by Krista R. Crockett, Executive Director, Texas Pain Society
Physicians in Texas now have online access to the Texas Prescription Program (TPP). This program gives physicians the real-time ability to query the prescription database and find out which controlled substances their patients have been prescribed by other practitioners. Texas physicians can register and begin using the database by visiting www.texaspatx.com
"The importance of this new program cannot be overstated with respect to the protections it offers practitioners from Texas Medical Board complaints based upon the prescription of controlled substances to patients who are already receiving those drugs from other providers," says Austin attorney Dan Ballard.
Access to TPP information is statutorily restricted, and is available to practitioners and pharmacists who are inquiring about their patients, and to various regulatory and law enforcement personnel.
Monitoring of controlled substance prescriptions is not new to Texas. The Texas Legislature created the TPP in 1982 to monitor Schedule II controlled substance prescriptions. The TPP program has since been expanded to including monitoring of Schedule III through Schedule V controlled substance prescriptions.
Federal authorities monitor the substances from manufacture through distribution to retail facilities; however, most pharmaceutical drug diversion occurs at the retail/consumer level. The TPP seeks to control misuse by following controlled substances to the point of ultimate use.
The need for a prescription monitoring program has increased dramatically in recent years due to what is being dubbed "generation Rx." According to the Drug Enforcement Administration, nearly 1 in 10 high school seniors admits to abusing powerful prescription painkillers. A shocking 40 percent of teens and an almost equal number of their parents think abusing prescription painkillers is safer than abusing "street" drugs. Prescription pain relievers are new drug users' drug of choice, as opposed to marijuana or cocaine. (1)
Until recently, practitioners and pharmacists who wished to access TPP information had to complete a form on the DPS website (http://www.txdps.state.tx.us/InternetForms/Forms/TP-11.pdf) and send it via fax or mail. The DPS then verified the request, pulled the data, and returned the information via mail.
In 2009, legislation was passed to strengthen the TPP, including the creation of a secure web site "to allow practitioners and other authorized users easy and quick access to the data in the prescription monitoring system so that:
- prescribers and pharmacies can make better decisions when prescribing and dispensing controlled substances; and
- regulatory agencies and law enforcement can identify licensees and individuals who are attempting to prescribe, dispense, or obtain controlled substances for illegal use."
The improvements also included:
"(B) To make the data more useful and up to date, pharmacies should be required to submit prescription data to the program at least every seven days rather than the current requirement to submit no more than the 15th day after the end of the month in which the prescription was dispensed or up to 45-days after the prescription was dispensed so that the data is more up to date and useful to all who access the system.
(C) The Texas PMP should adopt those requirements in the National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER) that will allow the Texas PMP to share data with other states that operate a prescription monitoring program.
(D) The portion of the Texas Controlled Substances Act that deals with the PMP should be amended based on certain agreed upon provisions of the Prescription Monitoring Program Model Act developed by the Alliance of States with Prescription Monitoring Programs.
(E) The current requirement for a practitioner's DPS and DEA controlled substance registration numbers to be on all prescriptions for controlled substances in Texas should be modified to require only the DEA controlled substance registration number.
(F) All licensing boards for health care professionals allowed to prescribe controlled substances should be allowed to access to data collected by the PMP."
Physicians will now have easier access to the monitoring program through the Prescription Access in Texas II (PAT II) web site, https://www.texaspatx.com/Login.aspx. The TPP receives between 40 and 45 million records per year, and potentially more than 150,000 users will query the system. Due to the number of users and the volume of information, and to ensure security and software compliance, PAT II is being rolled out in stages. At the time of publication, the anticipated rollout schedule for the online PAT II program is as follows:
- June 30 — existing pilot users (doctors and pharmacists) and existing vetted law enforcement users.
- July 31 — medical board investigators and physicians.
- July 31 — nursing board investigators, new law enforcement, and mid-level practitioners.
- Aug. 15 — pharmacy board investigators and pharmacists.
- Aug. 31 — board investigators for podiatry, dental and veterinary; and podiatrists, dentists and veterinarians; out-of-state practitioners.
All registrants who would like to use PAT II will need to have a current medical license, a current DPS number, and a current DEA number. The PAT II site features tutorials and FAQs that explain how the program works.
RISK MANAGEMENT CONSIDERATIONS
By Dan Ballard, JD
As the PAT II web site is now available, physicians and practices should consider how to best manage their access. Once registered, providers may not share their log-in information with anyone. According to the PAT II web site, the Texas Health and Safety Code, Chapter 481 does not allow delegation of authority to access the PAT II web site. This means that practitioners may not delegate a staff member to research the data on their behalf.
Consequently, there is an additional prohibition on access to non-patient records. Physicians and practices may consider developing written policies that clarify:
- Prohibitions on sharing log-in information; access to the data is not delegable.
- Rules regarding access; persons accessing the database should access only their own patients. Accessing other information is prohibited and would constitute a HIPAA violation.
In the last several years, state licensing boards in Texas have conducted a number of investigations against providers based in part upon the provider prescribing controlled substances to a patient while that patient was obtaining similar prescriptions from other providers.
Providers should be aware that licensing boards will very likely begin expecting physicians to query the new database on any patient who is suspected of doctor shopping to obtain controlled substances. In the past, the defense against these kinds of allegations has been " But how would I know my patient is already getting drugs from another physician?" With the new database in place, this defense will be difficult to assert.
Many physicians have asked "Can't I just trust what my patient tells me and take their word at face value?" The answer given by state licensing boards is "No, absolutely not." Providers should take reasonable measures to detect fraud and abuse when it comes to prescribing controlled substances. Using this new database will be viewed as one of those reasonable measures.
One practice tip that should be considered — after you ask the patient if he or she is receiving controlled substances from another physician, tell the patient that you are going to query the prescription database to "assure that nothing gets missed." Letting the patient know this in advance gives them the opportunity to tell the truth and will help you maintain good rapport with the patient.
If the patient expresses dissatisfaction at being "policed" by the physician, it may be helpful to offer the explanation that "This is just part of the new process we need to go through in prescribing controlled substances."
While there is a recently enacted law that makes it a felony for a patient to falsely deny that they have a prescription for a controlled substance issued for the same time period by another practitioner, there is currently no law requiring the physician to take the further step of turning that patient in to law enforcement authorities.
Currently, one prescribing practice receiving attention in Texas is writing for the "unholy trinity" of hydrocodone, lorazepam, and carisoprodol. If the patient is obtaining one or two components of this cocktail from another physician, and you then prescribe the third component, then you may unwittingly participate in a very undesirable prescribing practice. Querying the new database may prevent this from occurring and may protect you from licensing board scrutiny on this issue.
Practitioners should also be aware that they may access the database to inquire about their own prescribing activity regarding controlled substances (not just for a specific patient). One instance in which this could be useful is if a physician suspects that controlled substance prescriptions are being written or called in fraudulently under the physician's name.
Using the new online database will help protect your patients, the public, and you from the many problems associated with prescribing controlled substances. Properly used, this new database can be a powerful tool in protecting everyone from the hazards of prescription drug diversion.
- Drug Enforcement Administration. State prescription drug monitoring programs. October 2011. Available at http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm#4. Accessed July 19, 2012.