Advocates inch closer to a national PDMP

Health IT Now, an advocacy organization, has created the Opioid Safety Alliance, a working group comprised of 18 tech companies, pharmacies, associations and councils. The collective was tasked with exploring how technology and data could help address the opioid crisis.

“What we found was a problem in getting the right information in front of the provider to make an informed clinical decision,” says Executive Director Joel White.

The key strategy the alliance calls for is a national prescription drug monitoring program (PDMP) that addresses three challenges in the existing state-based PDMPs.

1. Data latency: Typically PDMP data is not reported or seen in real time, and some data can be up to a month old.
2. Interoperability: The state systems don’t exchange data. While progress is being made, it’s slow and expensive.
3. Selective data: PDMP data collection tracks prescription fills but doesn’t track attempts to shop a prescription, a key problem with drug-seeking behavior.

White says a national plan with a facilitator model could be incorporated into the existing prescription process while saving prescribers and pharmacists time. He estimates it currently takes between two to six minutes for a pharmacist or prescriber to log into their local PDMP, enter the patient’s info, get the historical data, make an assessment and log back into their management systems. And some providers also have the responsibility to check neighboring states when access is available.

That’s a burden on the provider and an annoyance to the patient who might be kept waiting.

“With a national PDMP, you don’t have to wait for the response or manually go through the data,” White says. “Every script at the point of sale, dispensing or prescribing gets put into the system, and that information gets pushed out in real time. There’s no delay in the data, and it would be available nationwide.”

Most of today’s existing PDMPs are or soon will be connected through the PMP InterConnect platform managed by the National Boards of Pharmacy. However, the more difficult challenge is creating interoperability between PDMPs and electronic health record systems, which are often proprietary.

As proposed, the national prescription tracking system could potentially leverage the electronic transactions that are already happening in real time at pharmacies when a prescription fill is requested. Such data could be captured and pushed out to the PDMPs through a facilitator.

“The beauty of the system is that it leverages the current technology at every pharmacy counter and in most physician offices today,” White says. “The challenge is that this data is out there, and the technology is already implemented. We’re just not using it in the right way.”

White estimates a national PDMP might cost about $26 million—less than 1% of funding Congress has recently allocated for the opioid crisis and mental health. The alliance proposes the Department of Health and Human Services contract with a private company to build a national facilitator to link all PDMPs and transaction flows. The private contractor model was used to set up Medicare Part D, the prescription drug benefit for Medicare enrollees that is privately administered.

Quick turnaround

The alliance is just getting started, but it isn’t wasting any time. White says the goal is to have legislation that could be signed into law by August with a national facilitator up and running next year.

“When you stop the inappropriate prescription to the abuser, they will turn to heroin, fentanyl or street opioids,” White says. “One of the things about this model is that when you’re getting information back to the clinician, they can have a conversation about treatment. But we’re not necessarily getting into the law enforcement aspect. What we are helping to do is prevent people from getting to the point of using illicit opioid drugs.”

A national PDMP is part of the newly released federal strategy to address the addiction crisis. In fact, on Thursday, Health and Human Services Secretary Alex Azar held a listening session with state officials who work on PDMPs and are advocating for a national database.