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1

PMP

Prescription Monitoring Program is a web-based electronic database that aids in the reporting of dispensed controlled substance prescriptions.

2

PMP Mission

To provide practitioners, pharmacists, and other authorized users the ability to review a patient’s controlled substance prescription history and assist in the prevention of diversion, abuse, misuse, and drug overdose deaths associated with controlled substance prescriptions.

3

Registrants

- Healthcare Professionals
- Delegates - Up to four (4) delegates per practitioner/pharmacist, a delegate can have an unlimited number of practitioners/pharmacists
- Law Enforcement
- Regulatory Board Agents
- Medicaid Compliance Officers

4

Available Delegate User Roles

- Prescriber Delegate - Unlicensed
- Prescriber Delegate - Licensed
-Pharmacist Delegate - Licensed

**Supervisor must have an email registered with AWARXE**

5

All User Regulatory Facts

• Only authorized account holder can access the NM PMP.
• Sharing login information is a violation of both federal and state regulations.
• Although delegates can pull PMP patient reports on behalf of a practitioner, the practitioner is ultimately responsible to review the PMP patient report.
• The practitioner shall document the review of the PMP patient report as required per their licensing board regulation.

6

Medical Board Licensees Regulatory Facts

- For the initial controlled substance II-V prescription and if the day supply is greater than four (4) days, or if there is a gap in prescribing any controlled substance for 30 days or more, obtain and review the NM PMP patient report for the previous 12 months and from adjacent states if available.
- For a renewal or continuous use of a controlled substance II-V, obtain and review a NM PMP patient report no less than once every three months.
- Practitioners licensed to practice in an opioid treatment program shall review a PMP patient report upon initial enrollment into the opioid treatment program and every three (3) months thereafter while prescribing, ordering, administering, or dispensing opioid treatment medication in schedules II-V.
- Document your review!

7

Practitioners don't have to check PMP when...

Practitioners do not have to consult the PMP report before prescribing, ordering, or dispensing a controlled substance II-V:
- If the dispensed quantity is for a period of 4 days or less
- To a patient in a nursing facility,
- To a patient in hospice care
- When prescribing, dispensing or administering Testosterone, Pregabalin, Lacosamide, Ezogabine, Stimulant therapy for pediatric patients less than age 14

8

Pharmacist Regulatory Facts

- For opioid prescriptions, obtain and review the NM PMP patient report for the previous 12 months and from adjacent states if available.
- For a renewal or continuous use of an opioid, obtain and review a NM PMP patient report (and from adjacent states if applicable) no less than once every three (3) months.
- Document your review!

9

Pharmacists don't have to check PMP when...

Pharmacists do not have to consult the PMP report before dispensing a prescription for:
- an opioid written for a patient in a long term care facility (LTCF)
- for a patient with a medical diagnosis documenting a terminal illness.

10

Dispensers Regulatory Facts

- All dispensers (e.g. pharmacies, dispensing practitioners) must report within one business day if more than 12 doses within a 72 hour period was dispensed.
- If a dispenser did not dispense any controlled substances, a “zero report” must be submitted within one business day.
- If a dispenser becomes aware of an data entry error, the correction must be submitted to the PMP within five (5) business days.

11

PMPi

- The PMP InterConnect (PMPi) facilitates the transfer of PMP data across state lines.
- PMPi allows participating states across the United States to be linked, providing a more effective means of combating drug diversion and drug abuse nationwide.
- Currently, 45 states and jurisdictions have agreed to securely share PMP data through PMPi.

12

Information from PMP Reports

• Multiple providers and/or pharmacies
• Prescriptions obtained from nonlocal providers and/or pharmacies
• High doses of opioids
• Opioids in combination with other sedating substances (e.g. benzodiazepines)
• Early refill requests
• Cash payments when insurance is available

13

Opioid Overdose + Multiple Practitioners

-The risk for a patient to die from an opioid overdose increases when a patient receives prescriptions from multiple practitioners

Including:
- Multiple opioids are prescribed
- Care is not coordinated or
communicated with other providers
- Dangerous combinations of
medications are prescribed

14

Opioid Overdose + Doses

-The risk for a patient to die from an opioid overdose increases significantly as their dose increases.
- 3x greater risk at 80-120 MME/d*
- 6x greater risk at 120-200 MME/d*
- 17x greater risk at 200+ MME/d*

15

Opioid Overdose + Sedatives

-The risk for a patient to die from an overdose from an opioid in combination with a sedative increases significantly with more overlap

16

Suspected Pharmacy/Prescriber Shopper Alerts

-Some patients will have a “Suspected Prescriber/Pharmacy Shopper Alert”
- Do not stop here!
- Continue reading and analyzing the PMP patient report.
- Provide appropriate care (e.g. contact providers and/or dispensing pharmacy, referral to SAMHSA treatment centers, contracts, etc.)

17

Reports Available

• Quarterly Reports to Licensing Boards
• Prescriber Feedback Report

18

Quarterly Reports to Licensing Boards include...

• Total number of patients
• Total number of opioid patients
• Total opioid Morphine Milligram Equivalents (MME) filled
• Total number of benzodiazepine (BZD) patients
• Total BZD Diazepam Milligram Equivalents (DME) filled
• Percent of opioid patients with ≥90 MME/day
• Percent of opioid patients with ≥90 days of opioids in 6 months
• Percent of BZD patients with prescriptions ≥30 DME/day
• Percent of BZD patients with ≥90 days of BZDs in 6 months
• Percent of opioid patients with concurrent BZDs ≥30 days
• Number of “holy trinity” patients
• Controlled substance prescriptions per prescribing day, 3 months
• Percent of estimated required reports requested
• PMP reports required under Board rules (estimated)
• PMP reports requested on patients
• Percent of patients with a total of 5 or more practitioners or pharmacies in 6 months

19

Prescriber Feedback Report (PFR)

- Reports reflect top 1% of prescribers with 20 or more patients receiving controlled substances within 6 month period
- Individual practitioners receive their own PFR

Break Down:
- MDs (63%)
- Nurse practitioners or other advanced practice nurses (23%)
- Osteopathic physicians or physician assistants (5%)
- Dentists (5%)
- Podiatrists, psychologists, pharmacist clinicians, or nurse midwives (all <2%)

20

Data Elements of PFR

• Number of opioid and benzodiazepine (BZD) patients
• PMP utilization rates for opioids and BZD
• High opioid doses
• Long term opioid patients
• High BZD doses
• Long term BZD patients
• Number of prescriptions dispensed for opioids and BZDs
• Concurrent opioid and BZD treated patients
• Multiple provider episodes
• Reference to like practitioners in New Mexico

21

PMP Measures

- 18% decrease in patients receiving dangerous combinations of opioids and benzodiazepine together
- 20% decrease in patients receiving controlled substances from multiple providers
- 66.1% of chronic opioid users with a PMP query
- 42.1% of chronic benzodiazepine users with a PMP query
- 20.5% of new opioid patients with a PMP query
- 22.8% of new benzodiazepine patients with a PMP query

22

NarxCare

The Narx Report includes a patient’s NarxScores, Predictive Risk Scores, Red Flags, Rx Graph and PDMP Data, as well as access to Resources and Care Team Communications all in a single, easy-to-use interface.

23

PMP Current Project

-PMP Integration within Workflow: EDIE, Electronic Health Records
-NarxCare