RD702 - Virginia Prescription Monitoring Program 2019 Annual Report

Executive Summary:

The Virginia Prescription Monitoring Program (PMP) is a statewide electronic database containing information on dispensed Schedule II-V prescriptions, naloxone, drugs of concern, and cannabidiol or THC-A oils dispensed from an in state pharmaceutical processor. The primary purpose of the PMP is to promote safe prescribing and dispensing practices for covered substances by providing timely and essential information to healthcare providers. Both the Code of Virginia (§ 54.1-25.2) and Virginia Administrative Code (18VAC76-20) contain laws and regulations applicable to the PMP.

In addition to the utility for healthcare providers, the data collected can be useful in identifying unusual patterns of prescribing and dispensing for review by the applicable regulatory board. Approximately one million prescriptions are reported to PMP monthly and developing specific, meaningful criteria to detect aberrant behavior is challenging. Consequently, investigative findings by regulatory boards and analysis methodologies are regularly reviewed and refined. Notably, 13% of cases initiated through this process have been found in a violation; by comparison, only 8% of complaint-driven cases involving patient care were found in violation. The section entitled Identifying unusual patterns of prescribing and dispensing, beginning on page 8, describes this process and case findings in depth.

As a result of legislation during the 2019 General Assembly session gabapentin became a Schedule V controlled substance in Virginia on July 1, 2019. This did not result in any operational changes for PMP as gabapentin became reportable as a drug of concern in 2017. Notable findings in the 2019 Annual Report (analyses based on January 2018-June 2019)

Prescribing of opioids is decreasing with the greatest decrease—46%—in very high-dose prescriptions. Specifically, prescriptions for daily dosages of 120 morphine milligram equivalents or greater decreased from 5.7 to 3.1 per 100 Virginians.

Regulations Governing Prescribing of Opioids and Buprenorphine (18VAC85-21-10), promulgated by the Board of Medicine, became effective in March 2017 and imposed limits on prescribing buprenorphine without naloxone (mono-product) for opioid use disorder due to the potential for misuse and abuse. There was an immediate decline in mono-product prescriptions that has since stabilized.

Pursuant to Code of Virginia § 54.1-3408.02, beginning July 1, 2020 any prescription containing an opioid must be transmitted electronically (e-prescribing) from the prescriber to the dispenser. Although only 19% of opioids were submitted electronically in June 2019, this represents a 61% increase since January 2018.

Utilization of the PMP by prescribers, pharmacists, and their delegates has increased markedly in recent years. As of August 2019, year-to-date prescription history requests surpassed the annual total in 2018.