DoD lacks data sharing with state prescription drug monitoring programs

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The Department of Defense, which supports healthcare delivery for 9.4 million beneficiaries, is experiencing challenges in sharing data with state-run Prescription Drug Monitoring Programs in order to combat the opioid epidemic.

Rep. Mike Coffman (R-Colo.), chairman of the House Armed Services Subcommittee on Military Personnel, says his congressional panel is concerned about DoD’s efforts to ensure data reporting transparency with PDMPs—electronic databases that track controlled substance prescriptions by flagging suspicious patient prescribing activities.

“We understand there have been some challenges with developing a PDMP model that balances military-related cybersecurity and operational concerns with the need for data transparency with non-military treatment facility clinicians and pharmacists that are serving TRICARE beneficiaries accessing multiple points of healthcare services,” said Coffman during a hearing held last week.

In her testimony before the subcommittee, Vice Admiral Raquel Bono, MD, director of the Defense Health Agency, acknowledged that there are currently limitations on this kind of data sharing.

“Principal among these limitations is that due to operational security concerns, military treatment facility (MTF) pharmacies cannot currently share opioid prescribing information from MTFs with state PDMPs,” testified Bono. “Additionally, a military provider has no visibility of an opioid prescription obtained through a cash transaction at a civilian pharmacy.”

According to Bono, those kinds of transactions are captured by state PDMPs but not DoD’s Pharmacy Data Transaction Service (PDTS), which enables military providers to view opioid prescriptions obtained at a civilian pharmacy or through the mail order program and billed through TRICARE.

However, Bono assured the subcommittee that DoD is working to enhance its ability to share data on its beneficiaries with state PDMPs. In particular, she testified that the agency has partnered with Express Scripts Inc. (ESI), DoD’s pharmacy benefits manager, to develop and utilize such an electronic database for TRICARE. Bono noted that 63 percent of DoD beneficiaries receive opioid prescriptions from civilian pharmacies.

“We’ve been working with ESI to establish a Prescription Drug Monitoring Program that will connect with the states,” said Bono. “This provides a key tool in the opioid fight as it will allow DoD providers to access state PDMPs as well as allow civilian providers to access the DoD PDMP.”

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She added that the enhanced DoD PDMP will interface with state PDMPs through a portal that will be single-use and enable anonymous access. According to Bono, this new capability is slated to be available by December, at which point the agency will be able to link with state PDMPs.

“Although prescriptions filled for DoD beneficiaries through the mail (order) or retail (pharmacy) venues are readily reported to the states, the establishment of the DoD PDMP will provide a full controlled substance profile for all providers and pharmacists,” Bono concluded. “Our DoD PDMP solution will operate through a commercially available portal and hub technology that not only allows us to bi-directionally share DoD controlled substance information with states but addresses operational security concerns.”

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