Electronic Prescription Monitoring

Led by the Texas Department of Public Safety (DPS) and law enforcement concerns about the escalating illegal use of prescriptions for narcotics and other controlled substances, Texas established an electronic prescription monitoring system. In doing so, it requires the monitoring of 4.5 million Schedule II prescriptions and up to 50 million prescriptions for Schedules II through V.

Implementation by DPS has been problematic. The department lacks a clear plan to acquire a state-of-the-art system. Instead, it chose to use its current and now-antiquated system for monitoring Schedule II prescriptions.

In addition, DPS has imposed burdensome requirements on both physicians and pharmacists. Physicians now must obtain a DPS number and write it on each controlled substance prescription, along with the patient's age or date of birth. Pharmacists must adapt their proprietary data management and claims systems to collect DPS numbers and must verify that all other required data are complete before filling a prescription.

Medicine's 2009 Agenda

  • Support measures to transfer the database and necessary appropriations to the Texas Board of Pharmacy (TBP). TBP can acquire a robust and scalable system that collects the necessary data electronically without imposing undue compliance costs on pharmacies. DPS and law enforcement would have access to the data.
  • Remove the DPS number requirement from each controlled substance prescription. Pharmacists may still collect the numbers in their systems, as necessary.
  • Eliminate the "special prescription program" for Schedule II. With electronic monitoring, it becomes redundant and, thus, unnecessary.

Medicine's Message

  • TMA supports an efficient and effective electronic prescription monitoring system for all controlled substances. The system should be automated to minimize compliance issues for both pharmacists and physicians.
  • Requiring physicians to write their DPS number on each controlled-substance prescription not only is burdensome for physicians but also poses a security risk by disclosing physicians' identifiers, which could increase the potential for diversion.
  • Physicians believe an electronic prescription monitoring system should be robust, meet the needs of law enforcement and licensure boards, enhance patient care, and protect patient privacy. Any system must provide access to a near time (or real time) medication database for the purpose of patient medication "audits" for routine and emergency care. This would allow physicians to identify "drug-seeking" patients who may be seeking controlled substances for abuse or illegal resale. It also would allow physicians to monitor their own prescribing patterns and identify potential unauthorized use.