Future uncertain for Kansas prescription drug monitoring program

Despite apparent early success, 15-month-old program could end due to lack of funding

0 | Health Care Delivery, HIE-HIT

K-Tracs, the electronic system used by Kansas medical providers to check patient prescription histories, could end soon for lack of funding, according to officials at the Kansas State Board of Pharmacy, which oversees the prescription monitoring program. Kansas is one of 49 states with the systems, which are used to help prevent "doctor shopping" and other practices that contribute to abuse of controlled medications.

K-Tracs, the electronic system used by Kansas medical providers to check patient prescription histories, could end soon for lack of funding, according to officials at the Kansas State Board of Pharmacy, which oversees the prescription monitoring program. Kansas is one of 49 states with the systems, which are used to help prevent "doctor shopping" and other practices that contribute to abuse of controlled medications.

— Since the launch of the state’s electronic monitoring program early last year, officials at the Kansas Board of Pharmacy have fielded more than 156,000 digital queries from a growing number of doctors and pharmacists who use K-TRACS to check on possible prescription abuse by their patients.

Despite its apparent success, the prescription drug monitoring program faces extinction as early as this fall when the federal grant money that has sustained it ends, said Christina Morris, the program’s director.

“If we don’t find funding,” she said, “we shut down.”

K-TRACS began with a two-year, $400,000 grant from the U.S. Department of Justice that ends in October. Morris said replacement funding hasn’t been identified.

The National Association of State Controlled Substance Authorities also provided about $32,000 for the program, but those dollars are dedicated to special projects.

The Kansas Legislature authorized the monitoring program in 2008, but it took awhile for the federal funding to materialize so it could be implemented.

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THE K-TRACS logo.

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Kansas doctors and pharmacists began querying the database in April 2011. Since then, the number of registered users has grown from about 850 to about 5,500. The system allows the medical providers to log on to the computerized database using a software called RxSentry and review the prescription histories of their patients. Without the K-TRACS system, it would be difficult for the doctors or pharmacists to know if the patients already had similar or the same prescriptions from other providers.

Kansas is one of 49 states to authorize a prescription drug monitoring program, according to the Alliance of States with Prescription Monitoring Programs. Missouri is the only state without one.

'Growing, deadly epidemic'

A primary purpose of the programs is to reduce what the U.S. Centers for Disease Control and Prevention has called the “growing, deadly epidemic of prescription painkiller abuse.”

Prescription painkiller overdoses killed nearly 15,000 people in the United States in 2008, according to the agency. That’s more than three times the number of people killed by those drugs in 1999.

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The electronic system is considered an improvement on the paper-based monitoring that required fax or mailing.

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The prescription drug databases track individual drug purchases, giving pharmacists, doctors and regulators a tool to see a patient’s complete pharmaceutical record.

The aim is to prevent so-called “doctor shopping,” when addicts obtain overlapping prescriptions from a number of physicians and fill them at various pharmacies.

Supporters say digital monitoring also can help reduce Medicare and Medicaid fraud, but privacy advocates contend the programs intrude into what should be a patient’s confidential medical record.

Privacy concerns scuttled efforts to pass the Prescription Drug Monitoring Act in this year’s session of the Missouri General Assembly.

Officials with the Kansas program said their data suggest some spillover problems from Missouri residents along the shared border.

Kansas officials alert doctors and pharmacists with a letter once a patient exceeds a certain number of prescriptions in a quarter. The threshold is confidential so as not to alert potential abusers, Morris said.

In the first quarter of this year, she said, nearly two-thirds of the 171 letters sent involved patients who lived in Missouri or in bordering Kansas counties, including Johnson and Wyandotte.

Morris said thanks to newly enacted legislation, Kansas officials now have authority to alert law enforcement officials or refer individuals to substance abuse programs if the database indicates a user with a problem.

The programs are proving useful as early warning systems, said John Eadie, director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Mass.

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KHI News Service

Pharmacist Michael Conlin of Topeka's Jayhawk Pharmacy logs onto the online system for the state's Prescription Monitoring Program, which also still allows reporting using paper forms. The program allows the tracking of prescriptions that are controlled substances and is intended to safeguard against prescription abuse. The system is relatively new in Kansas but use of it has grown quickly. Future funding for it remains an open question.

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“If you know where doctor shopping is beginning to crop up, then you will have the capacity to inform those communities immediately,” he said. “We know now from the data that we have looked at that there is a close association between overdoses and deaths and doctor shopping.”

The Kansas database has helped officials identify potential abusers.

For example, in the first quarter of this year, officials said, a 57-year-old Gardner resident saw 30 physicians and visited 16 pharmacies, according to the database. The person received 44 prescriptions for a total of 1,457 pills, enough to last 459 days with normal use.

Feedback about the program from the medical community and legislators has been positive, Morris said.

“But it seems like no one really wants to pay for it,” she said.

Morris outlined several potential funding options to keep the program going:

• Request a funding extension from the Justice Department through September 2013.

• Seek about a year’s worth of funding from the pharmacy board to give the program more time to establish a permanent funding source.

• Provide the information for a fee to the two networks authorized in Kansas to transfer patient data among providers through the state’s health information exchange.

Bob Twillman, chair of the advisory committee that oversees the program, said he was “pretty confident” that officials could reach agreement with the health information exchange networks.

The state legislation authorizing the program prohibited charging user fees to physicians or pharmacists, Morris said.



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