Nebraska s Prescription Drug Monitoring Program Collecting Naloxone and Other Prescription Medications

Transcription

1 Nebraska s Prescription Drug Monitoring Program Collecting Naloxone and Other Prescription Medications Kevin C. Borcher, PharmD PDMP Program Director NeHII, Inc. BJA Harold Rogers PDMP National Meeting September 6, 2017

2 LB237 (2011) Neb. Rev. Stat Sec. 1. purposes of (1) preventing the misuse of prescription drugs in an efficient and cost-effective manner and (2) allowing doctors and pharmacists to monitor the care and treatment of patients for whom a prescription drug is prescribed to ensure that prescription drugs are used for medically appropriate purposes

3 Introduced by Senator Sara Howard Approved by Governor Ricketts on February 24, 2016 Report all dispensed controlled substance prescriptions by January 1, 2017 Report ALL dispensed prescriptions by January 1, 2018 Prevents opting out Allow prescribers and dispensers to access the system at no cost Establishes Veterinary Prescription Monitoring Task Force Neb. Rev. Stat Neb. Rev. Stat (19) Since an emergency exists, this act takes effect when passed and approved according to law.

4 Introduced by Senator Kuehn Senator Sara Howard s priority bill Approved by Governor Ricketts on May 9, 2017 Allows for a designee of a prescriber or dispenser HIE participants may access Mandatory training Veterinarians to report dispensed controlled substance prescriptions beginning July 1, 2018 Neb. Rev. Stat to Neb. Rev. Stat Since an emergency exists, this act takes effect when passed and approved according to law.

5 Neb. Rev. Stat (3) Prescription information that shall be submitted electronically to the prescription drug monitoring system shall be determined by the entity described in section and shall include, but not be limited to: (a) The patient s name, address, and date of birth; (b) The name and address of the pharmacy dispensing the prescription; (c) The date the prescription is issued; (d) The date the prescription is filled; (e) The name of the drug dispensed or the National Drug Code number as published by the federal Food and Drug Administration of the drug dispensed; (f) The strength of the drug prescribed; (g) The quantity of the drug prescribed and the number of days supply; and (h) The prescriber s name and National Provider Identifier number or Drug Enforcement Administration number when reporting a controlled substance.

6 Patient Drug Dispenser Prescriber Last Name Prescription Number Name Last Name First Name NDC Number Address First Name Address Drug Name Phone Number NPI Number Date of Birth Strength NPI Number DEA Number Gender Quantity Dispensed DEA Number (when reporting a controlled substance) Phone Number Refill Number Days Supply Date Issued Date Filled Bold - Required Payment Method

7

8 Non-controlled substance reporting tramadol (prior to being scheduled) carisoprodol gabapentin Virtually all drugs are drugs of concern from a patient safety aspect

9 LB390 Approved May 27, 2015 Since an emergency exists, this act takes effect when passed and approved according to law. Nebraska Revised Statute Naloxone; authorized activities; immunity from administrative action or criminal prosecution. (1) A health professional who is authorized to prescribe or dispense naloxone, if acting with reasonable care, may prescribe, administer, or dispense naloxone to any of the following persons without being subject to administrative action or criminal prosecution: (a) A person who is apparently experiencing or who is likely to experience an opioid-related overdose; or (b) A family member, friend, or other person in a position to assist a person who is apparently experiencing or who is likely to experience an opioid-related overdose. (2) A family member, friend, or other person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opioid-related overdose, other than an emergency responder or peace officer, is not subject to actions under the Uniform Credentialing Act, administrative action, or criminal prosecution if the person, acting in good faith, obtains naloxone from a health professional or a prescription for naloxone from a health professional and administers the naloxone obtained from the health professional or acquired pursuant to the prescription to a person who is apparently experiencing an opioid-related overdose. (3) An emergency responder is not subject to administrative action or criminal prosecution if the emergency responder, acting in good faith, obtains naloxone from the emergency responder's emergency medical service organization and administers the naloxone to a person who is apparently experiencing an opioid-related overdose. (4) A peace officer is not subject to administrative action or criminal prosecution if the peace officer, acting in good faith, obtains naloxone from the peace officer's law enforcement agency and administers the naloxone to a person who is apparently experiencing an opioid-related overdose.

10 LB487 Approved April 27, 2017 Since an emergency exists, this act takes effect when passed and approved according to law. Nebraska Revised Statutes 25-21,280, , , , , , , and (1) A health professional who is authorized to prescribe or dispense naloxone, if acting with reasonable care, may prescribe, administer, or dispense naloxone to any of the following persons without being subject to administrative action or criminal prosecution: (a) A person who is apparently experiencing or who is likely to experience an opioid-related overdose; or (b) A family member, friend, or other person in a position to assist a person who is apparently experiencing or who is likely to experience an opioid-related overdose. (2) A family member, friend, or other person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opioid-related overdose, other than an emergency responder or peace officer, is not subject to actions under the Uniform Credentialing Act, administrative action, or criminal prosecution if the person, acting in good faith, obtains naloxone from a health professional or a prescription for naloxone from a health professional and administers the naloxone obtained from the health professional or acquired pursuant to the prescription to a person who is apparently experiencing an opioid-related overdose. (3) An emergency responder, acting in good faith, obtains naloxone from the emergency responder's emergency medical service organization and administers the naloxone to a person who is apparently experiencing an opioidrelated overdose shall not be:. (a) Subject to administrative action or criminal prosecution; or (b) Personally liable in any civil action to respond in damages as a result of his or her acts of commission or omission arising out of and in the course of his or her rendering such care or services or arising out of his or her failure to act to provide or arrange for further medical treatment or care for the person who is apparently experiencing an opioid-related overdose, unless the emergency responder caused damage or injury by his or her willful, wanton, or grossly negligent act of commission or omission. This subdivision shall not affect the liability of such emergency medical service organization for the emergency responder's acts of commission or omission.

11 Naloxone reported in Nebraska since 2011 Gaps/Barriers Voluntary data feed Naloxone reported if pharmacies submitted to PBMs Who is the patient to dispense to? Insurance coverage Naloxone cost Concern regarding the tracking of those who have had naloxone dispensed Patients could opt out from PDMP in the HIE Unable to run reports Naloxone not typically reported

12 Prescribing/dispensing practices Increase awareness about expanded access Legislation to increase reporting Mandatory All Prescriptions Reporting January 1, 2018 Improved data reporting capabilities with DHHS and PDMP vendor

13 Required reporting as of January 1, 2018 Comprehensive medication history 10 x more data than traditional PDMP with only controlled substances Patient safety tool Allows clinicians to make better informed decisions Identify medications from multiple prescribers and pharmacies Identify potential drug interactions, allergies Reporting capabilities Can be used as a tool for medication history

14 Only as accurate as the history obtained Patient Family/caregiver Patient/family to bring in all medication bottles Call pharmacies Review EHR Distractions Time-consuming

15 Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking including drug name, dosage, frequency, and route and comparing that list against the physician s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital Institute for Healthcare Improvement

16 Readmissions % for HF, AMI, Pneumonia % 2 $$$ Medicare Reimbursement/HRRP 2,597 hospitals penalized in FY $528 million 0.73% average penalty 3% max penalty TJC 2005 National Patient Safety Goal #8 accurately and completely reconcile medications across the continuum of care. National Patient Safety Goal #3 (July, 2011) Obtain information on the medications the patient is currently taking when he or she is admitted to the hospital or is seen in an outpatient setting. This information is documented in a list or other format that is useful to those who manage medications. (Effective 1/1/15) 1 Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM, Suter LG, Drye EE, Krumholz HM. Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. JAMA. 2013;309(4): Zuckerman RB, Sheingold SH et al. NEJM 2016; 374: Kaiser Health News, 8/2/2016

17 Adverse Drug Events Strategies for effective medication reconciliation 1 Coordinated communication that includes standardized medication lists, medication administration programs (MAP), interventions, and referrals; A foundation of automation and technology to close the communication gap between health care professionals 1 Hume K, Tomsik E. Enhancing Patient Education and Medication Reconciliation Strategies to Reduce Readmission Rates. Hospital Pharmacy. 2014;49(2): doi: /hpj

18 Studies demonstrate that electronic health record medication lists often contain errors or omissions Medication reconciliation verifying the list of medications that a patient takes is difficult, and increasingly so, due to multiple factors The success of prescription drug monitoring programs at reducing erroneous opiate prescriptions offers hope that such a program would work for all medications 1 Askin E, Margolius D. Am J Mag Care. Oct e336-e337

19 2018 All Prescriptions Workgroup DHHS NeHII DrFirst Pharmacists NACDS Software vendor engagement Code modification Accept specific vs. all classes Development timeline Pharmacist, uploader engagement Gaps/barriers Obsolete NDC New products Testing/pilot partners

20 Database volume 10 x increased prescriptions PDMP system performance Errors and error reporting Potential for 10 x increased errors NDC Drug database subscription update frequency Obsolete NDC Product reporting Prescription vs. prescription drug Nuclear pharmacies Medical gases Compounded products, TPNs UPC Reporting diabetic supplies, OTC, DME Veterinary products NADA 6-digit identifier

21 NPI vs. DEA ASAP 4.2 = AN10 Several data errors due to missing NPI 1-2% dispensers with no NPI and/or DEA Possible solutions for missing NPI fields (PHA01, PRE01) Modified DEA Provider telephone number

22 Kevin Borcher PDMP Program Director, NeHII PDMP Support Amy Reynoldson, Prescription Drug Overdose Prevention Coordinator, DHHS Like us on Facebook Follow NeHII on