Aubrey Westgate

	Many states now require providers to review Prescription Drug Monitoring Program (PDMP) databases when prescribing controlled substances to patients. So how is this affecting pharmacists?

 conference in Baltimore on February 7, Tomson George, RPh, Senior Manager, Professional Affairs, 

 Co., shared how the chain is approaching PDMPs and how that approach is affecting its pharmacists.

	“What PDMPs do for our pharmacists is give them that additional insight to help make that decision in a difficult [medication] situation,” said George. The information ‘empowers’ pharmacists to do what’s best for patients, regardless of what the doctor says, in some cases.”

	Overall, he said, PDMPs help pharmacists exercise professional judgment and ensure safe dispensing of controlled substance prescriptions and provide a resource for identifying trends when encountering a patient of concern.

Related article: More than 40% of physicians not using Rx monitoring sites

	PDMP usage by pharmacists has increased dramatically since 2011, when few providers and pharmacists were using PDMPs, said George. Reasons for lack of use included:

		Very challenging PDMP registration processes 

	This began to change in 2012, when more discussion regarding PDMPs occurred at the state level, said George. “That’s really the year I think we saw lots of this evolution.” He noted more movement in PDMP standardization, more usage of unsolicited reports by PDMPs, enhanced access to PDMPs, and more interstate data sharing between PDMPs.

	Overall, in 2013, the percentage of registered prescribers in PDMPs increased 28%, and the percentage of registered pharmacists increased 38%.  

	Today, Walgreens pharmacists use PDMPs almost daily, said George.

	Up next: The questions every pharmacist should be asking

Title 21 of the Code of Federal Regulations, section 1306.04

A responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription

Related article: PMP helps one state reduce painkiller Rxs

	In recent years, legal cases involving the Drug Enforcement Agency made it clear that, when a pharmacist feels that a prescription is questionable, simply calling a doctor’s office to verify that prescription does not always satisfy the verification requirements, said George.

	As a result, Walgreens directed pharmacists to use their professional judgment, training, and experience to ensure that a prescription is valid and issued for a legitimate medical purpose. It also identified the use of PDMPs as one way pharmacists can help validate questionable prescriptions.

	Walgreens also identified five questions pharmacists should ask to identify if a prescription is questionable: 

	The questions “helped give our pharmacists a guiding principle,” said George.

Related article: Why is Missouri the last drug monitoring holdout?

	Pharmacists were asking patients and providers more questions related to prescriptions, and some patients were experiencing processing delays. However, more pharmacists were registering for and using PDMPs, and pharmacists were more safely dispensing controlled substance prescriptions, said George. “We’re not here to second-guess the doctors, we’re really trying to do what’s best for the patient.”

	All pharmacies should have policies that support the use of a PDMP as part of the pharmacists’ corresponding responsibility, said George.

	In addition to using PDMPs in situations that raise concerns, pharmacists should check the PDMP when encountering out-of-state prescriptions, early refills, and cash prescriptions. He added that these red flags are probably more visible to pharmacists than to prescribers.

	“Each one of us, whether practitioner, or pharmacist, is a piece of the puzzle,” he said.

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How PDMPs are helping both patients and pharmacists.

Prescription Drug Monitoring Programs Benefit Pharmacists

	As the opioid epidemic intensifies, state-based Prescription Drug Monitoring Programs (PDMPs) are stepping in to help address the issue. At the same time, states are asking providers (and in many cases requiring them) to review PDMPs when they are considering prescribing controlled substances to patients.

	Pennsylvania recently joined the growing number of states that mandate provider usage of PDMPs. Its 2014 law, “

Achieving Better Care by Monitoring All Prescriptions Program ACT

,” provided for the PA PDMP, and legislation went into effect June 30, 2015. Pharmacies began reporting all controlled substances June 24, 2016, and providers 

were required to begin using the PDMP database August 25, 2016.

 conference in Baltimore on February 7, presenter Dean T. Parry, RPh, Associate Vice President, Clinical Informatics, Care Support services, at 

, shared how the 12-hospital integrated system in Pennsylvania and New Jersey is helping providers meet the new requirements.

Related article: Why is Missouri the Last Drug Monitoring Holdout?

	Goals of the PA PDMP program include:      

		Collect data on all controlled substances dispensed in the state  

		Require all providers to access the database before dispensing a new controlled substance prescription, (as of January 2017, requiring them to access it regardless of whether the prescription is new or a referral)    

		Allow providers to view a complete record of their controlled substance prescriptions that have been filled    

		Allow patients to view their own controlled substance record for prescriptions that have been filled

	To comply with the PDMP requirements, Geisinger providers now must:    

		Review PDMP data before issuing a controlled substance prescription    

		Review the PDMP if they suspect diversion or abuse  

		Document in the EHR if the database information alters their decision to issue a controlled substance

		Document in the EHR that they reviewed the database

	Actions taken by Geisinger to prepare providers for the program, according to Parry, included:    

		Educating providers about the program and the need to enroll  

		Educating pharmacists as a “key source of support” for providers

	Despite the challenges associated with the PDMP, Parry has received some positive feedback from providers. For example, through PDMP reviews, many have identified patients with previously unknown abuse or misuse problems. 

A look at PDMPs in PA-what they are doing and how they are helping patients.

Author | Aubrey Westgate

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Prescription Drug Monitoring Programs Benefit Pharmacists

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