Missouri is the only state without a statewide Prescription Drug Monitoring Program (PDMP), and though opponents cite concerns about privacy and the growth of the national opioid epidemic despite the near-ubiquity of PDMPs, State Auditor Nicole Galloway says she thinks Missouri needs one.

Galloway made the recommendation in her report on state's oversight procedures for prescription drug benefits through Medicaid, the Children's Health Insurance Program (CHIP), and the Missouri Rx (MORx) program, which are administered by the Department of Social Services. The report was released on Dec. 27.

PDMPs collect data from pharmacies dispensing controlled substances and make the information available to authorized users through an electronic database. 

"Each day, more Missouri families feel the effects of opioid addiction, and law enforcement, medical professionals and advocates have been working tirelessly to address the growing problems of opioid misuse and abuse," Auditor Galloway said. "A step in the right direction is ensuring state prescription drug benefit programs have access to available information that could address abuse."

In 2017, then-Governor Greitens declared a State of Emergency in Missouri regarding opioid addiction, and then used executive order to create a PDMP. The state legislature, however, chose not to fund it.

Many Missouri counties and cities already participate in a PDMP created by St. Louis County, but most Lake of the Ozarks area communities have resisted, with residents and elected officials pointing to concerns about who would suddenly be able to access individuals' private medical information.

The St. Louis County PDMP currently includes data from 10 cities and 48 counties in the state. As a result of recommendations in Galloway's report, the Department of Social Services has taken steps to access information from the St. Louis County PDMP to better identify potentially inappropriate use of controlled substances within the Medicaid and CHIP programs.

According to the St. Louis County Public Health Department website, delegated healthcare professionals will have access to PDMP data.

Among delegated healthcare professionals who could access the data: 

-Nurse Practitioner/Clinical Nurse Specialist

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-Midwife with Prescriptive Authority

-Physician Assistant

-Medical Resident

-Pharmacist’s Delegate – Unlicensed Pharmacy Technician

-Pharmacist’s Delegate – Licensed Pharmacy Technician

-Pharmacy Intern

-Prescriber’s Delegate – Licensed Medical Intern

-Dental Hygienist, Nurse

Healthcare professionals who could access the data:

-Physician

-Dentist

-Podiatrist

-Optometrist

Law Enforcement who could access the data:

-ATF

-Corrections

-DEA

-Drug Court

-FBI

-FDA

-HHS

-Homeland Security

-Local Law Enforcement

-Medicaid Fraud Units

-Military Police

-Multi-Jurisdictional Task Force

-OIG

-Parole

-Probation

-State Attorney General

-State Criminal Justice Department

-State Drug Control Agent

-State Police

-State Prosecutor (District or Commonwealth Attorney)

-US Attorney

-VA Investigator

-State Medicaid Program

-Board of Medicine Investigator

-Board of Pharmacy Investigator

-Board of Nursing Investigator

-Board of Podiatry Investigator

-Board of Dentistry Investigator

-Board of Optometry Investigator

The cost of outpatient prescription drugs within Medicaid and CHIP represents 14 percent of all spending. Between 2010 and 2015, the Auditor's office says these costs increased. The Department of Social Services implemented processes, including encouraging use of generic drugs and requiring the usage of lower cost drugs before prescribing higher, in an effort to reduce costs. As the result, prescription drug costs have decreased in 2016 and 2017.

The audit also recommended additional efforts by the Department to ensure federal regulations are followed to gather required prescription drug information from prescribers and prevent payments for unallowable claims. 

The complete audit of the Department of Social Services' Prescription Drug Oversight, which received an overall rating of good, can be found here.       

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