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Prescription Drug Monitoring Programs (PDMP)

Nearly all states have enacted laws to establish PDMPs, electronic databases to collect data on controlled substances dispensed or prescribed within their jurisdictions. However, the absence of business rules governing or allowing sharing of information from state to state and across pharmacies, lack of interoperability among the operational PDMPs, and variation in the timeliness of data reporting make it difficult for states and law enforcement to prevent misuse, abuse and fraud.

In March 2013, NCPDP published a white paper (NCPDP Recommendations for Improving Prescription Drug Monitoring Programs) detailing a plan to help nationally standardize PDMPs to better track and deter abuse of controlled substance prescriptions. The plan leverages NCPDP’s Telecommunication Standard in use industry wide and best practices to improve prescriber and pharmacy clinical decision making at point-of-care, and support real-time access to PDMP data across state lines. It integrates the prescription monitoring process into workflows and provides timely clinical data to prescribers and pharmacists, which also helps ensure access for patients with a valid medical need for controlled substances. Read more

State PMP Tracking Document

All states, except Missouri, currently have a prescription monitoring program (PMP). In the absence of a national program, NCPDP Work Group 9 Government Programs created and maintains a document, which provides information on all state PMPs. Information includes the PMP name, schedules monitored, format, batch/on-line, submission methods, reporting frequency, processor, overseeing agency and contact information. This State PMP Tracking Document is updated quarterly.

Implementation Timeline Discussions

Electronic Prior Authorization Transactions: The NCPDP prior authorization transactions are part of an approved, published standard – the NCPDP SCRIPT Standard. The industry has requested the adoption of the NCPDP SCRIPT Standard version 2013101 prior authorization transactions under the appropriate regulatory requirements. Per OESS in August 2014, a notice of proposed rulemaking (NPRM) is going through the approval process, with an expected publication of early 2015. WG11 Prior Authorization Workflow to Transactions Task Group provided a recommended implementation timeframe for the regulation to OESS. See the WG11 November 2014 documentation for the recommendation letter.

Telecommunication Quantity Prescribed (460-ET): Per OESS in August 2014, a notice of proposed rulemaking (NPRM) is going through the approval process, with an expected publication of early 2015. (This is the same NPRM as for the ePA transactions above.) WG1 Telecommunication FAQ Task Group and the NCPDP SNIP Committee provided a recommended implementation timeframe for the regulation to OESS. See the WG1 November 2014 documentation for the recommendation letter.

SCRIPT Standard Next Version: During the August 2014 Work Group meetings, the WG11 Co-Chairs led discussion on the industry preparing to move to a next version of SCRIPT Standard. See the WG11 or WG14 work group pages August documentation, or the meeting minutes on the MC page. During August Work Group meetings, the first two documents were discussed briefly. The attendees discussed a cyclical timeframe period. To assist discussion, the focus was switched to discussing when the next version of SCRIPT Standard would be implemented. The three documents:

  • Changes since SCRIPT 10.6
  • Timeframe Considerations
  • New Standard Process

The attendees modified the dates during discussion, and approved starting the regulatory process in February 2016. Please review the documents in the November WG11 zip file, as there will be continued discussion during November WG11.

Telecom, Batch, Medicaid Subrogation Standards Next Version: During the November 2014 Work Group meetings, WG1 will begin discussing the industry preparing to move to a next version of these standards. See the meeting minutes after the meetings. It is expected discussion will continue. Read less