Electronic Rx monitoring programs gain popularity

A new patient enters a pharmacy with an Rx for OxyContin (oxycodone, Purdue). The patient seems nervous, the script is smudged, and there was a recent front-page news article about stolen Rx pads. What's the next step here?

"We can respond in less than five minutes during working hours," said Keith Macdonald, executive director of the Nevada State Board of Pharmacy. Nevada is one of 21 states having an active prescription monitoring program, or PMP, according to the National Association of State Controlled Substances Authorities (NASCSA). Four other states have approved PMP legislation; another dozen states are considering it.

NABP and most pharmacy groups support PMPs. The Senate Health, Education, Labor, and Pensions Committee recently approved a bill to set national PMP standards and provide start-up funding for state PMPs.

PMP details vary from state to state. Most require pharmacies to electronically report all controlled substance scripts at least monthly. Threshold alerts screen for potential problems, typically flagging patients who fill scheduled scripts at multiple pharmacies or from multiple physicians. Most PMPs also generate reports on specific patients, prescribers, dispensers, and consolidated trend data.

"Tracking controlled-substance Rxs interests both law enforcement and health care," said Kristina Lunner, director of congressional relations for the American Pharmacists Association. Older PMPs such as KASPER, the Kentucky All Schedule Prescription Electronic Reporting system, are based on law enforcement. "Any benefit to pharmacists or physicians is incidental in these older, enforcement-oriented programs," said NASCSA president Danna Droz, who once managed KASPER. "Newer programs housed in boards of pharmacy or health departments are designed as healthcare tools. We see greater benefits when healthcare providers are included."

Wyoming has a second-generation PMP, run by the board of pharmacy. Law enforcement access to the PMP database is limited by law. Law enforcement agencies can request reports, but healthcare providers make the disclosure decision, said board records analyst Denise Lane.

Indiana is moving from a PMP run by the state police to an expanded program under the board of pharmacy. The new program, Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT), tracks all scheduled products. The old system tracked only Schedule IIs. The older program was expanded when KASPER began pushing Rx drug abusers into bordering states. INSPECT is now run by the board of pharmacy, but only law enforcement personnel can obtain reports-a limitation that board director Joshua Bolin wants to remove. "Our goal is to create a system that is open to both law enforcement and health care," he said.

The Iowa Pharmacy Association is pushing its own PMP legislation; a viable state program would exempt states from implementing federal rules.

Not all pharmacists are eager for electronic monitoring. Ohio is moving toward a PMP with lukewarm pharmacy support. "Southern Ohio gets a lot of border jumpers," said Ohio Pharmacists Association executive director Ernest Boyd. "When Ohio's proposal came up, our southern members said, 'This could make us a target with an electronic eye keeping watch.' Our membership is supportive, but not enthusiastic."