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MAPS Michigan Automated Prescription System

What is MAPS? Michigan Automated Prescription System. MAPS requires pharmacists, veterinarians and dispensing physicians to electronically report all controlled substances dispensed in Schedules 2 - 5. Tax Dollars. No Tax Dollars used for MAPS$20.00 from each controlled substance registrationSAME AMOUNT AS BEFORE.

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MAPS Michigan Automated Prescription System

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    2. What is MAPS? Michigan Automated Prescription System MAPS requires pharmacists, veterinarians and dispensing physicians to electronically report all controlled substances dispensed in Schedules 2 - 5

    3. Tax Dollars No Tax Dollars used for MAPS $20.00 from each controlled substance registration SAME AMOUNT AS BEFORE

    4. What Benefit will the Practitioner obtain from MAPS? The ability to access dispensing data – state wide to determine – all substances – dispensed to a particular patient.

    5. Five Schedules Schedule I: No accepted medical use. Schedule II Limited use but high abuse. Severe restrictions on prescribing. No refills Schedule III and IV: Similar. Most opiates in III in combination with ASA or APAP. Benzodiazepines in IV. 5 refills/6 months Cough Syrups and Lyrica in Schedule V

    6. EXEMPT FROM REPORTING MCLA 333.7333a 1. MEDICATIONS ADMINISTERED DIRECTLY TO PATIENTS 2. DISPENSING FROM A HEALTH FACILITY OR AGENCY LICENSED UNDER ARTICLE 17 BY A DISPENSING PRESCRIBER FOR NO MORE THAN A 48 HOUR SUPPLY 3. SAMPLES 4. SCHEDULE 5 EXEMPT NARCOTICS

    7. MCLA 333.7333a Access to MAPS data Health Professional Boards. Investigation Employee or agent of the Department State, Federal, or Municipal employee or agent whose duty is to enforce drug laws. State operated Medicaid program. Practitioner or pharmacist who certifies info is for treatment of bona fide current patient. Info used for bona fide drug related criminal investigatory or evidentiary purposes.

    8. ON-LINE REQUESTS PROCESSED FIRST. USUALLY WITHIN MINUTES DURING BUSINESS HOURS FAXED REQUESTS TAKE LONGER. GENERALLY 1-2 BUSINESS DAYS. REQUIRES US TO CREATE PAPER. RECORDS SAVED ON PAPER VS DIGITAL RECORDS FOR ON-LINE

    9. Requires internet access Requests and reports may be mailed.

    10. FAXED REQUESTS ARE NOT AS SECURE AS ON-LINE ON-LINE REQUESTS USE 128 BIT ENCRYPTION SSL WHICH IS SAME AS THAT USED FOR FINANCIAL TRANSACTIONS FAX MAY BE ACCESSABLE TO ANYONE IN THE PHARMACY OR PHYSICIAN OFFICE. DIGITAL REPORTS MAY BE VIEWED ON SCREEN. PASSWORD AND LOGIN REQUIRED

    11. MAPS Reports Patients with common names. Almost 60 million records. Identifiers missing or inaccurate. Requires multiple reports. Possibility of combining records. All counted as one report.

    12. ABILITY TO GENERATE SYSTEM WIDE ALERTS AND MESSAGES (PATIENTS) ON-LINE ANALYTICAL PROCESSING ABILITY TO SPOT TRENDS ABILITY TO DRILL DOWN TO SPECIFIC DATA. ABILITY TO SEARCH BY ANY COLLECTED CRITERIA.

    13. Patient Benefits Pain experts estimate as many as 20% of patients not honest about drug use. But, that means that 80% are honest (majority)

    14. Over 300 “doctor shoppers” identified since 2004 Majority involve hydrocodone (Schedule 3) which was due to old program monitoring only Schedule 2

    15. Dr. Shopper LetterDr. Shopper Letter

    16. Scripts Reported in 2003,2004,2005 12,498,338 13,689,728 14,355,989

    17. Scripts Reported Monthly: 1.2 to 1.3 MILLION

    18. Total Data RequestsFor 2004: 34,000 Average of 190 Daily

    19. Requests for 2005 Averaged over 200 daily. >60,000 Majority are physicians

    20. MAPS REQUESTS 2006 >90,000 CURRENTLY AVERAGING > 400 DAILY OVER TWO-THIRDS ON LINE

    21. 2006 MAPS DATA Average of 400 requests daily Capture over 1.2 million scripts/month 75% of requests are done on-line On-line turnaround time < hour During business hours. Number 1 reporting pharmacy? Medco Health in Las Vegas Nevada

    22. Schedule 2 scripts increased under MAPS No more serialized forms for Schedule 2. Patients probably received Schedule 3 analgesic (hydrocodone) instead before MAPS

    23. Increase in Schedule 2 scripts linked to improved patient care regarding pain. Diversion of Schedule 2 doesn’t appear to have increased. Increased incidence of “prescription mills” of 1970’s.

    24. MAPS 2004 Schedule 2 increased 15.8% Schedule 3 increased 11.6% hydrocodone increased 16.2% Schedule 4 increased 9.4% Schedule 5 decreased 2.2% (2.2%) Grand Total Increase of 9.5% Almost 14 million prescriptions.

    25. MAPS 2005 Schedule 2 increased 7.7% Schedule 3 increased 5.3% hydrocodone increased 10.09% Schedule 4 increased 1.05% Schedule 5 increased 9.18% (Lyrica) Overall increase of 4.87% Stadol decreased 12.65%

    26. hydrocodone/acetaminophen Schedule 3 Vicodin, Lorcet, Lortab, Norco, Anexsia 2003: 3,174,922 2004: 3,689,073 increase of 16.2% 2005: 4,061,462 increase of 10.09%

    27. hydrocodone/acetaminophen Total 2005 prescriptions: 14,355,989 hydrocodone accounts for 28.29% All prescriptions increased 9.5% in 2004 All prescriptions increased 4.87% in 2005 hydrocodone increased at more than twice the rate of increase for all others in 2005.

    28. DATA: Drug Abuse And Treatment Act of 2000 office based substance abuse treatment with buprenorphine (Subutex, Suboxone) Danger to patient when buprenorphine mixed with benzodiazepines or other analgesics

    29. Physician registered with DEA and issued DEA registration beginning with X Eight hours of training. Initially limited to 30 patients. Recently increased to 100. Records subject to same confidentiality as methadone and alcohol treatment records. Title 42 of the CFR

    30. Subutex: Scripts in 2005 1,104 vs. 685 in 2004 *Suboxone: Scripts in 2005 25,798 vs. 11,919 in 2004 *naloxone

    31. Suboxone/Subutex in 2005 Subutex: 1,104 scripts Suboxone: 25,798 scripts Overall increase of 123% in 2005 Why large disparity? Reckitt Benckiser does not detail Subutex.

    32. Update of DATA 2000 for office based substance abuse treatment with buprenorphine (Subutex, Suboxone) Law changed in December 2006 and now allows practitioner to treat up to 100 patients instead of 30.

    33. Bureau taking over MAPS from contractor Bureau will be uploading disks and paper forms. Obtained 350K grant from Feds. Bureau will correct data or return to pharmacy. Normally would require minimum of 1 FTE.

    34. Bureau operating MAPS Labor will be shifted from viewing and approving reports in the next few months. MAPS will become automated and provide a limited amount of data 24/7. Estimated savings to Bureau of greater than $600,000 annually.

    35. Recently installed new software on state owned equipment GREATER EMPHASIS ON-LINE REPORTS. W-GET PROGRAM FOR UPLOADING RECORDS IF PHARMACY CHAIN HAS IT DEPARTMENT. TRACK PATIENTS AND PRESCRIPTIONS BY METHOD OF PAYMENT.

    36. MAPS UPGRADES Eliminate Social Security Numbers No identifier required if under 16 y/o Twice monthly reporting (near time) Require “positive identification” if patient not known to pharmacist or staff. Proposed Rules published on Bureau Web Site: www.mi.gov/healthlicense.

    37. Prescribing controlled substance for self or family. Long term prescribing of controlled substance considered by experts to be below minimal standards. Short term or emergency deemed acceptable. May cause concern for pharmacist.

    38. Pharmacist professional responsibility Rule 338.490 prohibits pharmacist from dispensing prescription if: Prescription appears improperly written, multiple interpretations, possible harm to patient, non-legitimate purpose.

    39. Scope of practice MCLA 333.17751(3) Pharmacist or prescriber shall dispense a prescription only if the prescription falls within the scope of practice of the prescriber.

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