Study: Payers need access to Rx drug monitoring programs


The use of prescription monitoring data could help reduce overdoses, deaths and healthcare costs, according to a new report issued by the Prescription Drug Monitoring Program Center of Excellence.

The report details the importance of data sharing between prescription drug monitoring programs (PDMP) and third-party payers. Most third-party payers typically only see data on prescriptions for which they've paid--PDMP data provides a complete prescription history for a particular patient.

The report--which highlights a December 2012 meeting of more than 75 insurers, federal leaders and state PDMP administrators in Washington, D.C.--also suggests the cost effectiveness of PDMPs to third-party payers. Abusing prescriptions may cost a medium-sized insurer more than $42 million a year. Despite potential costs savings, only Michigan provides PDMP data to private insurers.

At the end of last year, the American College of Physicians published a similar report that also recommended all 50 states pass legislation to allow electronic prescribing. The group urged the use of nonopioid treatments before using addictive medications, and also encouraged patients to sign "pain contracts" prior to pain treatment.

"Opioid abuse is the most urgent issue in workers' compensation," Bruce Wood, director of workers' compensation with the American Insurance Association said Tuesday in an announcement. "Giving workers' compensation payers access to PDMP information would permit them to see if an injured worker is getting opioids from multiple sources."

Painkiller overdoses killed 15,000 people nationwide in 2008, FierceHealthPayer: Anti-Fraud previously reported. If states adopt the use of PDMPs to determine if patients are doctor shopping or acting with a street dealer, insurers can identify prescriptions of dangerous substances early on. In many states, doctor shopping is a daily issue, mostly due to the lack of consequences for physicians.

For more:
- here's the research announcement
- read the report (.pdf)

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