders to a survey indicated they had changed their prescribing practices to a patient as a result of using PMP Patient Activity Reports (PAR); 91% rated the “effectiveness of the PAR in maintaining the care and health of your patient” as good to excellent.
• Kentucky – A 2010 survey of users of Kentucky’s PMP, Kentucky All Schedule Prescription Electronic Reporting (KASPER), found that were an aid to clinical practice, with 70% of prescribers and dispensers judged PMP reports to be “very” or “somewhat” important in helping them decide what drug to prescribe a patient; 90% of prescribers and pharmacists “refused to prescribe or dispense a controlled substance based on the information contained in a KASPER report.”
• Louisiana – Five doctor shoppers who each obtained an average of 16.9 controlled substances prescriptions per month prior to rollout of the state’s PMP in September dropped to 0 prescriptions by December.
• As the Massachusetts PMP began sending unsolicited PMP reports regarding possible doctor shoppers to prescribers in 2010, prescribers were asked about the usefulness of the reports. Of the first 162 responders, only 14% said they were “aware of all or most of other prescribers,” and only 13% said “based on current knowledge, including the report, the patient appears to have legitimate medical reason for prescriptions from multiple prescribers.”
PMPs – properly set up and implemented – can be valuable tools in the battle against opioid abuse and diversion. Alas, the AMA and some other provider and “patient advocacy” groups find fault with PMPs, decrying the extra labor involved in ensuring patient safety and raising what are mostly ill-founded concerns with patient data.
There will be much more to come on PMPs; they need support, strengthening, and financial resources. Remember this.