New Developments in PDMPs: California, Colorado and Minnesota

1. New Developments in PDMPs:
California, Colorado and Minnesota
Presenters:
• Mark R. O’Neill, RPh, Program Manager, Colorado Prescription Drug
Monitoring Program
• Barbara A. Carter, PMP Manager, Minnesota Board of Pharmacy,
Prescription Monitoring Program
• Tina Farales, Department of Justice Administrator, Prescription Drug
Monitoring Program, California Department of Justice
• Artin Armagan, PhD, Manager, Advanced Analytics Lab, SAS Institute
PDMP Track
Moderator: John L. Eadie, Coordinator, Public Health and Prescription Drug
Monitoring Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center, and Member, Rx and Heroin Summit National Advisory Board

2. Disclosures
• Barbara A. Carter; Tina Farales; Mark R. O’Neill, RPh;
and John L. Eadie have disclosed no relevant, real, or
apparent personal or professional financial
relationships with proprietary entities that produce
healthcare goods and services.
• Artin Armagan, PhD – Ownership interest: Walmart
(spouse)

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Express the value of PDMPs as healthcare
tools.
2. Describe PDMP enhancements that improve
data integrity and streamline retrieval and
viewing of PDMP searches and reports.
3. Identify the features and benefits of
California’s upgraded PDMP, CURES 2.0.
4. Provide accurate and appropriate counsel as
part of the treatment team.

5. New Developments in PDMPs:
Colorado
Mark R. O’Neill, RPh
Program Manager
Colorado Prescription Drug
Monitoring Program

6. Focus on Value: A map of Colorado’s rising drug-
related deaths between 2002 and 2014.
Representation of the need for PDMP programs
in the United States.

7. Colorado Drug Overdose Death Rate 2002
“Colorado Drug Death Rate Tops U.S. Average,” Colorado Health Institute, Feb. 2016

8. Colorado Drug Overdose Death Rate 2014
“Colorado Drug Death Rate Tops U.S. Average,” Colorado Health Institute, Feb. 2016

9. Colorado PDMP: An overview
 Began 2007. 6 prescribing Boards /
Pharmacy. 2 person staff.
 3rd Party vendor. ~ $175,000 / year.
Funded by prescriber fees.
 Colorado Population: 5.5 million
 Over 2.6 million patient specific queries in
2015

10. Enhancements: PDMP as a Healthcare Tool
 Legislative Update 2014
 Mandatory registration (not mandatory use) of all DEA
registered prescribers
 Daily reporting by pharmacies to increase reliability and
trust of data
 Delegated authority for increased use and access for
prescribers and pharmacists – up to 3 trained delegates
 Access granted to Colorado Department of Public Health
and Environment

11. Prescription Trends 2014 - 2015
722,964
601,895 585,587
420,108
521,806
450,984
467,922
402,576
400,676
306,348
358,041
329,191300,000
400,000
500,000
600,000
700,000
Prescriptions Dispensed Patients recieving prescriptions

12. Tackling Doctor Shopping - Push Notices
 Obtaining controlled substances from multiple sources in
potentially dangerous quantities.
 Prescribers and pharmacists can use the PDMP to stop
“doctor shopping.”
 Push Notice letters are sent out to prescribers and
pharmacies monthly.
 Push Notices are often a “reality check” for prescribers
and pharmacists

14. Streamlined Retrieval of Data
 Automated Access:
 Single log-on access to patients’ PDMP files
 Inclusion of “Rxcheck”
 Allows for efficient, reliable and secure access.
 Currently used at two practice sites in Colorado: one
major chain pharmacy and one federal facility.

15. Streamlined Retrieval of Data
 Integration of Electronic Health Records through the
Harold Rogers PDMP Grant for Practitioner and Research
Partnerships
 5 major Emergency Departments at Colorado hospitals

16. Colorado: Outreach and Education
 Outreach to Colorado – Speakers Bureau offers ongoing
PDMP information.
 Consortium for the Prevention of Prescription Drug Abuse:
Created as “Task Force” for continued improvement of
PDMP.
 New PDMP dedicated website
 Training webinars
 YouTube videos
 Production of PDMP brochure

17. New Developments in PDMPs:
Minnesota
Barbara A. Carter
PMP Manager
Minnesota Board of Pharmacy

18. Disclosure Statement
• Barbara A. Carter, has disclosed no relevant,
real or apparent personal or professional
financial relationships with proprietary
entities that produce health care good and
services.

19. Learning Objectives
• Express the value of PDMPs as healthcare
tools.
• Describe PDMP enhancements that improve
data integrity and streamline retrieval and
viewing of PDMP searches and reports.
• Identify the features and benefits of
California’s upgraded PDMP, CURES 2.0.
• Provide accurate and appropriate counsel as
part of the treatment team.

20. DATA REPORTING & DATA INTEGRITY:
THE PATH TO IMPROVEMENT
Barbara A Carter, PMP Manager, Minnesota Board of Pharmacy

21. Identifying the Issues
• Compliance in Reporting
– Are all dispensers reporting?
– How often are they reporting?
• Data Quality
– How accurate is the data?
– Are there missing records?

22. Facts and Figures
2010
• 1,700 licensed
pharmacies
• 6.6M prescription records
(CS II-IV)
2015
• 2,000 licensed
pharmacies
• 8M prescription records
(CS II-V)

23. Are all dispensers reporting?
• Honor System
– Unmet Expectations
• Unique Pharmacy Identifier
– Pharmacy DEA#
• Match with MN pharmacy license #
• Monthly Compliance
– 1st notice
– 2nd notice ($10,000 fine)
– Phone Call
– Complaint filed

24. How often are they reporting?
• Daily reporting required
– By procedure not statute
• Inadequate Reporting
– Definition
• Less than 20 reports monthly
• Identify manageable threshold
– 10 reports
– 18 reports

25. DATA QUALITY
• Who uploads the data?
– Pharmacy staff
– Corporate office
– External vendor
• How are errors communicated and to whom?
– Error reports
• Email
• Fax
– Data uploader

26. Errors impacting end user
• Minor
– Days supply invalid (>180 days)
– Refill code is not a #
• Serious
– Invalid prescriber DEA#
– Invalid NDC #
• Fatal
– Blank prescriber DEA#
– Blank DOB

27. Current initiative
• Blast communication-2 months in advance
– Uploader and PIC
• Error correction within 7 days receipt of edit report
• Establish relationship with data uploader
• Auditing Begins
– Weekly error summary report
• Identify worst offenders
– Errors that impact end user
• Allow 7 days to pass then audit for error resolution

28. Determining Compliance
• Errors resolved within 7 days
• Outstanding errors
– Phone call to Pharmacist in Charge (PIC)
• Secure email with prescription details
• Ongoing collaboration with PIC, uploader and PMP
vendor
– Complaint filed with Board

29. Outcomes
• Compliance in reporting improved
• Frequency of reporting improved
• Improvement in data quality
• Relationships improved

30. Lessons Learned
• Communication is Critical
– PMP and Dispenser
– Dispenser and their Vendor
• Start Out Small
• Hidden Issues uncovered
• Dedicated Resources
• Work in Progress

31. Next Steps
• Recognize “gold star” performance
• Update contact lists
• Update error report communication
preference
• Create tutorials-how to’s for data providers
• Increase frequency of communications
• Educate, educate, educate

32. THANK YOU

33. New Developments in PDMPs
California’s CURES 2.0

34. Mike Small has disclosed no relevant, real or
apparent personal or professional financial
relationships with proprietary entities that
produce health care goods and services.
Artin Armagan has disclosed that his spouse is
employed as a pharmacist by Duke Raleigh
Hospital and Walmart Pharmacy.

35. New Developments in PDMPs
California’s CURES 2.0
Learning Objective:
Identify the features and benefits of California’s upgraded
PDMP, CURES 2.0.

36. California Health and Safety Code section § 11165. (a)
To assist health care practitioners in their efforts to ensure
appropriate prescribing, ordering, administering, furnishing, and
dispensing of controlled substances, law enforcement and
regulatory agencies in their efforts to control the diversion and
resultant abuse of Schedule II, Schedule III, and Schedule IV
controlled substances, and for statistical analysis, education, and
research, the Department of Justice shall . . . maintain the
Controlled Substance Utilization Review and Evaluation System
(CURES)…Review and Evaluation System (CURES)…

37. The Iatrogenically Addicted Patient and the
Doctor Shopper
~
Information Delivery
~
Support the Public Health Sector
~
The Public Needs to Know
~
Analytics

38. Automated Registration
California clinical users are provided a fully automated
registration process.
Delegation Authority
Prescribers and dispensers can easily assign delegates who can
initiate CURES 2.0 patient inquiries on their behalf.
Compact Flagging
Prescribers can easily notate their patients with treatment
exclusivity compacts, forewarning other providers that additional
prescribing to these patients can be potentially counter-
productive to their existing treatment regimen.
CURES 2.0 User Features

39. Peer-to-Peer Communication
Prescribers and dispensers can instigate alert messages to fellow
doctors and pharmacists about mutual patients of concern.
Patient Safety Messaging
Prescribers are alerted daily with information regarding their
patients who reach various prescribing thresholds.
CURES 2.0 User Features

40. CURES 2.0 systematically de-duplicates and de-identifies
county and statewide data sets for County Health Officers and
researchers.
Quarterly and annual de-identified data sets are produced for
County Health Officers.
This data enables counties to calculate current rates of
prescriptions, examine variations within the state, and track
the impact of safe prescribing initiatives.
De-Duplicated / De-Identified Data

41. 1. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who are Currently Prescribed More than 100 Morphine
Milligram Equivalency Per Day
2. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Have Obtained Prescriptions from 6 or More
Prescribers or 6 or More Pharmacies During Last 6 Months
3. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed More than 40 MMEs
Methadone Daily
4. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed Opioids More Than 90
Consecutive Days
5. For Each Individual Prescriber, a List of That Prescriber's Rx
Recipients Who Are Currently Prescribed Both Benzodiazepines
and Opioids
Patient Safety Messaging

46. 1 Total Number of Prescriptions for Opioid Drugs by Month, by
State, County and Zip Code
2 Total Number of Prescriptions for Opioid Drugs by Calendar Year,
by State, County and Zip Code
3 Total Number of Unique Patients Prescribed Opioids by Month,
by State, County and Zip Code
4 Total Number of Unique Patients Prescribed Opioids by Calendar
Year, by State, County and Zip Code
5 Number of Opioid Pills Prescribed by Month, by State,
County and Zip Code
6 Number of Opioid Pills Prescribed by Calendar Year, by State,
County and Zip Code
7 Median Number of Opioid Pills Per Prescription by Month, by
State, County and Zip Code
Public Reports

47. 8 Median Number of Opioid Pills Per Prescribed by Calendar Year, by
State, County and Zip Code
9 Number of Patients Receiving Opioid Prescriptions by Month, by
State, County and Zip Code, by Age as Follows: ≤ 14; 15-24; 25-44;
45-64; ≥65
10 Number of Patients Receiving Opioid Prescriptions by Calendar Year,
by State, County and Zip Code, by Age as Follows: ≤ 14; 15-24;
25-44; 45-64; ≥65
11 Number of Opioid Pills and Benzodiasepine Pills Prescribed to the
Same Patient by Month, by State, County and Zip Code
12 Number of Opioid Pills and Benzodiasepine Pills Prescribed to the
Same Patient by Calendar Year, by State, County and Zip Code
Public Reports

48. 13 Number of Patients, by Month, Prescribed Both Opioids and
Benzodiasepine, by State, County and Zip Code
14 Number of Patients, by Year, Prescribed Both Opioids and
Benzodiasepine Within Any 30 Day Window, by State, County and Zip
Code
15 Total Morphine Milligram and Morphine Kilogram Equivalents
Prescribed by Month, by State, County and Zip Code
16 Total Morphine Milligram and Morphine Kilogram Equivalents
Prescribed by Calendar Year, by State, County and Zip Code
17 Morphine Milligram and Morphine Kilogram Equivalents Prescribed by
Month, by State, County and Zip Code for: Oxycodone, Hydrocodone,
Morphine, Methadone, Hydromorphone, Buprenorphine, Fentanyl,
Oxymorphone, Codeine, Levorphanol, and Zohydro
Public Reports

49. 18 Morphine Milligram and Morphine Kilogram Equivalents Prescribed by
Calendar Year, by State, County and Zip Code for: Oxycodone,
Hydrocodone, Morphine, Methadone, Hydromorphone,
Buprenorphine, Fentanyl, Oxymorphone, Codeine,
Levorphanol, and Zohydro
19 Number of Very Frequent Opioid Prescribers (580+ Opioid Rx/Yr),
Frequent Prescribers (50-579 Opioid Rx/Yr), Occasional Prescribers
(8-49 Opioid Rx/Yr), and Rare Prescribers (1-7 Opioid Rx/Yr), by State, by
State, County and Zip Code
20 Number of Very Frequent Schedule II Drug Prescribers (580+ Sked II
Rx/Yr), Frequent Prescribers (50-579 Sked II Rx/Yr), Occasional
Prescribers (8-49 Sked II Rx/Yr), and Rare Prescribers (1-7 Sked II Rx/Yr),
by State, County and Zip Code
21 Total Number of Prescriptions for all Schedule II Drugs by Month, by
State, County and Zip Code
Public Reports

50. 21 Total Number of Prescriptions for all Schedule II Drugs by Month, by
State, County and Zip Code
22 Total Number of Prescriptions for all Schedule II Drugs by
Calendar Year, by State, County and Zip Code
23 Total Number of Prescriptions for Schedules II, III, and IV Drugs, by
Schedule and Total, by Month, by State, County and Zip Code
24 Total Number of Prescriptions for Schedules II, III, and IV Drugs, by
Schedule and Total, by Calendar Year, by State, County and Zip Code
25 Total Number Patients Receiving Schedule II, III and IV Drug
Prescriptions, by Month, by State, County and Zip Code
26 Total Number Patients Receiving Schedule II, III and IV Drug
Prescriptions, by Calendar Year, by State, County and Zip Code
Public Reports

51. 27 Median Number of Pills Per Prescription for Schedules II, III, and IV
Drugs by Month, by State, County and Zip Code
28 Median Number of Pills Prescribed for Schedules II, III, and IV
Drugs by Calendar Year, by State, County and Zip Code
29 Median Number of Pills Per Prescription for Schedule II Drugs by
Month, by State, County and Zip Code
30 Median Number of Pills Prescribed for Schedule II Drugs by
Calendar Year, by State, County and Zip Code
31 Median Pills , by Month, Per Schedule II, III, or IV Prescription by
Age as follows: ≤ 14; 15-24; 25-44; 45-64; ≥65
32 Median Pills , by Year, Per Schedule II, III, or IV Prescription
by Age as follows: ≤ 14; 15-24; 25-44; 45-64; ≥65
Public Reports

52. 33 Number of Prescriber and Dispenser Registrants, by Month, by
State, County and Zip Code
34 Number of Prescriber and Dispenser Registrants, by Year, by State,
County and Zip Code
35 Number of Patients Who Obtained 4 or More Schedule II, III, or IV
Prescriptions from 4 or More Dispensers During Prior 12 months, by
State, County and Zip Code
36 Number of Patients Who Obtained 4 or More Schedule II, III, or IV
Prescriptions from 4 or More Dispensers During the Calendar Year,
by State, County and Zip Code
37 Number of Patients with Same Prescription Drug from 3 or More
Prescribers, by Month, by State, County and Zip Code
Public Reports

53. 38 Number of Patients with Same Prescription Drug from 3 or More
Prescribers, by Calendar Year, by State, County and Zip Code
39 Number of CURES Inquiries by Prescribers, by Month, by State,
County, and Zip Code
40 Number of CURES Inquiries by Prescribers, by Year, by State, County,
and Zip Code
41 Number of CURES Inquiries by Dispensers, by Month, by State,
County, and Zip Code
42 Number of CURES Inquiries by Dispensers, by Year, by State, County,
and Zip Code
43 Numbers of Prescribers Prescribing Opioids and Benzodiazepines
Concurrently to a Patient, by Month, by State, County, and
Zip Code
Public Reports

54. 44 Numbers of Prescribers Prescribing Opioids and Benzodiazepines
Concurrently to a Patient, by Year, by State, County, and Zip Code
45 Number of Patients Currently Prescribed More than 100
Morphine Milligram Equivalency Per Day, by Month, by State,
County, and Zip Code
46 Number of Patients Currently Prescribed More than
100 Morphine Milligram Equivalency Per Day, by Year,
by State, County, and Zip Code
47 Number of Patients Who Are Currently Prescribed More than 40
Milligrams Methadone Daily, by Month, by State, County, and
Zip Code
48 Number of Patients Who Are Currently Prescribed More than 40
Milligrams Methadone Daily, by Year, by State, County, and
Zip Code
Public Reports

55. ASAP DATABASE
ENTITY
RESOLUTION
ANOMALY
DETECTION
DE-
IDENTIFIED
DATA
REPORTING
ALERT
GENERATION

56. ENTITY RESOLUTION
John Doe
01/01/70
456 HARRISON AVE
CARY, NC 27513John Doe
01/01/70
123 HARRISON AVE
CARY, NC 27513
John Doe
01/01/70
789 HARRISON AVE
CARY, NC 27511
Johnnie Doe
01/01/70
123 HARISON AVE
CARY, NC 27511
ONE ENTITY

57. PATIENT SCENARIOS
1. Rx Recipients Who are Currently Prescribed More than 100
Morphine Milligram Equivalency Per Day
2. Rx Recipients Who Have Obtained Prescriptions from 6 or More
Prescribers or 6 or More Pharmacies During Last 6 Months
3. Rx Recipients Who Are Currently Prescribed More than 40 MMEs
Methadone Daily
4. Rx Recipients Who Are Currently Prescribed Opioids More Than 90
Consecutive Days
5. Rx Recipients Who Are Currently Prescribed Both Benzodiazepines
and Opioids

58. ENTITY RESOLUTION & SCENARIOS

59. TIME
30 MME80 MME110 MME110 MME + BENZO
OPIOID
OPIOID
OPIOID
BENZO

60. ALERTS
• Patient Name
• Patient DOB
• Patient Address
• Patient City
• Patient Zip Code
• # of Anomalous
Scenarios
• Triggered Scenarios

61. DE-IDENTIFIED DATA
 Anonymized Patient ID
 Anonymized Prescriber ID
 Anonymized Pharmacy ID
 Patient Birth Year
 Patient Gender
 Patient Zip Code
 Patient County
 Patient State
 Prescriber Zip Code
 Prescriber County
 Prescriber State
 Pharmacy Zip Code
 Pharmacy County
 Pharmacy State
 Product Name
 NDC
 Drug Form
 Strength
 Quantity
 Days Supply
 Date Filled
 Refill Number
 Payment Code
 Prescriber Specialty
 Prescriber Board Certification
Indicator
• Personally identifying information redacted.
• Anonymized patient IDs maintained to be consistent
from report to report.
• Generated quarterly and annually for each county and
the entire state.

62. Questions?
Thank You!

63. New Developments in PDMPs:
California, Colorado and Minnesota
Presenters:
• Mark R. O’Neill, RPh, Program Manager, Colorado Prescription Drug
Monitoring Program
• Barbara A. Carter, PMP Manager, Minnesota Board of Pharmacy,
Prescription Monitoring Program
• Tina Farales, Department of Justice Administrator, Prescription Drug
Monitoring Program, California Department of Justice
• Artin Armagan, PhD, Manager, Advanced Analytics Lab, SAS Institute
PDMP Track
Moderator: John L. Eadie, Coordinator, Public Health and Prescription Drug
Monitoring Program Project, National Emerging Threat Initiative, National HIDTA
Assistance Center, and Member, Rx and Heroin Summit National Advisory Board