Many of you are likely familiar with Prescription Drug Monitoring Programs (PDMPs) specific to your state. We have been seeing an increase in calls coming into our Psychiatry Risk Management Line specific to this issue. The calls seem to be increasing surrounding a common theme:
Dr. Smith, a psychiatrist, is prescribing a controlled substance for a patient. He receives a call from a pharmacist notifying him that the patient presented a prescription to be filled but the pharmacist checked the online PDMP and noticed the patient has also been filling the same prescription written by another provider at a pharmacy a few miles away. The psychiatrist contacts Risk Management to obtain advice on how to proceed.
By way of brief background, Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. Every state now has a PDMP, with the final state, Missouri, recently enacting theirs several months ago. PDMPs are designed to monitor information for suspected abuse or diversion (i.e., channeling drugs into illegal use), and can give a prescriber or a pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions.1
PDMPs do not come in a “one size fits all” format. They vary widely. Depending upon the state, data may be made available to prescribers, law enforcement officials, licensing boards and others designated. Each state has different types of information available and different applicable rules.
Some of these issues include:
- Is the prescriber obligated to register with his state’s PDMP?
- Is it mandatory to check database prior to prescribing?
- How often must a prescriber check the program? Is he required to check prior to initially prescribing, on a periodic basis or are there requirements of how often the database must be checked?
- Who can access the database? Is the prescriber the only person who can access the database or can he delegate an additional person?
- What are the prescriber’s obligations if they receive information indicating drug diversion, misuse, etc.?
- Is the prescriber permitted to alert other prescribers about the patient’s potential drug diversion/misuse?
- Is the prescriber required to notify consumers that PDMP info may be accessed
- Does a particular state provide immunity for accessing, failing to access or reporting data to PDMP?
- Which types of prescriptions are stored in the database?
- How quickly is the PDMP uploaded and made available for viewing by the prescriber?
It is important to understand your obligations and responsibilities in the jurisdiction where you practice. It is always best to obtain advice from a risk management professional or an attorney should you have questions about your state’s PDMP or if you experience an issue with a patient.
There are a number of risk management issues to consider:
- Be aware of and observe federal and state prescribing regulations;
- Safeguard prescription pads and log-in credentials;
- Refer to DEA Practitioner’s Manual for more information and requirements when prescribing;
- Understand your state’s PDMP system and implement policies and procedures within your practice that comply with state regulations/requirements; and
- Thoroughly document all aspects of prescribing for a patient.
If you suspect drug diversion:
- Are you required to report the patient to law enforcement?
- Can you contact the other provider to inform him of the issue or are there privacy considerations that prevent you from doing so?
- Did it involve theft/loss of controlled substances? If so, you may be required to complete DEA Form 106.2
- Should you consider terminating the patient relationship?
For the most up to date information on regulations/requirements in your state, it is important to check your board of medicine in your state as well as your online PDMP website. An additional resource is the National Alliance for Model State Drug Laws: http://www.namsdl.org/library/CAE654BF-BBEA-211E-694C755E16C2DD21/ (Caution: your state may have more up to date information available).
1 Prescription Drug Monitoring Programs: Evidence-based practices to optimize prescriber use,” The Pew Charitable Trusts, (December 2016).
2 DEA: Office of Diversion Control, Electronic Prescriptions for Controlled Substances, http://www.deadiversion.usdoj.gov/ecomm/e_rx/ ; DEA: Practitioner’s Manual, An Informational Outline of the Controlled Substances Act