2017 Pharmacy Update Tennessee Controlled Substance ... · Adds a professional duty to check the database before prescribing to someone ... Indian Nations 07 ... receive emails from

2017 Pharmacy UpdateFebruary – April, 2017

Tennessee Controlled Substance Monitoring Database

D. Todd Bess, PharmD 1

Tennessee Controlled Substances Monitoring Database Program as a Tool to Improve Patient Care and Fight the Drug Epidemic

D.ToddBess,Pharm.D.DirectorTennesseeControlledSubstanceMonitoringDatabase

April 12, 2018

• I have no financial relationships to disclose.

• I will not discuss off label use and/or investigational use in my presentation.

DisclosureInformation

• Appriss will probably move the CSMD to a new platform in the near future.

• In order for you to move with it, you MUST have and keep active email address in CSMD that is unique and only you have access.

• If you are required by law to have access to CSMD and do not keep an active email in “My Account” of current platform, you will have an issue with access to the CSMD once the transition occurs.

• Please remember to revoke any Supervisory Relationships that are no longer active.

CSMDNewsFlash!




NewFeatureonPatientReport

• Language on patient report to remind users on how this patient was identified and has a padlock icon associated with a name on the report. ▫ The patient with the lock indicator before the name has the same first

name, last name and date of birth of a person that has been reported to the CSMD by TennCare, and has been locked into a single pharmacy (TennCare will only provide coverage for this patient at their assigned pharmacy). Please assess if your patient is an active TennCare Enrollee that is locked into one pharmacy, and if so please refer this patient's pharmacy care to their assigned pharmacy.

ComingSoon:NewFeatureonPatientReport

2017MembersoftheCSMDCommittee

Member Name Board

Melanie Blake, M.D. Board of Medical Examiners

Katherine N Halls, DDS Board of Dentistry

Brent Earwood, APN, CRNA Board of Nursing

Brad Lindsay Board of Optometry

Shant Garabedian, DO Board of Osteopathy

Mike Dickerson, D.Ph. Board of Pharmacy

Sheila Schuler, DPM Board of Podiatry

Stephen Ladd, DVM Board of Veterinary Medical Examiners

Omar Nava, PA‐C Committee on Physician Assistants

Robert Ellis Public Member Board of Medical Examiners

Lisa Tittle Public Member Board or Pharmacy




DoallHealthcareProvidershavetoRegister?

“If you provide direct care and prescribe controlled substances to patients in Tennessee for more than 15 days per year or you are a dispenser in practice providing direct care to patients in Tennessee for more than 15 days per year, you are required to

register with the CSMD.”

• CSMD FAQ on website has been updated

• https://www.tn.gov/health/health‐program‐areas/health‐professional‐boards/csmd‐board/csmd‐board/faq.html

• Requirements for Prescribers and dispensers are now similar

▫ Adds a professional duty to check the database before prescribing to someone exhibiting drug seeking behavior for any controlled substance

▫ Adds requirement for dispensers to check patients with prescriptions for opioids and benzodiazepines similar to prescribers

• Add CRNAs as providers that can have access

• Effective upon the Governor’s signature on April 27, 2016

PrescriptionSafetyAct2016(PublicChapter1002)

WhyisitimportanttochecktheControlledSubstanceMonitoringDatabase?

Despite the rise in opioid abuse, during the fall of 2015, a single patient was able to procure 89 prescriptions in a 90 day period by visiting a large number of dentists throughout the state of Tennessee.

*Additional information* No single prescription would

have hit the mandatory check requirement

Patient used multiple pharmacies

Prescribing history may show specific trends in prescriptions filled

Prevention of potential overdose

Pharmacist intervention as another mode of

defense

Doctor Shopping could have

been avoided




• Patient Report

• Prescriber Analytics for the CSMD

• Reports and Survey

OutlineforDataAnalyticsRelatedtoTNControlledSubstanceMonitoringDatabase(CSMD)

CSMD Data Analytics

PATIENTREPORT

ConsiderationswithuseoftheTennesseeCSMD




PatientRequestPage:OptionalQuestionAddedforUserstoIndicateSuspectedOverdoseorPoisoning

Training User

“None” of these Patients

ClinicalRiskIndicators(highriskpatients)onCSMDReports

Y = 4 Practitioners in last 90 days

Y= 4 Pharmacies in last 90 days

Y ≥ 90 but < 120 Active Cumulative Morphine Equivalents per day

R≥ 5 Practitioners in last 90 days

R ≥ 5 Pharmacies in last 90 days

R≥ 120 Active Cumulative Morphine Equivalents per day




ClinicalRiskIndicators(highriskpatients)onCSMDReports

Female and child bearing age (15‐45 years of age)

“Please remember that narcotic prescriptions for women of child bearing age could result in Neonatal Abstinence Syndrome (NAS) should pregnancy occur; please discuss with your patient methods to prevent unintended pregnancy.”

PaymentType IdentifyingNumber

PrivatePay 01

Medicaid 02

Medicare 03

CommercialIns. 04

MilitaryInst.andVA 05

WorkersComp 06

IndianNations 07

Other 99

ConsiderationsWhenReadingCSMDReport




PROPOSEDGatewayStatePMPClinicalRiskIndicators

PROPRIETARY AND CONFIDENTIAL

This example provided to TN CSMD by Appriss for educational purposes.

Remove a Linked Patient from a Gateway Report

You have the ability to remove linked patients

in the Patient Information section.

Linked Records are any patient records that were linked to make up this Patient Report. To the far right is an interactive column labeled Mark X to Remove.

Each record in this list can be clicked and selected for removal from this Patient’s report.

(The ability to remove records within PMP

Gateway will be available in Q3/Q4 of 2017.)

Sample Gateway Report integrated into an EMR System



RemoveLinkedPatientswithinGatewayReport

Remove a Linked Patient from a Gateway Report(continued)

To remove one or more linked record from a

patient report:

1. Mark the patient(s) to be removed from the patient report by clicking Remove. A red “X” will appear marking the record for removal. To unmark it, click remove again. When you mark the first patient for removal, two action buttons will automatically appear. TIP: Mark all patients you want removed from the report before you click Remove X Marked.

2. Click the Remove X Marked button to process the marked record(s) and re-run the report.

Sample Gateway Report integrated into an EMR System







View Refreshed Gateway Patient Report

The refreshed report will automatically display

excluding the patients that were removed,

including all associated prescription history

information.

• Sample Gateway Report integrated into an EMR System




CSMD Data Analytics

PRESCRIBERRELATEDACCESSTOREPORTS

PractitionerSelfLookup




PractitionerSelfLookupwithOptiontoIncludeAPRN/PA

PrescriberDashboardinCSMD(CSMDproductiondate8/6/2017)

• Available in the past

• Turned off due to alert fatigue

• Recently reengineered to avoid alert fatigue

• Order of Notifications▫ Correlates to indicators on patient reports with slight variation as no symbols on dashboard

but if you click view all notifications the symbols will appear

– Multiple Practitioners ≥ 5

– Multiple Dispensers ≥ 5

– Multiple Practitioners = 4

– Multiple Dispensers = 4

– MME ≥ 120

– MME ≥ 90 <120

CSMDUserDashboard(ClinicalRiskNotifications)a

PrescribersreceiveemailsfromCSMDeachweekiftheyhavenewnotifications




Welcomes Test Test

CSMDUserDashboard(ClinicalRiskNotifications)

• 60% of respondents received a Clinical Risk Notification

▫ 71% felt the information was useful

• How did the information increase awareness (could choose more than one response)

▫ 89% more aware of patients going to multiple prescriber

▫ 57% more aware of patients going to multiple dispensers

▫ 66% more aware of patients receiving highest dose of opioids

ClinicalRiskNotificationsonHomePageinCSMD

Practitionervs.PeerReport




ProposedCSMDPrescriberReport

Multiple provider and dispenser thresholds exceeded

Requests for You / Your Delegates

CSMD Data Analytics

REPORTSANDSURVEYS

• In 2016, approximately 94% of overall Controlled Substances Prescriptions in TN were dispensed by licensed pharmacies and reported to the TN CSMD.

• Special thanks to pharmacy practice, human prescriber dispensers, and veterinarian prescriber dispensers across Tennessee for helping build a powerful tool that allows Tennessee to better fight the Prescription Drug Crisis!

PrescriptionsintheTNCSMD




*VA registrants were included in 2013 ‐ 2017.

NumberofRegistrantsoftheCSMD,2010‐2017*

13,18215,323

22,192

34,802

38,87142,835

46,576

47,294

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2010 2011 2012 2013 2014 2015 2016 2017

Nu

mbe

r of

Reg

istr

ants

Year

RatioofNumberofPrescriptionstoNumberofRequestintheCSMD,2010‐2017*

Prescribers

Strongly Agree Somewhat Agree Neutral/No Opinion

Somewhat Disagree Strongly Disagree

30%

35%

25%

4% 6%

Prescribers

51%

28%

19%

1% 1%

Dispensers

AfterviewinginformationfoundintheCSMD,Ichangedthetreatmentplanforapatient

AfterviewinginformationfoundintheCSMD,Irefusedtofillaprescriptionaswritten

Source: 2017 CSMD Prescriber and Dispenser Survey

~ 65% of Prescribers have changed their treatment plan

~ 79% of Dispensers are less likely to fill a prescription as written




NumberofPrescriptionsReportedtoTNCSMD,2010‐2017*

NumberofPrescriptionsReportedtotheTNCSMDbyClassofControlledSubstances,2010‐2017*

NumberofStimulantPrescriptionsDispensedAmongTNPatientsandReportedtotheCSMD,2010‐2017*




NumberofBenzodiazepinePrescriptionsDispensedAmongTNPatientsbyAgeGroupandReportedtotheCSMD,2010‐

2017*

MMEforLongActingOpioidsReportedtotheCSMD,2010‐2017*

MME for Long Acting Opioids Reported to the CSMD, 2010‐2017*

Year Overall patients in CSMD

TN patients Change among TN patients (%)

2010 3,186,575,097 3,053,655,395 ‐

2011 3,250,846,435 3,117,382,279 2.1

2012 3,281,165,787 3,144,485,150 0.9

2013 3,234,719,734 3,102,687,379 ‐1.3

2014 2,921,833,043 2,803,168,526 ‐9.7

2015 2,549,901,625 2,451,782,440 ‐12.5

2016 2,122,567,448 2,043,554,990 ‐16.7

2017 1,626,479,677 1,565,314,892 ‐23.4

* 1) The classes of controlled substances were defined based on a CDC document; 2) Excluding prescriptions reported from VA pharmacies; 3) Excluding buprenorphine products.

MMEforShortActingOpioidsReportedtotheCSMD,2010‐2017*

MME for Short Acting Opioids Reported to the CSMD, 2010‐2017*

Year Overall patients in CSMD

TN Patients Change among TN Patients (%)

2010 5,037,050,762 4,862,233,311 ‐

2011 5,725,823,620 5,467,276,130 12.4

2012 5,888,549,934 5,642,626,206 3.2

2013 5,673,351,755 5,456,618,080 ‐3.3

2014 5,493,079,304 5,281,031,358 ‐3.2

2015 5,368,706,323 5,165,968,521 ‐2.2

2016 5,043,745,375 4,860,744,219 ‐5.9

2017 4,582,128,792 4,425,089,600 ‐9.0

* 1) The classes of controlled substances were defined based on a CDC document; 2) Excluding prescriptions reported from VA pharmacies; 3) Excluding buprenorphine products.




ChangeinMMEDispensedAmongTNPatients,2011‐2017*

76%

5/5/90

Thenumberofpotentialdoctor/pharmacyshoppersdeclined76%between2011and2017




Conclusion

• Tennessee Controlled Substances Monitoring Database (CSMD) is a powerful tool to help protect your patients and your community

• Clinicians value and respond to their assessment of TN CSMD Patient Reports

• Major improvements of the CSMD Program are coming soon!

• Pharmacist and Pharmacies in your area can increase access to Life Saving Naloxone so discuss the new Collaborative Practice Agreement with THD Chief Medical Officer with your team to serve your patients and community!

Documents

2017 Pharmacy Update Tennessee Controlled Substance ... · Adds a professional duty to check the database before prescribing to someone ... Indian Nations 07 ... receive emails from