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Insurers Should Use Prescription Monitoring Databases to Reduce Overdoses: Report


Health insurers should use state prescription monitoring databases to reduce overdoses from abuse of opioids and other prescription drugs, according to a new report.

Sharing data between prescription monitoring databases and insurers would allow the companies to better detect inappropriate prescribing and dispensing, according to the report by the Prescription Drug Monitoring Program (PDMP) Center of Excellence at Brandeis University.

Most health insurance programs, including Medicare, Medicaid and workers’ compensation programs, only see data about prescriptions for which their particular plans have paid, MedicalXpress reports. PDMPs provide a patient’s complete outpatient prescription history for controlled substances. Allowing insurers to see all of their enrollees’ activity, including prescriptions paid for by other insurers, would allow them to spot patients who are “doctor shopping,” or who are acting in collusion with a street dealer, the report noted.

“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 Prescription Drug Monitoring Program Center of Excellence, said in a news release.

“Opioid abuse is the most urgent issue in workers’ compensation,” said Bruce Wood, Director of Workers’ Compensation with the American Insurance Association. “Giving workers’ compensation payers access to PDMP information would permit them to see if an injured worker is getting opioids from multiple sources.”

The report is the result of a meeting of more than 75 medical insurers, federal agency leaders and state PDMP administrators. It was discussed this week at the National Rx Drug Abuse Summit in Atlanta.

1 Response to this article

  1. Bob Garrity / April 23, 2014 at 2:03 pm

    Ohio Senator Sherrod Brown introduced the Stop Trafficking of Pills (STOP) Act to eliminate the Medicaid fraud that helps to finance prescription drug abuse back in 2011.

    The bill would require states to establish and implement a restricted recipient, or Lock-In program for high-risk prescription drug users. States would identify those individuals who would be considered high-risk users – for example, those who are receiving an excessive amount of prescription drugs or those who have been convicted of a drug-related offense – and identify prescription drugs that are dispensed under Medicaid that present a high risk of overutilization.

    Unfortunately, insurance companies may be a harder nut to crack. Though they might interfere with what an MD can prescribe (usually limiting to lower cost drugs/therapies), they really don’t believe that opioids are causing that much of a problem. It is simply a fight they don’t seem invested in fighting.

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