Since I have worked in a pharmacy since before BNDD came to being… I have seen the 45 year evolution of this war on drugs. Of course, back then.. there was no computers, no databases and only some of the “hard stuff”/narcotics was where the rules were focused.
The first PMP did not come on line until the early 90′s. The software funded by Purdue Pharma and access was limited to law enforcement who had active investigations.. meaning that pharmacies were going thru all this data submission so that 3-4 dozen reports a year for law enforcement could be generated.
In 2005 President Bush signed into law the creation of NASPER National All Schedules Prescription Electronic Reporting Act and the program has yet to be funded by Congress.
The state level PMP’s has yet to be implemented in all 50 states and it wasn’t until 2010 that some states started to attempt to link their PMP’s together. Right now, the vast majority of PMP’s are very time consuming to request reports from… as we all know.. time is money…
There are basically a few things that we should be worried about when presented a prescription
* The person is who they say they are.. they have presented you with a legit driver’s license
* The person has insurance when they claim that they are wanting to pay cash
* They are not a prescriber/pharmacy shopper
There are an three existing databases and one that the bureaucrats that could easily mandate be created.. if it doesn’t already exists
* State’s driver’s license
* SSN database
* Database of all people that have some sort of medication insurance.
Imagine a pt presenting a new controlled Rx and a driver’s license – SSN for those that doesn’t have a driver’s license.
The driver’s license (or SSN inputted ) is scanned at receipt of Rx… the system goes to the state’s driver’s license database and brings back a display of the driver’s license from the state’s database. IF SSN was put in… the system would go back to the state’s driver’s license and check for a existing driver’s license that was not divulged.
System then queries the SSN database and return the name/DOB for the SSN given or retrieved from driver’s license database.
System then queries the insurance database and comes back and indicates if this person has medication insurance
System then queries the state’s PMP or multiple PMP’s if the pharmacy is operating on state(s) borders. The PMP would routinely internally run programs that would flag a pt’s record as a “person of interest”
System would display if this particular person is a “person of interest” by the state’s PMP.
Within seconds… the computer display in front of you at intake would give you a image of the driver’s license, SSN & DOB, if the person has medication insurance and if the person is a potential prescriber/pharmacy shopper.
If all the data points do not match… why would you fill a controlled Rxs without questioning.. conversely if all the data points match.. why would you question the Rx(s).. unless it is from a known or questionable prescriber.
Pharmacists are suppose to do due diligence and responsible for implementing “corresponding responsibility” on all controlled Rxs.
Three of the four databases currently exists..
The states refuse to grant access.. to the driver’s license database(s)
the SSN database is only to be used by employer to determine if they are hiring legal residents
The PMP’s are difficult and time consuming in getting a report
The insurance database may already exist.. we just don’t know about it…
So the tools that Pharmacists need to perform timely due diligence .. is either restricted/limited access or troublesome to use.
Did I hear someone say “hands tied behind their backs ?”
Granted.. nothing is going to be 100 %… but is 50% less legal drugs getting to the street… while allowing legit pts to get their meds… worth the effort ?