POCP Blog

By Connie Sinclair, Senior Consultant

As the opiate crisis receives ongoing national attention, state policymakers and legislators continue to chip away at the problem with new laws and rules governing controlled substance prescriptions. The trend of mandating that prescribers must access the patient’s Prescription Drug Monitoring Program (PDMP) report before writing a prescription continues to advance. A solid majority of states now require such access and a growing body of evidence indicates they are on the right track. For example, the Centers for Disease Control and Prevention just reported that mandatory use of PDMPs helped to significantly reduce opioid prescriptions in three states, including hard-hit Ohio and Kentucky.

Recognizing the effectiveness of PDMPs, states are focusing on increasing uptake in two ways: legislation requiring mandatory use and integration of PDMP reports with electronic health records (EHRs).

Mandatory use. The trend of states mandating use began in 2012 and has been slowly building, but until recently, the majority held that consultation of PDMPs before writing for controlled substances was optional. High profile legislation in New York, which among other things, required prescriber PDMP access, grabbed national headlines and helped accelerate the trend. As of the publication of this blog, 33 states have some form of required access, although details vary greatly.

An interesting aspect to this trend is that beyond simply requiring it, states are getting much more specific about the who, what, when and how of PDMP access, and there is no consistent pattern emerging. Access might be based upon the prescribed drug class, DEA schedule, days supply to be prescribed and the Maximum Morphine Equivalent of the dosing, and might also vary by type of pain, diagnosis, practice setting or prescriber type. Prescribers need help sorting this out and require efficient and timely access in order to be compliant.

EHR Integration. PDMP use typically has been outside the provider’s workflow, requiring a separate log-in to access the state-wide controlled substance prescription information. This has been a huge barrier to adoption. To address that issue, a growing number of states are encouraging and facilitating integration of PDMP access with EHRs, which are now the primary vehicle for electronic prescribing (ePrescribing) in physician offices and hospitals. Michigan is an example. Michigan’s PDMP, the Michigan Automated Prescription System (MAPS), will soon will be connected with EHRs from such major vendors as Cerner, McKesson and Epic. Smaller systems will be brought on board later. Officials hope this will bring use of MAPS from 28% to 80%. Michigan prescribers, who are resisting an access mandate, are hoping the easier workflow will increase utilization and stave off the need for a mandate. This effort is being made “affordable” due to $2.1 million in federal and state funding to help with license fees and other costs, according to .

Many states have statutes that bar PDMP data from being fully integrated within EHR databases and local medication profiles. We are now seeing some states remove that barrier. Some implementations get around that problem by displaying the PDMP report within the prescribing workflow, but stop short of saving it permanently in the record. To make the access mandate easier for prescribers, South Carolina has ruled that PDMP access compliance is met if the PDMP data is automatically displayed in the integrated EHR.

Keeping up with developments. We expect to continue to see new state legislation aimed at making PDMPs an even more valuable tool in fighting the opioid abuse epidemic. Point-of-Care Partners is on top of those efforts. Our ePrescribing State Law Review service was created to keep companies current with federal and state regulatory changes so they can proactively identify opportunities and modifications that may be needed. Subscribers receive ongoing, in-depth analyses of relevant prescribing rules and have access to POCP regulatory experts. An abbreviated summary, the ePrescribing State Law Capsule, is available on a complimentary basis.

To learn more, visit our Regulatory Resource Center or contact me at connie.sinclair@pocp.com.

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