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Buried deep in President Donald Trump’s strategy for managing the opioid crisis is a proposal to create a national prescription drug monitoring program — a database that would cross state lines and limit access to medications for people who live close to interstate borders.
Workers compensation experts say such a program, already in place in 49 states, would be beneficial, as the resulting data sharing between states would add a layer of transparency to claims.
“It makes sense,” said Richard Victor, Boston-based senior fellow at the Sedgwick Institute, which does research on workers compensation issues, and former president of the Workers Compensation Research Institute.
However, states that currently have PDMPs in place are already sharing data through The National Association of Boards of Pharmacy’s PMP InterConnect network, according to experts, and many are concerned a national program would supersede state interests or laws.
“Many states are sharing data ... states are in various stages in that process. A national PDMP would universalize state sharing, but whether the national solution would be a better one is an open question,” said Thomas Clark, Waltham, Massachusetts-based clearinghouse manager and senior research associate at The Prescription Drug Monitoring Program and Technical Assistance Center at Brandeis University.
“I’m not sure how ready states are to go that route — each PDMP is custom-made for its own state’s priorities, so a national system in some ways may override those considerations,” said Mr. Clark. “In terms of interstate data sharing, there is no question that knowing what neighboring state prescribers are prescribing patients is important. Knowing what a state on the opposite coast is doing is maybe not so critical, but at least the neighboring states are very important.”
Despite strides states have taken, visibility on prescriptions for injured workers is an ongoing struggle in comp, experts say.
“We need to know what injured workers are taking,” said Brian Allen, Salt Lake City-based vice president of government affairs for Mitchell International Inc., a technology firm that manages pharmacy transactions, among other tasks, in workers comp. “PDMPs give greater visibility,” he said.
The proposed national program would help stop drug seekers, Mr. Allen said. He points to small clusters of states, such as the New England area, and the notion that a person in search of opioids can pass through five states in one day.
Mr. Victor is, however, cautious of the execution of a national system, adding that states with PDMPs are “short on resources” to implement and oversee such a database. He argues that often times programs go underfunded despite allocations.
“Under-resourced programs after legislation weakens implementation,” he said.
One solution could be for insurance companies — who have a vested interest in ensuring patients are not getting prescriptions from multiple sources — could partner financially with the government, Mr. Victor said.
Privacy concerns are another potential downside to a national program, say experts.
“Some of the concerns around PDMPs usually revolve around patient privacy issues,” said Dr. Dan Hunt, Lansing, Michigan-based corporate medical director at AF Group. “They want to be sure that the appropriate people have access to the information and that inappropriate people don’t. It would not be unrealistic to think that with all of the data hacks that go on in our world today ... there would be concerns about how that would be managed.”
Some experts say that while a national program is a step in the right direction, there are many elements to consider.
“I think there are important questions to consider in regard to how this will be done and how this will work, meaning if they come alongside the states that already have programs in place and require all states to connect, there are a lot of things to determine as far as software, accessibility ... each state has certain requirements about what type of data should be reported,” said Dr. Paul Peak, Memphis, Tennessee-based assistant vice president of clinical pharmacy at Sedgwick Claims Management Services Inc. “There is a lot of need for clarity as far as how we streamline those data elements and who can have access. In some states, the pharmacist, the prescriber and potentially law enforcement can view what’s on the database, while in other states even the payer can view.”
President Donald Trump’s plan to combat the U.S. opioid crisis is getting mixed reviews.