RD677 - Virginia Prescription Monitoring Program 2021 Annual Report – November 1, 2021

Executive Summary:

The Virginia Prescription Monitoring Program (PMP) is a statewide electronic database containing information on dispensed Schedule II-V prescriptions, naloxone, and cannabis 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. Investigative findings by regulatory boards and analysis methodologies are regularly reviewed and refined. Notably, 14% of cases initiated through this process resulted in a violation; by comparison, only 8% of complaint-driven cases involving patient care resulted in a violation. The section entitled Identifying unusual patterns of prescribing and dispensing, beginning on page 7, describes this process and case findings in depth.

The disruption to the healthcare system caused by Covid-19 also impacted observed trends in dispensations reported and PMP use. The most pronounced changes occurred abruptly in the early months of the pandemic but quickly reverted and continues to follow expected trends. More specifically, following continuous increases over the last several years, quarterly requests to the PMP declined for the first time in 2020Q2 but quickly rebounded and continue to rise.

Notable findings in the 2021 Annual Report

• A central utility of the PMP is to monitor a patient’s use of multiple prescribers and pharmacies in acquiring controlled substances. Multiple provider episodes, defined as five or more prescribers and five or more pharmacies in a six-month period, has decreased markedly in the last several years. In early 2018 the rate was 10.6 per 100,000 residents and as of mid-2021 was 2.0 per 100,000 residents.

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. Since that time, mono-product buprenorphine prescriptions declined by two-thirds (66%).

• Pursuant to Code of Virginia § 54.1-3408.02, any prescription containing an opioid must be transmitted electronically (e-prescribed) from the prescriber to the dispenser. Within one-year of the law taking effect in July 2020, 86% of opioids were e-prescribed.