Prescription Monitoring Programs Ohio’s Experience · 2007-01-31 · 1 Prescription Monitoring Programs Ohio’s Experience Danna E Droz, RPh, JD Administrator Prescription Monitoring

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Prescription Monitoring ProgramsPrescription Monitoring ProgramsOhio’s ExperienceOhio’s Experience

Danna E Droz, RPh, JDDanna E Droz, RPh, JDAdministratorAdministrator

Prescription Monitoring Program Prescription Monitoring Program Ohio Board of PharmacyOhio Board of Pharmacy

National Conference of State Legislators National Conference of State Legislators San Antonio, TXSan Antonio, TX

December 6, 2006December 6, 2006

2

WA

ORMT

ID WY

ND

SDMN

IANE

WI MI

CO KS MOIL INUTNV

CA

AZ NM OK

TXAK

AR

LA

TNKY

MS AL GASC

NC

OHVA

PANY

MEVT

CT

NH

NJ

MD

RI

DC

DE

HI

VW

FL

MA

States with current PMP Law

Operational

Enacted

Pending

33

Data Collection / Investigation Data Collection / Investigation without a PMPwithout a PMP

W a lg r e e n ’ s

R i t e A i dP h a r m a c y

R i t e A idP h a r m a c y

W a l g r e e n ’ s

L e w i s & C l a r k D r u g s # 1

J o e ’ sP h a r m a c y

A r e a D r u gT a s k F o r c e

D P HD r u g C o n t r o l B r a n c h

M e d i c a lB o a r dD e n ta l

B o a r d

C i t yP o l i c e

K S PP o s t

P h a r m a c yB o a r d

C o u n tyP o l i c e

W a l M a r tP h a r m a c y

S m i t h ’ sD r u g

L e w is & C la r kD r u g s # 2

P a t ’ s P h a r m a c y

W a lM a r tC e n t r a lO f f i c e

W a lM a r tP h a r m a c y

R i t e A idC e n t r a lO f f i c e

W a l g r e e n ’ sR e g io n a lO f f i c e

C i t yP o l i c e

44

Data Collection / Investigation Data Collection / Investigation after a PMPafter a PMP

Walgreen’s

Rite AidPharmacy

Rite AidPharmacy

Walgreen’s

Lewis & Clark Drugs #1

Joe’sPharmacy

Area DrugTask Force

DPHDrug Control Branch

MedicalBoard

DentalBoard

CityPolice

KSPPost

PharmacyBoard

CountyPolice

WalMartPharmacy

Smith’sDrug

Lewis & ClarkDrugs #2

Pat’s Pharmacy

WalMartCentralOffice

WalMartPharmacy

Rite AidCentralOffice

Walgreen’sRegionalOffice

CityPolice

55

Decision PointsDecision PointsGoalsGoals

Where will data come fromWhere will data come from

Drugs to includeDrugs to include

Agency to operate programAgency to operate program

Who can obtain informationWho can obtain information

Liability for Health Care providersLiability for Health Care providers

Funds to operate programFunds to operate program

Confidentiality & SecurityConfidentiality & Security

66

Goals ofGoals of PMPsPMPs

♥♥ Education & informationEducation & information

♥♥ Public Health InitiativesPublic Health Initiatives

♥♥ Early intervention & PreventionEarly intervention & Prevention

♥♥ Investigation & law enforcementInvestigation & law enforcement

♥♥ Protection of confidentialityProtection of confidentiality

77

Goals of a PMPGoals of a PMP

•• Prevent people from getting Prevent people from getting

drugsdrugs

•• “Cut them off”“Cut them off”

•• To decrease the number of To decrease the number of

pills dispensedpills dispensed

NOTNOT

88


Where will data come from?Where will data come from?Drugs to includeDrugs to include






99

DispensersDispensers•• PharmaciesPharmacies•• PractitionersPractitioners

OfficeOfficeEmergency RoomEmergency Room

Inpatients?Inpatients?•• Hospital/nursing homeHospital/nursing home•• JailJail•• Assisted LivingAssisted Living

EE--prescriptions: preprescriptions: pre--dispensing???dispensing???

1010



Drugs to include?Drugs to include?Agency to operate programAgency to operate program





11

WA

ORMT

ID WY

ND

SDMN

IANE

WI MI

CO KS MOIL IN

UTNVCA

AZ NM OK

TXAK

AR

LA

TNKY

MS AL GASC

NC

OHVA

PANY

MEVT

CT

NH

NJ

MD

RI

DC

DE

HI

VW

FL

MA

C-II onlyC-II, IIIC-II, III, IVC-II, III, IV, VUnknown

Schedules Reported

1212




Agency to operate program?Agency to operate program?Who can obtain informationWho can obtain information




13

WA

ORMT

ID WY

ND

SDMN

IANE

WI MI

CO KS MOIL INUTNV

CA

AZ NM OK

TXAK

AR

LA

TNKY

MS AL GASC

NC

OHVA

PANY

MEVT

CT

NH

NJ

MD

RI

DC

DE

HI

VW

FL

MA

Pharm Bd/ Licensing agencyHealth/Pub Health /Subst AbuseLaw EnfUnknown

Agencies That Operate the PMP

1414





Who can access information?Who can access information?Confidentiality & SecurityConfidentiality & Security



1515

NO NEW ACCESS!NO NEW ACCESS!

Entities already Entities already had access to had access to patient’s medical patient’s medical records and records and prescriptionsprescriptions

Rx records in Rx records in one placeone place

1616

Who can access the data?Who can access the data?

Prescriber Prescriber -- own patientown patient

Pharmacist Pharmacist –– own patientown patient

Licensing Board Licensing Board -- own licenseeown licensee

Law Enforcement Law Enforcement –– active active investigation investigation –– drug relateddrug related

??Grand Jury Subpoena??Grand Jury Subpoena

??Individual ??Individual –– own informationown information

17

WA

ORMT

ID WY

ND

SDMN

IANE

WI MI

CO KS MOIL INUTNV

CA

AZ NM OK

TXAK

AR

LA

TNKY

MS AL GASC

NC

OHVA

PANY

MEVT

CT

NH

NJ

MD

RI

DC

DE

HI

VW

FL

MA

LE/ Licensing AgenciesPharmacists/PharmaciesPhysiciansUnknown

-PMP Data-Primary Clients

1818

PMP IssuesPMP Issues

Profiling/ Fishing/ Targeting Profiling/ Fishing/ Targeting PhysiciansPhysicians•• Express purpose limitations in Express purpose limitations in

statutestatute•• Double signature each LE Double signature each LE

request request –– KY, OHKY, OH

1919






Liability for providers?Liability for providers?Funds to operate programFunds to operate program


2020

Liability for Health Care Liability for Health Care PractitionersPractitioners

Statutory protection on pointStatutory protection on point

•• OH, OK, ALOH, OK, AL

Open to interpretation Open to interpretation

•• ID, IN, ID, IN,

2121







Funds to operate programFunds to operate programConfidentiality & SecurityConfidentiality & Security

2222

PMPsPMPs are funded through:are funded through:

Federal grants Federal grants ––•• Hal Rogers GrantsHal Rogers Grants

•• NASPER GrantsNASPER Grants

State funds:State funds:•• Controlled substance license feesControlled substance license fees

•• General tax revenueGeneral tax revenue

•• Professional license feesProfessional license fees

•• Fines and forfeituresFines and forfeitures

2323








Confidentiality & SecurityConfidentiality & Security•• Separate presentationSeparate presentation

2424

OHIOOHIO PrePre--LegislationLegislation

2001 2001 -- Agency supports PMP Agency supports PMP conceptconcept

May 2001 Obtain sponsor for May 2001 Obtain sponsor for PMP legislationPMP legislation•• Sponsor met with BOP + LE Sponsor met with BOP + LE

officersofficers

•• Discussed other state lawsDiscussed other state laws

Draft PMP legislationDraft PMP legislation

2525

OHIOOHIO PrePre--Legislation, cont.Legislation, cont.

Medical Medical -- Board Board and Associationand Association

Pharmacy Pharmacy --Board and Board and AssociationAssociation

Nursing Nursing -- Board Board and Associationand Association

Dental Board Dental Board

Retail MerchantsRetail Merchants

Law Enforcement Law Enforcement (State and Local)(State and Local)

PhRMAPhRMA rep. rep.

Fall 2001 Fall 2001 -- Seek input from Seek input from stakeholdersstakeholders

2626

OHIOOHIO LegislationLegislation

Jan 2002 Jan 2002 -- Legislation introduced Legislation introduced in Housein House

May 2002 May 2002 –– Passed House Health Passed House Health CommitteeCommittee

May 2002 May 2002 –– Passed HousePassed House

November 2002 November 2002 –– Senate HearingsSenate Hearings

December 2002 December 2002 –– Died at end of Died at end of legislative sessionlegislative session

2727

OHIOOHIO Legislation, cont.Legislation, cont.

Jan 2004 Jan 2004 –– Legislation reLegislation re--introduced in Houseintroduced in House

May 2004 May 2004 –– Passed House Health Passed House Health CommitteeCommittee

May 2004 May 2004 –– Passed HousePassed House

November 2004 November 2004 –– Passed Senate Passed Senate Health CommitteeHealth Committee

2828

OHIOOHIO Legislation, cont.Legislation, cont.

December 2004 December 2004 –– Passed SenatePassed Senate

Dec 2004 Dec 2004 –– House concurred with House concurred with amendmentsamendments

Feb 2005 Feb 2005 -- Governor signedGovernor signed

2929

Ohio Automated RxOhio Automated RxReporting ProgramReporting Program

OAOA℞℞RSRS

3030

OAOA℞℞RSRS ImplementationImplementation

Summer Summer –– Fall 2005 Drafted RulesFall 2005 Drafted Rules

October 2005 October 2005 –– Hired AdministratorHired Administrator

Jan 2006 Jan 2006 -- Ohio Rules effectiveOhio Rules effective

Feb Feb –– Apr 2006Apr 2006•• Purchase equipmentPurchase equipment

•• Hire additional staff as neededHire additional staff as needed

•• Communicate with stakeholdersCommunicate with stakeholders

3131

OAOA℞℞RSRS ImplementationImplementation

May 2006 May 2006 –– Initial Rx data Initial Rx data reportingreporting

July, August 2006 July, August 2006 –– Internal Internal testingtesting

September 2006 September 2006 –– Pilot/external Pilot/external testingtesting

October 2006 October 2006 –– Full Full implementationimplementation

NovNov--Dec 2006 RefinementsDec 2006 Refinements

2007 Enhancements2007 Enhancements

3232

OAOA℞℞RSRS

Sales DatabaseSales Database Rx DatabaseRx Database

Manufacturers Manufacturers WholesalersWholesalers

PharmaciesPharmacies

Law EnforcementLaw Enforcement

PrescribersPrescribers& &

PharmacistsPharmacistsRegReg BoardsBoards

IndividualsIndividualsGrand JuryGrand Jury

OSBPOSBP--

PMPPMP

VendorVendor

3333

OAOA℞℞RSRSControlled substances CControlled substances C--II, III, IV, and VII, III, IV, and VCarisoprodol (Soma®)Carisoprodol (Soma®)Tramadol (Tramadol (UltramUltram®)®)Sales to prescribers by Sales to prescribers by pharmacies or wholesalerspharmacies or wholesalers

3434

OAOA℞℞RSRS

Statute requirementsStatute requirements

Pharmacies and wholesalers Pharmacies and wholesalers submit datasubmit data

OSBP staff collect, monitor & OSBP staff collect, monitor & review datareview data

OSBPOSBP--PMP releases data as PMP releases data as authorized by statuteauthorized by statute

3535

OAOA℞℞RSRS BudgetBudget

$180,000 $180,000 -- 2003 Hal Rodgers Grant2003 Hal Rodgers Grant



$ ? $ ? -- Supplemental FundsSupplemental Funds

Cannot charge pharmacist, Cannot charge pharmacist, pharmacy, or prescriber to support pharmacy, or prescriber to support OAOA℞℞RSRS

3636

OAOA℞℞RSRS BudgetBudget

Future FundingFuture Funding

•• Grants Grants

•• State Appropriations State Appropriations

•• Medicaid?Medicaid?

••Workers’ Compensation?Workers’ Compensation?

3737

OAOA℞℞RSRS

Board is required to:Board is required to:

Review data for potential law Review data for potential law violationsviolations

Notify LE agency or licensing Notify LE agency or licensing board of potential violationsboard of potential violations

Keep records of every requestKeep records of every request

3838

NASPERNASPER

Grant RequirementsGrant Requirements••Weekly reportingWeekly reporting

•• Minimum data fieldsMinimum data fields

•• Electronic formatElectronic format

•• InteroperabilityInteroperability

•• Criteria for use/disclosureCriteria for use/disclosure

•• Client authenticationClient authentication

•• Penalties for unauthorized Penalties for unauthorized disclosuredisclosure

39

WA

ORMT

ID WY

ND

SDMN

IANE

WI MI

CO KS MOIL INUTNV

CA

AZ NM OK

TXAK

AR

LA

TNKY

MS AL GASC

NC

OHVA

PANY

MEVT

CT

NH

NJ

MD

RI

DC

DE

HI

VW

FL

MA

30 days15 days7 daysDaily - plannedUnknown

Pharmacy Reporting Frequency

4040

NASPERNASPER

Data available to Data available to

•• Practitioner/Pharmacist for Practitioner/Pharmacist for treating/evaluating a patienttreating/evaluating a patient

•• LE/Licensing Agency in LE/Licensing Agency in furtherance of investigation of furtherance of investigation of diversion/misuse of a schedule II, diversion/misuse of a schedule II, III, or IV drug.III, or IV drug.

•• PMP of another statePMP of another state

•• HHS, DEA, Medicaid for researchHHS, DEA, Medicaid for research

4141

NASPERNASPER

Stick:Stick:•• Preference for Preference for

treatment $$ if treatment $$ if state has a state has a NASPER grantNASPER grant

Carrot:Carrot:$$ to $$ to implement or implement or enhance PMPenhance PMP

4242

RECOMMENDATIONSRECOMMENDATIONS••Allow data to be shared with Allow data to be shared with

outout--ofof--state entities, subject to state entities, subject to same criteria and penalties as same criteria and penalties as inin--state entitiesstate entities

••Plan for trainingPlan for training

PhysiciansPhysicians

PharmacistsPharmacists

law enforcementlaw enforcement

4343

Data from a PMP is Data from a PMP is NOT evidence!NOT evidence!

Investigation is still Investigation is still required. required.

4444

www.nascsa.orgClick on “Alliance of States WithPrescription Monitoring Programs”

www.deadiversion.usdoj.govClick on “Publications”, then “Program Reports”

ResourcesResources

www.natlalliance.orgClick on “Prescription Drug Monitoring Project”

4545

OAOA℞℞RSRS

Contact infoContact info

Phone: 614Phone: 614--466466--41434143

OAOA℞℞RSRS Fax: 614Fax: 614--644644--85568556

EE--mail: mail: [email protected]@ohiopmp.gov

4646

4747

Documents

Prescription Monitoring Programs Ohio’s Experience · 2007-01-31 · 1 Prescription Monitoring Programs Ohio’s Experience Danna E Droz, RPh, JD Administrator Prescription Monitoring