Initiated in 2002 as a pilot program in Southwest Virginia and expanded statewide in 2006 based on $20M received from a federal court settlement agreement, Virginia’s Prescription Monitoring Program’s (PMP) current expenditures of approximately $875,000 are used to track all Schedule II – IV controlled substances dispensed in the Commonwealth. With approximately 72,000 providers and dispensers registered to use the PMP, current programmatic priorities of the Department of Health Professions (DHP) include upgrading the PMP’s “basic functionality" – which requires users to step out of their workplace workflow to access PMP data – to “enhanced functionality" – in which PMP data can be automatically integrated into providers’ Electronic Health Record or other workflow (i.e., workflow integration). While DHP generates annual statistics on PMP use, it has limited ability to assess impact on prescribing and dispensing practices through routine program data. DHP estimates expenditures to climb to $1M by FY18 and the court settlement agreement funds to run out between 2027 and 2031 to support basic PMP functionality (i.e., PMP access that isn’t integrated into users’ workflow). DHP estimates the cost to integrate all PMP users to be $1.5M to $2.0M annually for the foreseeable future.

The study explored three models in detail that could support basic functionality of the PMP with funding administered by DHP:

• Health professional licensing fees: Around 50% of State prescription monitoring programs finance the majority of program expenditures through fees assessed on users. In Virginia, based on the number of providers and dispensers required to register with the PMP – just under 79,000 – and DHP’s estimates of program costs for basic PMP functionality over the next 5 years, an annual fee increase of approximately $13 to $19 would be anticipated to support basic PMP functionality on an annual basis.

• Controlled substances sales tax: Based on estimated sales of controlled substances in 2011, a retail sales tax of 0.013% to 0.026% would raise approximately $1M to $2M annually. Alternatively, based on the volume of controlled substances dispensed in 2016 (13,847,223 controlled substances tracked by the PMP were dispensed), a flat point-of-sale controlled substances tax of $0.08 to $0.14 would raise approximately $1M to $2M annually.

• Health insurance premium assessment: Based on premiums collected in 2016 from insurers regulated by the Bureau of Insurance, an assessment of 0.01% to 0.02% on total health insurance premiums for policies regulated by the Virginia Bureau of Insurance would raise approximately $1M to $2M annually.

Additionally, the study described a sequenced sustainability plan to implement one or more of the three funding models with the goal of ensuring both sustainable funding and increased use of the PMP. The sustainability plan involved contributions to the PMP from both DHP – supporting enhanced functionality in the short- and medium-term and basic functionality throughout – and PMP users – supporting enhanced functionality in the medium- and long-term.

Six policy options were presented for consideration by members of the Joint Commission on Health Care, who voted to take no action.