This week, Illinois became one of a growing number of states to require prescribers to check the state Prescription Monitoring Program ("PMP") before prescribing opioids or other Schedule II narcotics to a patient for the first time.
Illinois law (720 ILCS 570/314.5) already made it unlawful for patients to "medication shop" or "pharmacy shop", requiring patients to tell a prescriber or pharmacy if they are getting controlled substances from another prescriber or pharmacy. Senate Bill 772 amended the statute, effective January 1, 2018, imposing several new obligations on prescribers. First, all prescribers who hold an Illinois Controlled Substances license must register with the PMP. See 720 ILCS 570/314.5(c-5). Next, before giving a patient a new prescription for a Schedule II narcotic, such as an opioid, prescribers or their designee must attempt to access the patient's information in the PMP and assess the patient's controlled substance history. Prescriptions for oncology treatment or palliative care, or for a 7-day or less supply provided by a hospital emergency department for an acute, traumatic medical condition, are exempt from the requirement. Prescribers must document the attempt to access the PMP in the patient's medical record. Lastly, in an effort to crack down on "doctor shopping," the law requires that any unsolicited PMP reports issued to a prescriber also be sent to the applicable dispensing pharmacy for review. These reports are triggered when a patient is identified to have three or more prescribers and three or more pharmacies in a 30-day period.
Prescribers can register for access at https://www.ilpmp.org/.
The bill also requires the PMP to be linked to all electronic medical records systems by 2021. That includes integrating pharmacy records with the PMP to allow for faster transmission of dispensing data to the PMP database. Integrating the PMP with electronic medical records will enable prescribers to see PMP information alongside a patient's other health information, rather than requiring the prescriber to check a separate PMP website.
An earlier version of the bill was more stringent and would have required prescribers to check the PMP before prescribing any controlled substance. The Illinois State Medical Society opposed that version of the bill, saying they had concerns about the technological capacity of the state's PMP. But the Society said the law, as enacted, moves the State closer "to the goal of curbing the misuse of prescribed opioids."
Historically, when states were enacting PMP legislation in the early 2000s, prescribers and pharmacists were not required to check the database before prescribing or dispensing. Pharmacies only had to report their dispensing activity after the fact. That is still the law in more than 12 states, according to research by The National Alliance for Model State Drug Laws ("NAMSDL"). But, more and more, states are requiring prescribers to check the PMP before writing certain prescriptions to see how often a patient has been prescribed controlled substances, by how many other prescribers, and over what period of time.
Currently, 37 states have laws requiring prescribers to access the state's PMP before prescribing in certain circumstances, according to NAMSDL's research. At least 28 states have passed laws this year or last year, according to NAMSDL's data. State laws vary, so prescribers and pharmacists should be sure to understand the requirements in the states where they practice. For example, many states only require prescribers to check the PMP before prescribing specific types of drugs, such as opioids or benzodiazepines, while other states require a check before prescribing any controlled substance. Some states require a check only before the first controlled substance prescription is written for a patient, and other states require a check every time certain controlled substances are prescribed. At least 12 states have rules around checking the PMP before prescribing controlled substances for the treatment of pain, and 14 have laws specific to prescribing for the treatment of drug addiction.