Audit report raises concerns with effectiveness of prescription drug registry
An audit of the state’s prescription drug registry found several issues that hinder the system, making it not as useful as it could be in identifying misuse and abuse of prescribed medications.
Auditors found indications of doctor and pharmacy shopping, including one person who filled nine prescriptions in a 30-day window at four different pharmacies.
They also found more than 1,000 likely incorrect birth dates for people in the system, and prescribers writing prescriptions without licenses, though representatives with the state Board of Pharmacy said auditors didn’t take into account everything that could have led to their findings.
The Montana Prescription Drug Registry went into effect in 2012. It is administered by the Board of Pharmacy, which is under the Montana Department of Labor and Industry. The cost for the registry over the last seven years has been about $1.8 million, and it’s now primarily funded by fees paid by prescribers and pharmacists.
The registry tracks medications that are prescribed and dispensed within the state or to Montana residents. It had been voluntary until the most recent state Legislature passed a bill to require every person who is licensed to prescribe or dispense prescription drugs to register. That takes effect this fall. Previously, the registry had been used by about 54% of those who were eligible.
The registry is mainly used by medical providers and pharmacists to search a patient’s medical history to learn about their past and current prescriptions. It has a secondary use by law enforcement officers, who obtain subpoenas.
The registry could also be used to flag people who are shopping around for multiple doctors and pharmacies in order to obtain and potentially misuse or divert medications.
Auditors, however, found the Board of Pharmacy does not review or analyze the data in the registry to find those potential abuses. State law allows for that type of proactive use, but does not require it.
The system instead relies on doctors and pharmacists to “make their own conclusions” about a patient’s records, according to the audit.
Auditors tended to qualify their findings in the report by saying that other problems within the registry — such as a lack of oversight or review of the accuracy of information put into the system — could skew outcomes.
Still, they raised concerns about records showing 4,410 patients who went to four or more pharmacies or prescribers in a 30-day window, and 8,814 who did the same in a 60-day period. That type of behavior could indicate doctor or pharmacy shopping to misuse or abuse prescription drugs.
In one example, a patient got nine prescriptions for high-strength opioids from four doctors in a 30-day window, and filled the prescriptions at four different pharmacies in Kalispell, Helena, Spokane and Whitefish. In a single day, the person had two prescriptions written for OxyContin from two different doctors.
In another case, a person got 11 prescriptions from nine prescribers in a 30-day stretch and filled them at five pharmacies.
Auditors also found concerns with missing and nonsensical data, as well as inconsistencies in data reporting. The department disputed some of how auditors interpret their findings.
In some cases, the auditors found more than 1,000 dates of birth for patients in the registry that were “unreasonable.” Four records had dates listed in the future, 231 had invalid dates like 01/01/0001, 50 had birthdays before 1900 and the rest had dates before 1912, which the auditors found unlikely to be accurate.
Marcie Bough, executive officer of the Board of Pharmacy, told lawmakers on the Legislative Audit Committee that met Tuesday not all those incorrect dates represent something wrong. Pharmacists, Bough said, would use nonsensical birth dates for things like animal prescriptions, which can be distributed from regular pharmacies.
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