STATE PRESCRIPTION MONITORING PROGRAMS What states have prescription monitoring programs? As of November 2006, 33 states had enacted legislation which required prescription monitoring programs: 25 of those programs are currently operating and 8 are in the start-up phase. The 33 states with Prescription Monitoring Programs and/or enacted legislation are: Alabama, California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, North Dakota, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, Washington, West Virginia, and Wyoming. Currently, the state of Washington uses their program only for disciplinary purposes, however legislation has been introduced to expand the program statewide. Are other states planning to implement prescription monitoring programs? Fifteen additional states are in the process of proposing, preparing, or considering legislation. These states include, Alaska, Arizona, Arkansas, Delaware, Florida, Kansas, Maryland, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Hampshire, Oregon, and South Dakota. Has monitoring program data been used to target potential subjects of investigations? Program officials state that their systems are not used to target possible subjects of an investigation. Investigations using prescription monitoring data regarding healthcare professionals are usually conducted after an official complaint is received. Information from the PMP system is, however, gleaned and examined more closely when blatant abuses are revealed in the data. In addition, states use the data to verify that a problem exists and to determine the extent of the diversion or abuse. The systems are also queried regarding patients that are found to be operating as "doctor shoppers"--one individual visiting numerous doctors and pharmacies to obtain pharmaceutical controlled substances. Is the accessibility to controlled substance prescription data a violation of patient confidentiality? Every prescription monitoring program provides safeguards to protect patient confidentiality and access to controlled substance prescription information through statutes or regulations. After decades of operation, no program has reported a breach of confidentiality. In addition, those state authorities/officials with access to monitoring program data already have the authority to access the controlled substance information. The data doesn’t generate a case, it simply makes collection of the information easier and less intrusive. Who is authorized to review the data and once the data is collected, what is done with it? State statute or regulation limits accessibility to the PMP data. It is important to note that PMP program officials are not privy to any additional information than they are already able to receive by virtue of their existing positions and job functions. The only difference is that the monitoring programs provide ready accessibility to prescription information in a more user friendly format. Historically, when investigators needed to review prescription information for both routine pharmacy inspections and case investigations they would have to manually sort through paper copies of prescriptions. The PMP database eliminates this tedious process by requiring the prescription information to be maintained electronically. This allows investigators to obtain pharmacy data from multiple locations without having to visit each and every pharmacy. What are the annual costs to operate a prescription monitoring program? The cost of implementing and operating a prescription monitoring program differs from state to state because of the many variables that exist. The average cost to start a prescription monitoring program is approximately $350,000. State annual operating costs for prescription monitoring programs range from $100,000 to nearly $1 million. Cost variations occur due to the frequency of data collection (bi-weekly vs. monthly), the use of a third party vendor, the number of prescriptions written/filled in a state, the number of schedules (II-V) collected, and the use of official forms when required. What are some of the beneficial uses of prescription monitoring programs? Prescription monitoring programs are being used to deter and identify many types of illegal activity including prescription forgery, indiscriminate prescribing and "doctor shopping" -which is a felony in some states. Most programs provide patient specific drug information upon request of the patient’s physician or pharmacist. Some state programs proactively notify physicians when their patients are seeing multiple prescribers for the same class of drugs. This assists health care professionals in enhancing patient care by allowing them to intervene on the patient’s behalf and assist them in obtaining appropriate treatment. It has been an extremely successful program to thwart diversion in a number of states. What impact do monitoring programs have on bordering states that do not operate a monitoring program? States report that after a prescription monitoring program goes into effect, patients that are "doctor shopping" often move their criminal activities to bordering states. Information can be shared with other states if state statutes and regulations authorize them to do so. The National Alliance for Model State Drug Laws has drafted a Model Interstate Compact to assist states in their efforts to share prescription information across state borders. More information on the National Alliance for Model State Drug Laws can be found at www.natlalliance.org Additionally, the Integrated Justice Information Systems (IJIS) Institute is leading a project funded by the Bureau of Justice Assistance (BJA) to develop a system for the interstate exchange of prescription monitoring data. To accomplish this initiative IJIS is engaging in a pilot project between the states of California and Nevada to share state PMP program information. IJIS is addressing the information technology issues among states for implementing an interstate sharing agreement. For this project, IJIS is working closely with the practitioners from the Alliance of States with Prescription Monitoring programs, the Bureau of Justice Assistance and the Drug Enforcement Administration. IJIS’s goal in the project is to provide recommendations to states wishing to exchange PMP data on how to implement the data exchanges based on the new open standards emerging from the Global Justice XML Data Model that has been developed under the leadership of the BJA. More information on the IJIS Interstate PMP exchange project can be found at What additional time, if any, is required to submit prescription data to state authorities? The majority of pharmacies submit prescription information electronically. States have generally expressed satisfaction with the electronic system since it markedly reduced the paper work burden that existed when pharmacies manually submitted prescription data. How can a State start a prescription monitoring program? The Harold Rogers Prescription Monitoring grant program provides financial assistance to states that want to create, enhance or plan a Prescription Monitoring Program. Additional information can be found at What states have received a Harold Rogers Prescription Monitoring grant? In FY02, Congress allocated $2 million for the Harold Rogers grant program. Sixteen states applied to receive grants and 9 grants were awarded. Ohio, Pennsylvania, Virginia and West Virginia received grants to start a new state monitoring program. California, Kentucky, Massachusetts, Nevada, and Utah received grants to enhance their existing state monitoring programs. In FY03, Congress allocated $7 million for the Harold Rogers grant program. Nine states applied to receive new or enhancement grants and a technical assistance grant was awarded to the National Alliance for Model State Drug Laws. Florida, Maine, Alabama, New Mexico and Wyoming received grants to start new programs in their states. California, Idaho, New York and Nevada received enhancement grants. Additional funding was set aside in FY03 for an evaluation of the effectiveness of the existing programs. In FY04, Congress appropriated another $7 million for the Harold Rogers grant program. Twenty seven states applied to receive new, enhancement or planning grants and a total of 23 grants were awarded. Iowa, Mississippi, New Jersey, Oregon, and South Carolina received grants to start new programs. Alabama, Hawaii, Indiana, Kentucky, Massachusetts, Maine, New York, Nevada, Oklahoma, Pennsylvania, Virginia, and West Virginia received enhancement grants. Kansas, Colorado, Connecticut, North Carolina, Tennessee, and Washington received planning grants. In FY 2005, the Harold Rogers Prescription Drug Monitoring Program received $10 million in funding. Twenty- Two states were awarded grants. Alabama, California, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Mississippi, New York, Nevada, Oklahoma, and Virginia received enhancement grants, Missouri, Ohio, Tennessee, and Vermont received implementation grants, and Arizona, Louisiana, and New Hampshire received planning grants. In FY 2006, the Harold Rogers Prescription Drug Monitoring Program received $7.5 million in funding. Eighteen states were awarded grant funds: Alabama, California, Colorado, Connecticut, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Mississippi, New York, North Carolina, North Dakota, Ohio, Oklahoma, Texas, and Virginia. In FY 2007, the President’s Budget requests $9.9 million for the Harold Rogers Prescription Drug Monitoring Program. The FY07 grant solicitation was posted on BJA’s website at www.ojp.usdoj.gov/bja on October 20, 2006 and will close on January 7, 2007. DEA will work with the Office of Justice Programs (OJP) to review and evaluate the grant applications. Should there be a federal mandate for states to establish prescription monitoring programs or should states be encouraged to establish individual programs? In recognition of the proven effectiveness in curtailing the diversion and abuse of pharmaceutical controlled substances, the DEA has been a long time proponent of prescription monitoring programs (PMP). Further, it is DEA’s intent to identify the best available means to facilitate the establishment and/or enhancement of PMPs to ensure prescription data is collected from the largest possible proportion of controlled substance dispensers in the most efficient, cost-effective manner. Advantages of a national program may include an enhanced ability to identify and track prescription transactions across state lines. This is particularly important given the growing trend of filling prescriptions through mail order and Internet pharmacies. While several states report that their programs have the capability of generating reports regarding out-of-state prescribers or patients, they do not at this time routinely disseminate this information to other states. However, the size and cost of a national database may be prohibitive. The system would be required to collect data from in excess of 673 million prescriptions annually from the nations 61,000 DEA registered pharmacies and respond to requests for information from more than 900,000 DEA-registered practitioners. Additionally, the system would duplicate the efforts of state programs currently in operation. While only 33 states are currently operating prescriptions monitoring programs or have enacted legislation, these states including those considering or in the process of proposing legislation cumulatively account for 95 percent of the nation’s registered pharmacies and 95 percent of all practitioners. Conversely, because state databases are much smaller than that of a national program, state programs can more readily identify specific trends, either those of abuse or outmoded prescribing practices. In addition, state programs can identify patients that may be in need of drug treatment due to abuse or addiction. State programs also have the ability to assist physicians whose patients may be receiving inadequate pain treatment causing the patient to see multiple physicians in an attempt to obtain additional medication. Attempts at implementing prescription monitoring programs tend to meet with opposition from a variety of groups including medical associations, pharmacy groups, pharmaceutical companies, patient advocacy groups, and civil liberty groups. In addition to these interested parties, a federal program would meet with additional opposition from states’ rights groups as well as from officials in states currently operating programs. The question arises of whether a national program would be compatible with existing state programs. States currently operating programs may have to revise existing programs to accommodate a national program. Additionally, if federal legislation is passed and funding is appropriated, it would take a considerable period of time, possibly several years, to promulgate regulations and develop the necessary infrastructure required to allow the program to operate. 13. What is NASPER? On August 11, 2005, President Bush signed into law the National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER). The act creates a grant program for states to create prescription drug monitoring databases and enhance existing ones, similar to the Harold Rogers Prescription Drug Monitoring grant program. NASPER authorizes $60 million for the program through fiscal 2010. While the Harold Rogers Grant Program is placed within the Department of Justice, the NASPER program is placed within the Department of Health and Human Services (HHS). The NASPER grant program is authorized for $60 million over five years, with $15 million allocated for 2006 and 2007, and $10 million for 2008, 2009, and 2010. However, HHS did not receive an appropriation in its FY2006 budget for this program. Currently, HHS is conducting a study on the implementation of NASPER. Funding for NASPER in FY07 has not yet been determined. 14. What are the differences between the Harold Rogers Prescription Drug Monitoring grant Program and NASPER? The Harold Rogers grant program, housed in the Department of Justice, allows states to establish their own requirements with regard to Schedules monitored, information sharing, and accessibility/availability to the program data. Harold Rogers encourages the sharing of information and prescription data among states. Harold Rogers encourages the submission of Schedules II, II, IV & V. Eligibility for Harold Rogers grant funds has a very simple requirement: States applying for grants must have in place an enabling statute or regulation "that requires submission of controlled substance prescription data to a centralized database administered by an authorized state agency".