In response to the opioid crisis, lawmakers and regulators in Massachusetts have increased their focus on monitoring the prescription of legal painkillers by doctors and the dispensation of these drugs by pharmacies.
This heightened scrutiny of opioid prescriptions has resulted in changes to the Massachusetts Prescription Monitoring Program online database (PMP). Since 2014, Department of Public Health (DPH) regulations have required all Massachusetts prescribers to check a patient’s prescription history in the state’s online prescription databases before prescribing certain medications, such as narcotics and benzodiazepines, for the first time. The Massachusetts Medical Society’s Opioid Prescribing Guidelines, adopted by the Board of Registration in Medicine, further recommend that prescribers query the database periodically (every 60 to 90 days) for chronic pain patients receiving opioids as treatment.
Effective October 15, 2016, however, as part of the comprehensive opioid legislation signed into law in March 2016, prescribers will be required to:
- query the database every time a Schedule II or III narcotic medication, such as oxycodone, is prescribed; and
- check before writing first-time prescriptions of benzodiazepines and any drug in Schedule IV or V that DPH has designated as commonly abused.
In addition, the state recently spent $6 million to revamp the PMP, now called the Massachusetts Prescription Awareness Tool or MassPAT, which “went live” on August 22, 2016. At that time, about 70% of physicians licensed to prescribe in the state had enrolled. MassPAT is designed to be easier for physicians to use and to integrate with electronic medical records systems, and will include information from up to 45 other states.
Public Health Commissioner Monica Bharel recently stated that it was “too early to say” if MassPAT will be used to help law enforcement agencies target physicians who are dispensing medication improperly. However, law enforcement use of the database seems highly likely given that, historically, data from the PMP has been analyzed by the state’s Drug Control Program both to identify prescribing trends and to provide case information to regulatory and law enforcement agencies concerning drug distribution and diversion. In addition, Massachusetts has allowed PMP access to investigative unit officers from local, state, and federal agencies.
Massachusetts regulators have signaled they will take adherence to prescription database regulations seriously. On September 2, 2016, the Massachusetts Attorney General’s Office announced a “first-in-the-nation settlement” with CVS Pharmacy, Inc., the largest pharmacy chain in Massachusetts, resolving allegations that it failed to provide pharmacists with access to the PMP prior to March 2013. The settlement required CVS to:
- pay $795,000 to the state;
- agree to strengthen its policies and procedures surrounding the dispensing of opioids; and
- require its Massachusetts pharmacy staff to check the prescription database before filling prescriptions for commonly misused and diverted opioids. CVS had previously failed to provide sufficient internet connectivity to access the online program.
The AG’s office stated it would “continue to work with other [non-CVS] pharmacies on these issues.” Given the continued emphasis on the opioid crisis, prescribers and pharmacies can expect close scrutiny regarding compliance with the new requirements regarding MassPAT, and should be sure to sign up for the new system and familiarize themselves with the regulations.