The Fox is in the PMP Henhouse

By Doug Brockway

January 21, 2015

Before we get into the meat of this post suffice it to say that as a group of individuals there is absolutely no indication that doctors or pharmacists are less honest and upright than the average person.  In fact, someone who takes on those jobs, with the tasks, cases and experiences that are involved, and the work and sacrifice needed to succeed and thrive, is likely, on average, to be more honorable than most.

Still and all it takes almost no effort to do a search regarding health care fraud and find many, many cases of doctors and pharmacists engaged in all manner of unethical, fraudulent and illegal activities.  There are bad apples, what the Boston DEA’s SAC Ferguson has called “rogue” doctors and pharmacists.  When it comes to stopping doctor shopping and thus much opiate abuse the preferred systems technology, PMPs, put these rogue providers, these foxes in the henhouse.

We have previously made the case that PMPs are inadequate to the task of preventing opiate abuse. A key reason is that the only people examining a patient’s history of drug use in the PMP are doctors and pharmacists. PMPs are populated by having pharmacists enter into a data base all opiate prescriptions, all Schedule II and III drugs, that they fill.  They enter data identifying the patient, the doctor who wrote the prescription, the nature of the prescription (how many units of what drug), and the pharmacist filling the prescription. Requirements vary but in most states pharmacists have one week to submit the data after providing the drugs to the patient.

The rules and usage vary by state but doctors and pharmacists then inquire this data base prior to writing or filling a prescription for someone with existing, open, conflicting prescriptions or showing a pattern of over consuming opiates. When the provider is, per usual honest, the PMP can be effective. But it is known that the minority of doctors writes the broad majority of illegal prescriptions. PMPs can only work in these cases if “rogue” doctors and/or “rogue” pharmacists turn themselves in.

This is a major fault. With PMPs as they are, the largest sources of fraudulent prescriptions are created and then filled by the one minority that has a vested interest in the fraud[1].  Until this “loophole” is closed there will be foxes in the opiate abuse henhouse.

---

[1] Fortunately, there are methods to do the checking for the provider not by the provider