Prescription Drug Monitoring Programs: How They Prevent Fraud

Prescription Drug Monitoring Programs: How They Prevent Fraud

Prescription drug monitoring programs (PDMPs) are state-run electronic databases that track controlled prescription drugs. PDMPs help prevent prescription drug misuse, abuse, and diversion by collecting data on prescriptions for controlled substances that can be accessed by authorized users like doctors, pharmacists, and law enforcement. PDMPs are an important tool in the fight against the opioid epidemic and can help prevent fraud and abuse of prescription drugs.

What is prescription drug fraud?

Prescription drug fraud involves getting prescription drugs illegally or for non-medical uses. This includes:
Doctor shopping – seeing multiple doctors to get multiple prescriptions for controlled substances
Altering prescriptions to get more pills or higher doses
Forging or stealing prescriptions
Selling prescription drugs to others or on the black market
Prescription drug fraud contributes to the opioid crisis and puts lives at risk. PDMPs help prevent fraud by tracking prescriptions and alerting doctors and pharmacists to potential red flags like patients seeing multiple providers for opioids.

How do PDMPs work?

PDMPs collect data on controlled substance prescriptions dispensed in the state, including:
Patient name, address, and date of birth
Prescribing doctor information
Dispensing pharmacy information
Drug name, strength, quantity, number of refills
Date prescription was written and filled
This data comes from pharmacies that are required to submit prescription information. Authorized users like doctors, pharmacists, and law enforcement can access the PDMP database to view a patient’s prescription history.
PDMPs are updated frequently – in some states, data is submitted every 24 hours or in real-time. This gives users an up-to-date view of a patient’s controlled substance prescriptions.

How PDMPs help prevent prescription drug fraud

PDMPs help prevent fraud in several key ways:

Identifying doctor shopping

Doctor shopping is when a patient sees multiple providers to get prescriptions for opioids or other controlled drugs. It’s a red flag for misuse or diversion. PDMPs let doctors see all the prescriptions a patient has recently filled, even if written by other providers. This helps identify doctor shopping and prevent patients from getting inappropriate amounts of drugs.

Spotting altered or forged prescriptions

The detailed prescription data in PDMPs allows pharmacists to identify altered or forged prescriptions. For example, if a prescription looks forged or the drug, dose, or quantity appears changed, the pharmacist can check the PDMP. If the details don’t match a legitimate prescription written for the patient, the pharmacist can refuse to fill the prescription and alert authorities about potential fraud.

Tracking high-risk prescribing

PDMPs aggregate data that can reveal risky prescribing patterns. Public health and law enforcement officials can use PDMP data to identify providers writing large volumes of opioid prescriptions or prescribers with patients who use multiple pharmacies or doctors to obtain controlled drugs. This allows officials to target interventions toward high-risk prescribers to reduce inappropriate prescribing and potential diversion.

Monitoring drug supplies

PDMPs provide data on controlled substances being dispensed, which helps officials monitor supplies. Unusual dispensing patterns at pharmacies or spikes in total prescriptions of a drug can prompt investigations into potential diversion or investigations of prescribers and pharmacies. Monitoring drug supplies through PDMPs also helps identify shortages of critical medications.

Benefits of PDMPs

Studies show PDMPs are effective at reducing prescription drug abuse and doctor shopping:
A study found PDMPs were associated with a 12% decrease in opioid prescribing.
Research showed ED providers in states with PDMPs prescribe fewer opioids than those without access.
A CDC report found mandatory PDMP checks for providers reduced the number of patients seeing multiple doctors for opioids by 38%.
PDMPs give providers a comprehensive view of a patient’s controlled substance prescription history from all providers and pharmacies. This allows for more informed prescribing that improves patient safety and reduces misuse of prescription drugs.

Limitations and challenges

While PDMPs are an important tool, there are some limitations:
PDMP data doesn’t include cash payments or prescriptions filled out-of-state, which can limit the full picture of a patient’s history.
Technical issues like lag times in data submission or clunky database interfaces can deter use by providers.
Checking PDMPs adds workload for providers leading to poor compliance with use. Only 22% of providers reported checking PDMPs most of the time before prescribing opioids, according to a CDC study.
Privacy concerns around sharing prescription data in the database.
To address these challenges, states are implementing mandates for more frequent PDMP data submission and requiring providers to check PDMPs in certain situations. Continued improvements to PDMP systems and integration with electronic health records can also help maximize the benefits of PDMPs.

The future of PDMPs

As technology continues to advance, so can PDMPs. Some areas of future growth include:
Expanding data sharing: Interstate data sharing allows providers to access data from bordering states and prevents patients from crossing state lines to fill prescriptions undetected. Currently, 49 states participate in interstate data sharing through PMP InterConnect.
Integrating with health IT systems: Embedding PDMP access within electronic health records, pharmacy dispensing systems, and health information exchanges can promote use and streamline workflow.
Advanced analytics: Using PDMP data to power analytics like prescriber report cards, overdose spikes alerts, and high-risk patient notifications can further enhance PDMP capabilities.
Increasing authorized users: Expanding access to PDMP data beyond prescribers and pharmacists to other providers like dentists, nurses, therapists can help coordinate care and identify risks.
As technology and data analytics continue to progress, PDMPs have significant potential to become even more responsive tools for preventing prescription drug abuse and improving patient safety. While not a silver bullet solution, enhancing PDMPs and integrating them into clinical workflow can have a meaningful impact on addressing the opioid epidemic.

The bottom line

PDMPs are a key strategy for combating prescription drug abuse and fraud. By collecting controlled substance prescribing data and making it available to providers and officials, PDMPs help:
Identify doctor shopping and prevent patients from obtaining dangerous amounts of prescription drugs
Spot potentially altered or forged prescriptions
Monitor high-risk prescribing patterns and drug supplies
Allow providers to make safer and more informed prescribing decisions
While PDMPs have limitations, continued improvements in data sharing, system integration, and analytics will maximize their ability to prevent fraud and improve patient safety. More widespread use of PDMP data has great potential to help address the devastating impacts of the opioid crisis.