Controlled Substances Prescription Monitoring Program

Doug Skvarla, RPhCSPMP Director

Arizona State Board of Pharmacy

Conflict of Interest Disclosure

Faculty Disclosure Declaration:I have no actual or potential conflict of interest in relation to this program or presentation.

2018 Special Session Law

The following will affect prescribers and goes into effect April 26, 2018

Prescribers can no longer dispense schedule II opioids out of office. (exception is MAT treatment)

Prescribing limit of initial opioid prescriptions reduced to a 5-day supply. Exception, is that following a surgical procedure a 14 day supply can be prescribed for an opioid naive patient.(exceptions for oncology, hospice, MAT)

Initial prescriptions of opioids cannot exceed 90 MME/day (morphine milligram equivalents)

Effective 2019:• Mandatory electronic prescribing for schedule

II opioids

Large counties (greater than 150,000 people) starts January 1, 2019:Maricopa, Pima, Pinal, Yavapai, Mohave, and Yuma

Small counties (less than 150,000 people) starts July 1, 2019:Greenlee, La Paz, Graham, Santa Cruz, Gila, Apache, Navajo, Cochise, and Coconino

The following will affect pharmacists April 26, 2018

• Schedule 2 opioids must be dispensed with a red cap and warning label about potential addiction.

The following will affect pharmacists April 26, 2018

• Pharmacists will now be required to check the CSPMP and obtain a patient utilization report for the previous 12 months before dispensing a new prescription for a schedule 2 drug.

Effective 2019:• Pharmacies must be able to accept electronic

prescriptions in order to dispense scheduled II opioids. Prescribers will no longer be able to hand write schedule II opioid prescriptions.

Large counties (greater than 150,000 people) starts January 1, 2019

Small counties (less than 150,000 people) starts July 1, 2019

CSPMP Data Collection & Frequency

• The CSPMP is a centralized, electronic database of all dispensers of controlled substances (II-V)

• Dispensers include pharmacies and prescribers that dispense controlled medications out of the office

• Dispensers upload daily, including medical practitioners

Why use the PMP?

Ensure deliverance of optimal healthcare Identify, deter, and prevent diversion Safeguarding your DEA number Tool to facilitate appropriate CS prescribing Compliance with mandate DHS requires prescribers who write for

medical marijuana certificates to look up their patient in the PMP

A.R.S. 36-2606 Mandates PMP Use

The prescriber mandate went into effect October 16, 2017:“… a medical practitioner, before prescribing an opioid analgesic or benzodiazepine controlled substance listed in schedule II, III or IV for a patient, shall obtain a patient utilization report regarding the patient for the preceding twelve months from the controlled substances prescription monitoring program's central database tracking system at the beginning of each new course of treatment and at least quarterly while that prescription remains a part of the treatment. …”

Starting April 26, 2018 dispensing pharmacists must also review patient reports in the PMP.

CSPMP Registration

https://pharmacypmp.az.gov

CSPMP Registrations

0

5000

10000

15000

20000

25000

30000

Law Enforcement Prescribers Pharmacists Prescriber Delegates Pharmacy Delegates

6/1/2017 12/1/2017

Patient Lookups By Month, 2017

Who Has Access To The CSPMP?

Prescribers who have a DEA registration Pharmacists Delegates Medical Examiners Licensing Boards (Starting April 26th, 2018)

The following must provide written request for records:1. Local, state or federal law enforcement (i.e.

DEA)2. AHCCCS (Arizona Health Care Cost

Containment System)

How Do I Register for the PMP?

• Log in to: https://arizona.pmpaware.net

Select Create an Account from the main login screen.

How to create an account

You will be prompted to enter a unique email address and create a password. The email address you enter will be used as your login ID and as the primary email address for your account. Password requires a minimum of 8 characters and must include one uppercase, one lowercase, and one symbol.

Click Save & Continue to create your account credentials and move on

About Role Selection & the Registry Form

Click the Category Name to expand it and see the roles. Select only one, then click Save and Continue.

How Do I Register for the PMP?

After filling in all the information required, click on the “Submit Your Registration” button.

Verify Your Email• Registration is not automatic

1. Look for an email from no-reply-pmpaware@globalnotifications.com, click the link “verify your email” (check your junk mail folder)

2. ASBP staff verifies and approves registration after your email address has been verified.

Delegate Role

• While providers and pharmacist are not able to share their online account for the Controlled Substances Prescription Monitoring Program (PMP), they may still have delegates run their PMP reports. Delegates register for their own account, and the provider controls their access by approving or removing the delegate’s access within the providers PMP account.

• Once a delegate has registered for the PMP, the provider/pharmacist must approve a delegate before the delegate can gain access.

Delegate Role

Delegates can:• Run a patient report for a prescriber/pharmacistDelegates cannot:• Keep track of what a prescriber or pharmacist

prescribes/dispenses• Have access to a prescriber/pharmacist account to

keep the account updatedWhy:• A PMP account is to be accessible by the owner of

the account only. By law, PMP accounts is not to be shared with anyone, including employees and other users of the PMP.

PatientPMP Records

How Do I Access Records?

• Log into: https://Arizona.pmpaware.net

• Click on Menu

• Under RxSearch, click on Patient Request.

• Enter patient information

• Click the I agree to terms box

• Click on the Search Button

Patient Report Top Half

Patient Report Bottom Half

What should I do if…

I find incorrect information in a CSPMP report?

Confirm that the CSPMP data is correct by contacting the dispensing pharmacy

Fraudulent activity is discovered?Contact local law enforcement

What should I do if…

I look at the CSPMP report and have concerns about the patient’s health and safety. What next?

Ask open ended questions to patient about medication use

Consult with other healthcare professionals involved with the patient’s care

Discuss areas of concern with patient, emphasizing interest in patient safety

Make a professional decision

PMP Gateway Integration into EHRs

Integration: PMP Gateway

• Arizona’s law allows the use of electronic medical records that integrate data from the PMP as compliant with the law [A.R.S. 36-2606(H)]

• The Arizona State Board of Pharmacy received funding to pay for the PMP Gateway for healthcare systems in Arizona

• We are currently working to get healthcare systems, from large hospital systems to individual prescribing offices, using the PMP Gateway

• Pharmacies can integrate too

Integration Can Help Your EHR Turn This Workflow...

EHR

Prescriber Exits EHR Workflow

Navigate to State Website & Manually Login

Navigate to Search

View PDMP Report

Manually Enter Patient Identifiers

Wait for Report to Be Generated

Interpret Report Data

Prescriber Returns to EHR Workflow

Repeat Steps to Navigate to Neighboring State(s) PDMP as

necessary

More Data Needed?

4.22 MINUTES PER PATIENT Source: http://onlinelibrary.wiley.com/doi/10.1111/acem.12905/abstract

Into THIS Workflow

Prescriber navigates to their normal prescription workflow in the patient chart

CLICKShow Report

button

Prescriber reviews prescription history report and continues with normal prescription workflow

Source: Appriss Health

Integration: PMP Gateway

• Healthcare entities – large and small – who are interested in connecting to the PMP more efficiently should fill out the online integration interest form:https://pharmacypmp.az.gov/integration-interest-form.

• The PMP Gateway requires prescribers to have registration in the PMP at https://arizona.pmpaware.net/login. To find out whether your prescribers are registered, contact pmp@azpharmacy.gov.

Prescriber Reports

Prescriber ReportsTop Half

Prescriber ReportsBottom Half

• The largest amount of prescriber questions and concerns are regarding three areas.– Delegate searches– MME (morphine milligram equivalents) – Registration specialty

Prescriber Reports

• Concern 1: Delegate Searches– Concern is that more searches were completed by

prescriber than what the report show.

• Delegates for more than one provider, must select the correct provider for which the delegate running the patient report.

• The amount of searches are a monthly average

Prescriber Reports

Concern 2 Daily MME (morphine milligram equivalents) – Concern is that buprenorphine has a high MME conversion

factor (30:1)– Buprenorphine can be used a couple of different ways

• MAT (medication assisted therapy)• Pain management

– CDC is now recommending that buprenorphine to be removed from the MME calculation. This will be reflected in late March or early April, but it will still populate on the patient reports.

Prescriber Reports

Prescriber Reports

• Concern 3: Healthcare Specialty

Concern is that the prescriber is not being compared to a similar prescriber

• In registration you must take the time to select your specialty accurately

Calculating MME

Calculating MME

QUESTIONS?

Arizona State Board of PharmacyWeb page: pharmacyPMP.AZ.gov

Doug Skvarla, CSPMP DirectorArizona State Board of Pharmacy

P.O. Box 18520Phoenix, AZ 85005

602-771-2744Fax: 602-771-2748

dskvarla@azpharmacy.gov