Legislation establishing a prescription drug monitoring program (PDMP) in Missouri—the last state without one—has failed for several legislative sessions in a row. But now that a heavily amended version of the state House bill has emerged from the state Senate, Missouri seems closer than ever to building a program providing prescription information to prescribers and pharmacists making decisions about opioid treatment.
Sponsored by Rep. Holly Rehder, HB 90 passed through the Missouri House of Representatives by significant margins, but the Senate has been the end of the line for PDMP legislation for six sessions: a contingent of state senators, led by Sen. Rob Schaaf, has killed the bill based on concerns about patient privacy.
This April, however, the Senate approved the bill—with some controversial amendments. The major sticking point is how long the PDMP would store patient data. The Senate capped that period at 180 days. Advocates say that’s not long enough.
“The most important qualities of a PDMP are ease of use and timeliness of data. I agree with [the Senate version’s] detractors that the 6-month data purge may limit a clinician’s ability to characterize the trajectory of a patient’s controlled substance use patterns,” said Daniel Hartung, PharmD, MPH, an assistant professor at Oregon State University College of Pharmacy, who conducts Agency for Healthcare Research and Quality–research on PDMPs.
Another issue is a provision in the Senate version that only requires opioids and benzodiazepines be reported, instead of all schedule II–IV controlled substances.
At a crossroads
Missouri Pharmacists Association (MPA) CEO Ron Fitzwater, CAE, MBA, worries that the bill’s Senate amendments could “water it down to the point that it’s really not going to be very effective in its current form.”
The House appeared to concur, rejecting the Senate bill and opting to head to a conference committee, where the House and Senate would attempt to negotiate. But then sponsor Rehder asked to dissolve the committee and accept the bill as amended by the Senate. At press time, the House had not voted on that request.
“After intense lobbying from MPA and other health care groups, the amended Senate version appears to be losing support in the House. However, anything is possible in the last days of session,” Fitzwater said. “We will be closely watching the bill over the next couple of days.”
Life without a PDMP
In the absence of a statewide program, counties have patched together a PDMP of sorts, linking with systems of other counties. Fitzwater said it’s not nearly good enough. “[People] just end up going to pharmacies in counties that aren’t part of the cobbled-together program.”
Still, there is reason for optimism. “There’s been relatively little opposition to countywide programs, which means citizens are comfortable with a PDMP,” Fitzwater said. “We came out of the House with 102 to 54 votes. There’s support in the Senate if we can get a clean bill out of there. And there’s support [from Gov. Eric Greitens] to put together a legitimate program for the State of Missouri.”