Prescription Drug Monitoring Program Should Be Open To Insurers

April 23--If insurance companies and state Medicaid agencies had access to state prescription drug monitoring programs, they could use the data to help prevent prescription drug overdoses and deaths, according to a study released Tuesday.

In many states, including Oklahoma, third-party payers -- such as health insurance companies and the state's Medicaid program -- do not have access to their state's prescription drug program, according to the report from the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

These programs monitor prescriptions of controlled dangerous substances, including hydrocodone and oxycodone, powerful painkillers that are at the heart of the nation's prescription drug problem.

"At a time when the misuse and abuse of prescription opioids has reached epidemic levels, it's important that third-party payers be able to use states' prescription monitoring data to make sure these drugs are prescribed appropriately," Peter Kreiner, principal investigator of the center, said in a news release.

Unintentional drug overdose deaths have surpassed motor vehicle accidents as the leading cause of accidental death in both Oklahoma and nationally.

In 2012, 534 Oklahomans died from unintentional prescription drug overdoses, and state health authorities say about half of them had taken drugs prescribed by their doctors.

If third-party payers were given access to their state's prescription drug monitoring programs, not only could it affect the number of residents dying, but it also could help curb costs, the report states.

Costs are soaring

The costs stemming from the non-medical use of prescription opioids, including lost productivity, law enforcement and drug abuse treatment, are more than an estimated $50 billion each year, the report claims.

A recent analysis conducted for the Coalition Against Insurance Fraud estimated that costs to health insurers resulting from prescription drug diversion total at least $18 billion a year, but could exceed $70 billion, with nearly $25 billion borne by private insurers, according to the report.

The report points out that because many states -- including Oklahoma -- do not allow insurers access to the data, legislation and regulations would have to be adopted. Only Michigan is known to have provided data to private health insurers, according to the report.

As of 2012, 28 states were sharing prescription drug monitoring data with Medicaid or Medicare.

Oklahoma's rules

Oklahoma law limits access to the state's prescription drug monitoring program largely to medical practitioners, pharmacists and law enforcement.

Jennie Melendez, Oklahoma Health Care Authority spokeswoman, said only a few staff members, who are physicians and pharmacists, at Oklahoma'sMedicaid agency have access to the program.

It's not realistic for that handful of people to regularly check the program when there are thousands of Oklahomans filling prescriptions covered under Medicaid each month.

In March, the Oklahoma Health Care Authority reimbursed $40 million for about 197,000 SoonerCare members who filled 523,260 prescriptions. Hydrocodone was the top medication filled, agency records show.

Currently, Medicaid officials don't know when a SoonerCare member pays cash and receives a prescription covered by another provider. "Some people have a third-party insurance and, for example, they might also have their husband's Blue Cross Blue Shield," Melendez said. "That's where the PDMP comes in."

The report's authors say prescription drug monitoring programs are effective tools in helping combat prescription drug abuse.

___

(c)2014 The Oklahoman

Visit The Oklahoman at www.newsok.com

Distributed by MCT Information Services