1. Prescription Drug Monitoring Program
Reyne Kenton, BA
June 19, 2018

2. Objectives Identify Explain Provide Discuss Describe
Identify the mission and purpose of K-TRACS
Identify
Explain who can/should access K-TRACS data and the appropriate opportunities for utilization
Explain
Provide information on how K-TRACS can be used to identify potential “doctor shoppers,” individuals who may need referral for substance use disorders, and individuals at high-risk for overdose
Provide
Discuss current data and trends related to the opioid crisis in Kansas, including new increased availability of naloxone
Discuss
Describe efforts to increase participation, collaboration, and engagement across healthcare professions with K-TRACS
Describe
Objectives

3. The Prescription Drug Monitoring Program (PDMP) in Kansas.
Monitors Schedule II-IV controlled substance prescriptions, as well as drugs of concern dispensed within the state as reported by pharmacies and other dispensers
A web-accessible database, available 24/7, that provides tools to help address one of the largest threats to patient safety in the state of Kansas: the misuse, abuse, and diversion of controlled substance medications
Dispensers electronically report (daily) all controlled substance prescriptions dispensed in an outpatient setting
PDMPs are designed to be a clinical resource and tool, with some access for regulatory and law enforcement
What is K-TRACS
KSA (a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

4. What is K-TRACS
KSA (a): There is hereby created the Prescription Monitoring Program Advisory Committee which, subject to the oversight of the Board, shall be responsible for the operation of the Prescription Monitoring Program.

5. Reporting Who Reports? When and how do they Report?
Dispensers (pharmacies)
Exempt – hospitals for inpatient care, LTC, veterinarians, hospice
When and how do they Report?
Daily, including zero reporting
Electronically to data clearinghouse
What do they Report?
All CS II-IV and drugs of concern for any Kansan
Exempt – 48 supply from ED; direct patient administration
Reporting

6. Drugs of Concern Proposed changes to KAR 68-21-7 Adding gabapentin
Public Hearing March 8, :30pm
Adding gabapentin
90 days to comply
Current list:
Any product containing all three of these drugs: butalbital, acetaminophen, and caffeine
Any compound, mixture, or preparation that contains any detectable quantity of ephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors
Any compound, mixture, or preparation that contains any detectable quantity of pseudoephedrine, its salts or optical isomers, or salts of optical isomers and is exempt from being reported to the statewide electronic logging system for the sale of methamphetamine precursors
Promethazine with codeine
Drugs of Concern

7. Advisory Committee Authorized to:
review and analyze data for purposes of identifying patterns and activity of concern
notify the prescribers and dispensers who prescribed or dispensed the prescriptions
notify law enforcement or appropriate regulatory board(s) for additional investigation
may utilize volunteer peer review committees of professionals with expertise in the particular practice to create standards and review individual cases
Shall work with the following groups to develop continuing education programs:
Agencies with oversight of prescribers and dispensers
Kansas Bar Association for attorneys
KBI for law enforcement
Advisory Committee

8. Data Confidentiality Exceptions: No Exception:
Prescribers or Dispensers for purpose of patient care
Patient’s own record request
Regulatory Agencies with oversight of prescribers and dispensers
Law Enforcement
KDHE for Medicaid recipient information
Subpoena or court order in criminal action
K-TRACS personnel for operational purposes
Board personnel for administration and enforcement of PMP Act
Medical examiners, coroners, etc.
No Exception:
Civil proceedings
Requests under the Kansas Open Records Act (KSA et seq)
Data Confidentiality

9. Education and Information
Education and Information. PDMPs provide useful feedback to prescribers on their own prescribing trends as well as their patients’ controlled substance histories. PDMPs also provide useful information to prescribers when they suspect that a patient may be non-compliant in their controlled substance use.
Public Health Initiative. The public health community can use information from the PDMP to monitor trends and address controlled substance prescribing or utilization problems.
Prevent Misuse, Abuse, Diversion. Prescribers, dispensers, and consumers will be prevented or deterred from participating in illegal drug diversion schemes when a PDMP is in place.
Intervention. Identify patients for assessment and treatment of potential substance use disorder.
Why do we need it?

10. Prescribers
Pharmacists
Delegates
Who should use it?

11. Total Users by Role Physicians 5,388 Pharmacist 4,338
Nurse Practitioner 2,237
Prescriber Delegates 2,058
Physician Assistant 1,046
Dentists
Pharmacist Delegate
Other 1,776
Total 18,138
In 2017, 71.18% of all controlled substance prescriptions reported to K-TRACS were attributed to Active and Registered Kansas Prescribers. Nearly half of those not registered were MDs.

13. Threshold Patients The 5/5/90 Rule
Patient has prescriptions from a minimum of 5 prescribers and filled prescriptions at a minimum of 5 pharmacies in less than 90 days
Potential “doctor shoppers”
Multiple provider episodes
Threshold Patients

14. Patient Alert Enhancement

15. Statewide Integration- CDC Grant
HOW TO INTEGRATE
Statewide Integration- CDC Grant
Complete an “Integration Interest Form”
Review and sign the Terms and Conditions Agreement
Work with your EHR vendor and Appriss to integrate
Reduce barriers to registration and use of K-TRACS
Increase number of prescribers and dispensers using K-TRACS
State will cover all PDMP Gateway® connection costs for each Kansas EHR and PMS approved for integration
Already requested integration:
26 Hospitals
33 Pharmacies
20 Prescriber Practices

16. K-TRACS Integration

17. Harold Rogers Grant-BJA
How many patients you have prescribed opioids to as well as a comparison to those within your specialty.
Morphine Milligram Equivalent (MME) information is broken out so you can readily see where your opioid prescribing falls within multiple
MME ranges.
Opioid treatment duration, which shows the percentage of patients who have been prescribed opioids for fewer than 7 days, 7 to 28 days, 29 to 90 days, or more than 90 days.
K-TRACS usage, which shows exactly how much you and your delegate(s) are using the PDMP.
Multiple Provider Episodes (MPE) provide a look at the number of your patients who have met or exceeded the K-TRACS threshold of 5/5/90 – five prescribers and five pharmacies within 90 days.
Dangerous Combination Therapy provides you with details of your patient’s combination therapies that may increase a patient’s risk for overdose.

18. Harold Rogers Grant

19. K-TRACS Office Reyne.Kenton@ks.gov 785-296-6547
Questions?
K-TRACS Office