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Everybody Hurts: In the Prescription Drug Tracking Derby, Kentucky Wins

Everybody Hurts: In the Prescription Drug Tracking Derby, Kentucky Wins

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The U.S. Centers for Disease Control and Prevention has a set of guidelines for reducing prescription drug deaths.

The first recommendation? States should implement Prescription Drug Monitoring Programs (PDMPs) that look for patients who are trying to feed an addiction and doctors who are prescribing outside the norm. The CDC guidelines state:

CDC recommends that PDMPs focus their resources on patients at highest risk in terms of prescription painkiller dosage, numbers of controlled substance prescriptions, and numbers of prescribers; and prescribers who clearly deviate from accepted medical practice in terms of prescription painkiller dosage, numbers of prescriptions for controlled substances, and proportion of doctor shoppers among their patients. CDC also recommends that PDMPs link to electronic health records systems so that PDMP information is better integrated into health care providers’ day-to-day practices.

The CDC calls out a hopeful fact on its website about PDMPs: “Thirty-six states have operational Prescription Drug Monitoring Programs.”

But only a handful of those states actually use the PDMP to track doctors. Most focus solely on the patients. California’s excuse for doing neither has been a lack of money. The state says it would cost at least $3 million to launch a red-flag monitoring system and $1.6 million every year to run the program.

I wanted to see if there were even ballpark figures for what it would cost to set up and maintain a system that would flag doctors who overprescribe. My sense is that a system like California's CURES is primed for this and that it would just be a matter of doing a little coding work so that a certain number of prescriptions triggered an email to someone in law enforcement, etc. The data are there. The infrastructure is there, but it seems that the connections have not been made. 

I contacted Ruslan Nikitin, a research associate at the PDMP Center of Excellence, part of the Institute for Behavioral Health at Brandeis University and one of the few outfits that studies PDMPs. I asked him about the costs to start and run PDMPs effectively. He pointed me to a 2002 report by the U.S. General Accounting Office.

The numbers are old, of course, so I adjusted them for inflation. The start-up costs range from $64,000 on the low end (Utah) to $526,000 on the high end (Kentucky). So, at the very highest, these states spent only about 18% of what California says it would have to spend.

The operating costs are not in the millions, either. Nevada runs its program for about $142,000 annually, and Kentucky spends $633,000.

Nikitin wrote me, “Naturally, all the costs associated with a PMP are dependent on their primary goals, size of their dataset, using outside vendors/contractors, the number of end-users/requests, number of designated staff, etc.” 

So what about staffing? California has one dedicated person running its program right now. So does Nevada. Kentucky has six, but, again, it isn’t spending $1.6 million annually. It’s spending about $1 million less than what California says it would have to spend.

And what percentage of the budget does Kentucky’s state spending represent compared to California’s projected spending?

Kentucky spent about $9.4 billion out of its general fund in the last fiscal year. So the prescription drug tracking program amounts to 0.0067% of Kentucky’s spending.

If California spent exactly what it says it would cost - $1.6 million – to run the tracking program, it would amount to 0.0011% of state spending.

Still, someone has to pay those bills. I asked some smart people about how that might work, and I’ll tell you what they said in my next post.

Have an idea you’d like to share? Send it my way at or via Twitter @wheisel.

Image by James Wood via Flickr

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