Pharmacy Management

Leveraging PDMPs in the Opioid Battle

Prescription monitoring programs are a prime tool in the fight against opioid abuse. Unfortunately there are barriers to access.
By: | February 24, 2017 • 4 min read

Many of those in the industry may have read the recent musings of Judge Langham, the Deputy Chief Judge of Compensation Claims for The Florida Division of Administrative Hearings regarding the drug abuse crisis we have in our industry and the deaths resulting from that crisis.

He notes, “The bottom line is that drugs are directly killing people, lots of people. The 2015 total of 55,403 deaths from drugs comes out to an overdose death about every 9.5 minutes all day long.” Shocking!

We, in our industry, have certainly put a lot of focus on the opioid epidemic in workers compensation but as Judge Langham points out, it’s not just opioids we need to worry about. As he notes, the use of pharmaceuticals is staggering — there are deadly combinations of multiple drugs as well as drugs and alcohol that are killing our injured workers and sometimes their family members as well.

The pharmacy benefit management programs we all utilize are doing a good job of controlling workers’ comp pharmacy costs and identifying inappropriate or unapproved medications and high MED (Morphine Equivalent Dose) levels insofar as they know.

Our stove-piped insurance programs keep these PBMs in the dark about all the drugs a particular injured worker might be taking, i.e. the right hand and the left hand not knowing what the other hand is doing.

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What can we do about this; you ask? That is where the PDMPs come in.

PDMPs, or prescription drug monitoring programs, collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners, no matter the insurance coverage.

The data is used to support states’ efforts to educate, research, enforce and prevent abuse and diversion. PDMPs are managed by the individual states. Forty-nine states, the District of Columbia and one U.S. territory (Guam) currently have a PDMP that is operational (meaning collecting data from dispensers and reporting information from the database to authorized users).

The PDMP provides nationwide information about prescriptions that are being filled: their strengths, dosages and quantities; the prescribing physicians; the pharmacies that are filling them; and when they are being filled.

Bottom line, your PBM does not have the whole picture concerning an injured worker’s pharmaceuticals.

Per state law, PDMPs monitor controlled substances as defined by Federal and State Controlled Substances Laws. Some PDMPs also monitor additional drugs of concern. You can find out which drugs are monitored by a specific state by going to this website: www.pdmpassist.org.

Recent studies have shown that when states require mandatory reporting, it cuts down on abuse and leads to improved outcomes.

For example, in 2015, there were 439 total drug deaths in New Hampshire, of which 397 were caused by opiates/opioids. If nothing had changed, the state was on a path to hit 500 opioid related deaths in 2016. On June 7, 2016, Governor Hassan signed House Bill 1423, which mandates the use of the prescription drug monitoring program when initially prescribing an opioid and at least twice a year thereafter.

Their 2016 annual report showed that the PDMP is beginning to have positive effects on their opioid epidemic. Prescriptions for schedule II drugs, such as opioids, went down by almost 13% and the number of patients that were flagged for potential doctor shopping (using 5 or more doctors or pharmacies for prescriptions) decreased from 9/month to 3/month.

So you are probably thinking that this is just what we need, a way to look across insurance programs to identify inappropriate drug dispensing/usage and individual injured workers who may be at serious risk.

State law determines access to PDMP information. Most states only allow physicians and dispensing pharmacists to obtain PDMP reports on patients under their care. This allows the treating physicians and dispensing pharmacists an opportunity to intervene with the physician and the injured worker prior to dispensing a controlled substance if the PDMP suggests this might not be safe or in the injured worker’s best interest.

States may also provide PDMP information to other authorized groups such as law enforcement or licensing or regulatory boards but not to pharmacy benefit managers who are third party participants and not considered part of the injured workers treatment team.

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Bottom line, your PBM does not have the whole picture concerning an injured worker’s pharmaceuticals.

What do you need to do?

Take a look around, as there are new players in this PBM market who are taking this problem we have with controlled substances seriously and adding experienced dispensing pharmacists with access to this tool to their program on cases that appear to be at risk.

But keep this in mind as well. Knowing about all the injured worker’s prescribed controlled substances before dispensing is one thing. Providing clinical interventions once you know and before the controlled substance is dispensed is the real key to better outcomes.

Maddy Bowling is a principal in Maddy Bowling Consulting, Inc., a WC consulting firm. Bowling has 35 years of broad-based executive management experience within operating, corporate and consulting environments. She can be reached at [email protected]