Indiana’s Prescription Monitoring Program

1. Indiana’s Prescription Monitoring Program

2. What is INSPECT? • INSPECT is 1 of 34 operational, state-based Prescription Monitoring Programs (PMPs) in the US. • Housed in the Indiana Professional Licensing Agency. Administered by the Indiana Board of Pharmacy. • Pharmacies must report prescription data to INSPECT within seven (7) days of dispensing a controlled substance to a patient.

3. What INSPECT Doesn’t Track • Pseudoephedrine • Morphine/Methadone (less than 72-hour supply) • Veteran’s Administration facility dispensing • Any substance that is not controlled • Any substance dispensed that is less than a 72-hour supply

4. Why INSPECT is Necessary? • Rate of Rx abuse above national average • Rate of Rx addiction above national average • Rate of arrests for Rx abuse/diversion below national average Over 170% increase in the number of drug induced deaths between 1999 and 2005

5. What is Doctor Shopping? • When a patient seeks to obtain controlled substances from multiple health care providers, often simultaneously, by either: • Withholding material facts regarding their past and/or present controlled substance treatment • Engaging in deceptive practices meant to stymie attempts by their health care providers to better coordinate the provision of care

6. Is Doctor Shopping Illegal? • Although IC 16-42-19 does not use the term “doctor shopping” or “doctor shopping,” it does clearly state that, A person may not do any of the following: • Obtain or attempt to obtain a legend drug or procure or attempt to procure the administration of a legend drug by any of the following: • Fraud, deceit, misrepresentation, or subterfuge. • The concealment of a material fact. •  Communicate information to a physician in an effort unlawfully to procure a legend drug or unlawfully to procure the administration of a legend drug. Such a communication is not considered a privileged communication.

7. INSPECT Menu of Services • Rx History Reports • POI Alert Notifications • Practitioner Self-Lookup Tool • Rx Watch Website

8. INSPECT Service Offering #1 • Rx Patient Reports • Report of all patient controlled substance activities over a given date range. • Available online 24/7 to registered users of the INSPECT WebCenter. • We currently process around 3,000 requests per day to a user base of around 10,000 • The conditions under which eligible users may obtain data from INSPECT are outlined in statute (IC 35-48-7-11.1).

9. Eligibility for WebCenter Access • Licensing Board: Must be engaged in an investigation of a licensee • Attorney General’s Office: Must be engaged in an investigation, adjudication, or a prosecution regarding a violation of state/federal laws concerning controlled substances • Law Enforcement: Must concern an investigation and/or an adjudication involving the unlawful diversion or misuse of controlled substances. • Practitioners: Must be providing medical or pharmaceutical treatment, or evaluating the need for such treatment to the patient in question.

10. Request Rx History Report: Step 1 • On the drop-down menu, click “New Request”

11. Request Rx History Report: Step 2 Enter patient search criteria in the boxes provided Select report format Check certification box Click “Done”

13. Guidelines for All Users • All info via the web – internet required • No info provided without an account • New users must send in a signed/notarized application to complete registration process

14. Guidelines for Practitioners • YOU ALONE are ultimately responsible for the activity that occurs on your account. • Always validate the contents of the Rx Report! • Feel free to share information regarding the contents of a patient’s Rx History Report with mutual providers and law enforcement—but DO NOT send along your hardcopy. Advise mutual providers to obtain their own report.

15. Sharing with Law Enforcement • Practitioners in the audience: “Yikes—that definitely sounds like the sort of thing that could easily get me sued.” • Legislation passed during the 2010 General Assembly adds a provision to IC-35-48-7-11.1 stating, (n) A practitioner who in good faith discloses information based on a report from the INSPECT program to a law enforcement agency is immune from criminal or civil liability. A practitioner that discloses information to a law enforcement agency under this subsection is presumed to have acted in good faith.

16. Guidelines for Law Enforcement • Only obtain Rx History Reports for suspects/probationers who are subjects of active, ongoing investigation and/or adjudications – NO FISHING EXPEDITIONS! • The Rx History Report is NOT the evidence! Think of INSPECT as a sort of intelligence service—a means of streamlining your investigation and reducing the time it takes to collect the actual, hardcopy evidence available at the pharmacy level.

17. INSPECT Service Offering #2 • Person of Interest (POI) Alert Notifications • An unsolicited email notification delivered to practitioners (users and non-users). Two types: • INSPECT-Initiated POI Alert: A patient’s prescriptive activities are found to have exceeded the predetermined dispensing thresholds set forth by the IN Board of Pharmacy • User-Initiated POI Alert: A patient’s prescriptive activities are deemed problematic based on a mutual provider’s review of a patient’s Rx History Report accessed through the INSPECT WebCenter (Note: we plan to make this fully available by Winter 2011).

18. Contents of the INSPECT-initiated POI Alerts • Recipient informed that a patient under their care has exceeded dispensing guidelines set forth by the Board of Pharmacy. • Basic patient ID contained in the email. • Guidance for INSPECT users and non-users: • Users instructed to review the information in the INSPECT system • Non-Users provided with INSPECT registration application materials

19. “User-Led” Unsolicited Reporting • Working with vendor to develop a “User-Led” unsolicited reporting capability within the software • Feature will allow practitioner users to send patient reports along to other practitioner users within the system, assuming the recipient user has likewise provided health treatment to the patient subject of the report.

20. INSPECT Service Offering #3 • Prescriber Self-Lookup Tool • Similar to a credit report, this new functionality allows registered users of the INSPECT WebCenter Indiana to access their full controlled substance prescribing history for a requested period of time.

21. INSPECT Service Offering #4 • Rx Watch Website • New INSPECT Website scheduled for full release in 2011! • Functionalities include: • User-customizable analytic and GIS mapping tools • Periodically-updated (albeit patient de-identified) datasets for upload by researchers • Confidential “tip-submission” area for users • Video learning/training area.

22. RWATCH x HOME | NEWS | ALERTS | MAPS | LOGIN | LINKS | F.A.Q. RX WATCH NEWS ALERTS MAPS LOGIN LINKS F.A.Q. WHAT IS RX WATCH? • A tool will allow INSPECT to better coordinate with law enforcement and healthcare professionals about pertinent information about doctor shopping, prescription drug diversion and prescription drug dispensing trends. RETURNING USERS User Name: Password: RX WATCH NEWS & UPDATES • NEW! How to interpret the INSPECT Rx History Report • NEW! Online Pharmacy Zero Report Form • NEW! Pharmacy Change Order Form Login  Forgot Password? Click Here To advance the health and safety of Hoosiers through the collection and secure maintenance of controlled substance prescription data. Forgot User Name? Click Here REGISTER New to RX WATCH? Register for username and password. Home | News | Alerts | Maps | Login| Links | F.A.Q.

23. Contact Information • To receive a password reset, or if you have a question about the program, please email inspect@pla.in.gov • Help-Desk for non-password related inquiries: 317-234-4458 • To obtain further information and/or register for an account, please visit www.in.gov/inspect