President Trump’s proposed FY19 budget for the U.S. Department of Health and Human Services stresses the need for the agency to make the opioid crisis a top priority.

While HHS’ budget would be slashed by 21 percent, Trump would give the agency $10 billion in new discretionary funding for both the opioid epidemic and mental illness. To accomplish this, HHS wants to track high prescribers and utilizers of prescription drugs within Medicaid.

HHS Secretary Alex Azar told the House Energy and Commerce Subcommittee on Health that the agency would “require states to monitor high-risk billing activity to

identify and remediate abnormal prescribing and utilization patterns that may indicate abuse in the Medicaid system.”

HHS could leverage data from the Centers for Medicare and Medicaid Services to help “identify a practitioner who is writing an inordinate number of prescriptions,” Rep. Michael Burgess, MD, R-Texas, told Azar.

And those trends could be easy to spot within those databases.

In addition to leveraging Medicaid data, HHS could potentially look to state PDMP data to identify bad actors, Azar testified. The agency could also use its “authority to make sure that whenever we exclude a provider, it will automatically lead to transmission of that information [to the Drug Enforcement Administration].”

The DEA would have the authority to yank a provider’s ability to prescribe controlled substances, Azar said.

Further, PDMPs are already helping states track opioid prescriptions, as they flag patients with suspicious prescribing history, said Azar. But as part of the HHS budget proposal, the agency asks Congress to “require states have effective programs for this type of risk identification.”

At the moment, all states except Missouri currently have PDMPs in place, with varying degrees of use. After Trump declared the opioid crisis a public health emergency, many states have sought changes to laws to increase PDMP efforts and data sharing among states.

While Azar supports the continued interoperability efforts between state PDMPs, “there is a resource and burden question about forcing that interoperability to be nationwide.” Azar told the committee data sharing between bordering states might be more realistic.

The committee also noted that past PDMP efforts by federal agencies to integrate data within EHRs had slowed five years ago. The effort, Burgess told Azar, is “one of the opportunities to reduce the burden on practicing physicians is a way to seamlessly integrate” EHR and PDMP databases.

However, there are states currently sharing data between PDMPs. Just last week, North Carolina became the 46th state to sign onto the PDMP data sharing collective, which is designed to give providers the full prescribing history of patients across state lines.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

There is an estimated 20 -30 million pts dealing with moderate-severe intractable chronic pain. There is no known records how many of these same pts are or would test (CYP-450) as high/ultra opiate metabolizers and would require higher than “normal doses”.  If HHS/DEA is utilizing databases to come to a “maybe probably cause” and take action on this “maybe”… based on some arbitrary MME dose that anything above is considered abnormal… have they just thrown DUE PROCESS – out the window ?

Wouldn’t we expect many/most of these 20-30 million will be caught in that dragnet along with their prescribers ?

Are we quickly sinking to the point where healthcare and how much a pt is entitled to is being dictated by and driven by DATA that has nothing to do with the evaluation of the needs of individual pts ?