One state's move to spot Rx abuse in real time
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Missouri lacks a statewide prescription drug monitoring program, but its system for Medicaid users is showing both fiscal savings and clinical benefits.
Missouri, the only state without a statewide prescription drug monitoring program (PDMP), has instituted a new system to track pharmaceutical prescriptions through Medicaid claims – and is seeing dividends from that focus on higher-risk groups.
The state, along with the rest of the country, is in the midst of a prescription painkiller overdose epidemic. According to the Centers for Disease Control, the amount of prescription painkillers prescribed and sold in the United States has nearly quadrupled since 1999, and nearly 44 people die from overdoses every day. Because doctor- and pharmacy-hopping are the primary means by which people get improper access to prescription pharmaceuticals, statewide monitoring can help to spot and address abuse.
The CDC is providing funding for some states to improve their systems. Illinois recently won a $3.6 million dollar grant to improve its voluntary system’s usability in the hopes that more doctors will use it.
With Missouri’s statewide PDMP legislation stuck in the state house and senate, the state’s social services health care division (MO HealthNet) partnered with Xerox to create a program for low-income and vulnerable citizens – who, according to the CDC, are statistically at a higher risk for prescription drug abuse.
MO HealthNet is responsible for purchasing and monitoring health care services for Missouri’s 900,000 Medicaid recipients, and Steve Calloway, the agency's director of pharmacy, said it was important to get a system up and running. “Missouri is the only state without a prescription drug monitoring program," he said, "so we employed this tool to help our physicians and pharmacies who didn’t have the ability to log into a website and see what other medications a person has been prescribed.”
The system integrates medical claims information with prescription drug information. Josh Moore, who manages the MO HealthNet account for Xerox, said the automated authorization process can swiftly identify abuse, while also ensuring that those who legitimately need their medication are not left waiting.
“Automated prior authorization is part of our software to eliminate unnecessary calls to the pharmacy helpdesk when we know a patient should be on an opioid," Moore said. "So the good part about having the diagnosis in the system is that our system looks back chronologically and creates its own authorization in about half a second.”
The system also alerts doctors if a patient holds prescriptions for opioids from multiple prescribers. “The system allows for some feedback to the prescriber as well, so prescribers can become aware of problems that they weren’t aware of before, especially if a participant was utilizing more than one prescriber for opioids,” Moore said. Since fall of 2013, 300 providers have been notified about approximately 1,500 patients who were possibly abusing opioids, according to a press release by Xerox.
Both MO HealthNet and Xerox seem pleased with the results so far, particularly after they relaxed the program’s initial alert notification. “At first the program was too strict and resulted in numerous calls to the helpdesk," Moore said. "Over the course of a few months the program was changed, and is much better at not causing false positives.”
Both chambers of the Missouri legislature have working bills to create a statewide PDMP, but opponents argue that such a database would provide too much access to private data. And while the MO HealthNet system provides something of a stopgap solution, both Calloway and Moore said it was not intended to be a prelude to a statewide PDMP. Moore did note, however, that the fundamental technology and approach could certainly be applied more broadly. "A version of this tool could complement a broader state PDMP," he said, "whether in Missouri or any other state."
And Calloway added also cautioned that other PDMPs often don’t work as quickly as they should, and still need improvement -- perhaps by emulating some of the Xerox system's functionality. “Even the states that have prescription drug monitoring programs that are intended to address all prescription use have not landed on a magic bullet," he said. "The monitoring programs do not perform the same function as this software and may not offer real-time information.”