Two weeks ago, President Trump signed into law a sweeping, bipartisan bill intended to address the opioid crisis. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (or SUPPORT Act, for short) creates broad programmatic, funding, and policy levers for treatment and prevention of substance use disorders. It also includes a number of provisions related to health IT generally and prescription drug monitoring programs (PDMPs) in particular.
The SUPPORT Act acknowledges that virtually all U.S. states and territories have by now instituted PDMPS, and so rightly focuses on optimizing their use and ensuring that PDMP data is exchanged across state lines. Perhaps most notably, the law establishes 100 percent federal funding over the coming two years to states to design and implement PDMPs. To access this funding, states will piggyback on the existing State Medicaid Director (SMD) funding mechanism which is accessed via Advanced Planning Document (APD) requests to the Centers for Medicare and Medicaid Services.
The law highlights several critical features of PDMPs as priorities for the enhanced funding:
● Moving pharmacies to as near to real-time reporting as possible;
● Supporting the flow of PDMP data across state lines; and
● Establishing integration into clinical workflows, for instance by integrating it with electronic health records systems.
Each of these priorities is described in further detail below. First is the timing of the data. The bill pushes towards real-time or as close to real-time data as possible. According to the most recent data from Brandeis University, 45 states require pharmacies to report fill data in 48 hours or less. However, based on our experience, even in states with such reporting requirements it takes as long as 10 days for 90 percent of the fill data to be reported and up to a month for near complete reporting. Moving towards true real-time fill data will likely require legislative changes and potentially technology changes to allow pharmacies to send data to the state PDMP more frequently.
Second, the bill focuses heavily on interstate data sharing of PDMP data. It starts from the recognition that there are both technical challenges and legal/policy issues to address for interstate data sharing. While the legislation cannot and does not supersede state laws, it does indicate that states must work on data sharing agreements that comply with their state laws while also ensuring standards are in place to support the technical means of sharing data between states. It should be noted that the SUPPORT Act seems to indicate there will be funding for states to build out these usability-focused improvements, but does not specify the amount of funding available or the exact funding mechanism. Of course, any state that does receive this funding will be required to periodically report to HHS on their progress and will also be required to share aggregated, de-identified data with CDC for research purposes.
Lastly, the bill includes provisions for HHS, CDC, and ONC to support states in improving the usability of PDMPs, including but not limited to an emphasis on integration within EHRs. It’s clear that Congress was concerned about the reactive nature of today’s PDMPs, and the difficulties many providers have in using them. The bill asks CDC to work with states to build proactive notifications to providers about individuals who demonstrate a pattern of abuse. Rather than providers having to check the PDMP, the PDMP would support both last-mile connectivity into the workflow and the sending of proactive reports to providers to help them make more informed prescribing decisions. The bill is not specific about what such reports would be, but does indicate a desire to decrease alert fatigue and integrate appropriately into a providers EHR workflow.
There is also little in the bill related to PDMPs that is new, with the exception perhaps of a provision encouraging states to integrate information about treatment options and referrals into PDMPs, making it easier for providers to coordinate care when they have a patient with a potential opioid use disorder. What is novel, though, is the combination of unprecedented levels of federal investment with approaches that must be open and standards based and that require a broad range of both state and federal agencies to work collaboratively. And perhaps this is the most important part of the bill—even if it’s not in the text—all of us will have to work together, in an open and cooperative way. We need to be committed to breaking down data silos, supporting an ecosystem of technology solutions, and moving the market away from data blockers and “toll takers” in order for PDMPs to have maximum impact.