A Bitcoin-based Network to Replace Prescription Pill Monitoring Programs

 Prescription painkiller overdoses cause 44 deaths/day in the United States 1  Prescription Pill Monitoring Programs (PMPs).  Controlled Substance Utilization Review & Evaluation System (CURES) The Prescription Pill Epidemic Patient Activity Report 2 Patient nameDate prescription was filled Patient D.O.BPrescription number Patient addressDrug Name Pharmacy name/license numberDrug quantity and strength Prescriber name/DEA numberNumber of refills remaining  100 million entries stored as of 2013

Problems  Less than 10% of eligible health care workers are registered 3  “My joke to my colleagues is if I tried as hard as I can to build a terrible system, I don’t think I could meet this.” 3  Data is susceptible to hacking  16% rise in prescription painkiller overdoses from

PillPal: How Does it Work?

Pharmacy Directory CVS Pharmacy, 100 Main St, Los Angeles, CA Mike’s Pharmacy, 2 Oak Dr., Los Angeles, CA Ralph’s, 52 Stanford Ave, Los Angeles, CA Doctors, patients, and pharmacies are required to register and acquire verification for inclusion within the PillPal network

Doctor Directory Dr. Nicholas Woods Dr. Angela Low Dr. Michael Chang Patients have a user-friendly mobile application, whereas doctors and pharmacists have a “vendor” application (tablet/desktop) with more features

Prescription Directory Percocet /20/15 Drug Name Pill# Refills Date

Pharmacy Directory CVS Pharmacy, 100 Main St, Los Angeles, CA Mike’s Pharmacy, 2 Oak Dr., Los Angeles, CA Ralph’s, 52 Stanford Ave, Los Angeles, CA 90129

Dr. Nicholas Woods Percocet /20/15 Prescription Order Screen Alice Miller

Pharmacist creates a 3-of-4 multi-signature transaction invoice between all the participating parties. PillPal has a built-in Bitcoin wallet Pill Pal

Transaction Signature Requested SIGNREJECT Requester: CVS Amount: 0.25 BTC The end user will be blinded to the technical details

Create Order Signed Parties

Snow, P., et al. (2014). Factom: Business Processes Secured by Ummutable Audit Trails on the Blockchain  Timestamped  Decentralized  Non-Hackable  Easily audited

CURESPillPal 12 month patient activity reports (PARs) Centralized database Difficult to use Up to 7 days to input PARs Voluntary auditing Stored forever Unhackable User-friendly Near instant PAR input Easily audited Automated flagging Comparisons United States State-by-state legislature Single unified system

Current Cost Structure & Monetization Strategy Pharmacies and doctors would pay fees to access the PillPal network Fund a team of developers Cover Bitcoin transaction fees (~$ /transaction – compare to 2-3% for CCs) (may not be necessary depending on future updates to Bitcoin’s protocol)  400,000 annual budget (government)  ~215,000 licensed healthcare professionals in CA.  $6 fee imposed to those participating in CURES

“No One Uses Bitcoin” Insurance  Bitcoin is divisible to  Invoices are issued in “satoshis,” payment can be via any other method  It CAN be used for payment itself (and converted to dollars for the pharmacy)  If the patient is covered, they only need to sign the transaction

Working within the existing framework  Health Insurance Portability and Accountability Act (HIPAA)  42 U.S.C §§ 1320d to 1320d-8, and 45 CFR 164, et seq.  California Confidentiality of Medical Information Act  CA Civil Code §§ 56 to  California Information Practices Act  CA Civil Code § 1798, et seq.  CURES Legislation  CA Health and Safety Code § 11165, et seq.

 User goes to pillpal.com, fills out relevant information, creates private key/shared public key pair (BitPay’s CoPay/Gem/mSIGNA system – whatever is the preferred BIP32 HD wallet software chosen). The PillPal system links the user information to the key pair. Private keys are never shared with PillPal.  Individual doctors and patients need to create their own key pairs using the system. pharmacies would be registered by store/location. Doctors at a specific office/location are housed as child keys under one HD wallet.  When an order is assembled, the PillPal directory allows the pharmacist to access the parties to be invited to the transaction via their public keys. The pharmacist generates an invoice for the specified transaction. For every invoice, the pharmacy generates a new multi-signature wallet address from an HD MultiSig wallet. The doctor or pharmacist wallets are funded via PillPal through a known master address (it should always have funds). The pharmacist invites the correct doctor/patient.  Each invoice requires 3 (patient, doctor, pharmacist) of 4 signatures to be complete. PillPal holds the 4th key in the transaction and acts as a signing arbiter in the event something goes wrong.  The doctor/patient have essentially “1 touch” signing. The pharmacist waits to see proper identification of the patient before they sign off on the transaction.  The transaction is completed when 3 of 4 parties sign.  All information (transaction details) is maintained via Factom as the back-end of PillPal’s system The Details

Additional Features  Reminders to take medication, when to refill  Internal tracking of activity – simultaneous flagging/monitoring of doctor and patient risk behavior  Monitoring of pharmacy addresses for funds. Funds can be sent instantly.