PMP Lecture Flashcards

1
Q

PMP

A

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

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2
Q

PMP Mission

A

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.

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3
Q

Registrants

A
  • 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
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4
Q

Available Delegate User Roles

A
  • Prescriber Delegate - Unlicensed
  • Prescriber Delegate - Licensed
  • Pharmacist Delegate - Licensed

Supervisor must have an email registered with AWARXE

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5
Q

All User Regulatory Facts

A
  • 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.
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6
Q

Medical Board Licensees Regulatory Facts

A
  • 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!
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7
Q

Practitioners don’t have to check PMP when…

A

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
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8
Q

Pharmacist Regulatory Facts

A
  • 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!
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9
Q

Pharmacists don’t have to check PMP when…

A

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.
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10
Q

Dispensers Regulatory Facts

A
  • 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.
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11
Q

PMPi

A
  • 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.
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12
Q

Information from PMP Reports

A
  • 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
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13
Q

Opioid Overdose + Multiple Practitioners

A

-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
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14
Q

Opioid Overdose + Doses

A
  • 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*
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15
Q

Opioid Overdose + Sedatives

A

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

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16
Q

Suspected Pharmacy/Prescriber Shopper Alerts

A
  • 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
Q

Reports Available

A
  • Quarterly Reports to Licensing Boards

* Prescriber Feedback Report

18
Q

Quarterly Reports to Licensing Boards include…

A
  • 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
Q

Prescriber Feedback Report (PFR)

A
  • 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
Q

Data Elements of PFR

A
  • 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
Q

PMP Measures

A
  • 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
Q

NarxCare

A

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
Q

PMP Current Project

A
  • PMP Integration within Workflow: EDIE, Electronic Health Records
  • NarxCare