BioPharma: Getting Doctors Ready

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HIT Perspectives Biopharma Insights – February 2016

Getting Doctors Ready for New York’s War on Opioid Abuse

By Brian Bamberger, Life Sciences Practice Lead

Many doctors in New York will need help to electronically send all prescriptions – including those for controlled substances – beginning March 27, 2016. The reason is New York’s law known as I-STOP (Internet System for Tracking Over-Prescribing), which is a comprehensive program to combat rampant controlled substance diversion and abuse. I-STOP creates opportunities for pharmaceutical manufacturers in the near term to help prescribers navigate unfamiliar systems, resolve inevitable confusion when prescribing non-tablet products and provide patient education. This assistance can be replicated in the longer term as other states follow New York’s lead.

Misuse and abuse of prescription drugs are reaching epidemic proportions in the United States. They are overwhelming police, health care workers and families in every state, – in inner cities and suburbs alike. The numbers are staggering and heartbreaking. The Centers for Disease Control and Prevention (CDC) reports that roughly 47,000 Americans – or about 129 per day – died from a drug overdose in 2014. That surpasses deaths from guns or automobiles. Two-thirds of those deaths involved opioids or heroin. Prescription painkiller abuse is now considered a gateway to the use of heroin, which is cheaper and becoming more readily available than opioids.

Recognizing the threat posed by opioid abuse and diversion, New York took action with I-STOP. It offers a multipronged approach, including:

  • All prescriptions, both scheduled and nonscheduled, must be electronically prescribed (ePrescribed) by March 27, 2016. (The original date was moved out by a year because of readiness concerns by prescribers and vendors.
  •  ePrescribing system vendors must be certified to transmit scripts for controlled substances according to a strict process created by the Drug Enforcement Administration (DEA). Prescribers also must be registered to ePrescribe controlled substances and do so according to the DEA’s stringent protocols, which include using two-factor identification when logging onto the system.
  • Prescribers must complete a registration form with New York’s Bureau of Narcotics that identifies their certified system vendor and software version number.
  • Most prescribers of controlled substances are required to consult New York’s prescription drug monitoring program (PDMP) database before prescribing Schedule II, III and IV controlled substances. The database includes all controlled prescription drugs dispensed in the state. This advance consultation is expected to reduce doctor shopping, help identify rogue prescribers and pill mills and prevent the filling of bogus prescriptions for painkillers.
  • Creation of safeguards for distribution of prescription drugs prone to abuse, medical education courses, public awareness efforts and establishment of an unused medication disposal program.
  • Stiff penalties for noncompliance. According to the New York Bureau of Narcotic Enforcement (BNE), noncompliance is punishable by a $2,000 fine, imprisonment not exceeding one year or both. Furthermore, it is considered professional misconduct by the applicable professional boards and could lead to suspension or revocation of professional licenses.

Not surprisingly, this lengthy list of requirements means many providers will need all the help they can get to meet the March 27 deadline for ePrescribing and electronic prescribing of controlled substances (EPCS). Although many prescribers in New York have been ePrescribing for years, the majority were not ready when the first I-STOP deadline approached last March, which is why it was extended for a year. With the new deadline looming, a significant number of prescribers still are not ready – even through electronic health record (EHR) software vendors serving 96% of prescribers in New York are already certified for EPCS and all can handle regular ePrescribing. Similarly, nearly all pharmacies can process both kinds of electronic prescriptions. The problem lies in provider readiness. According to the latest Surescripts statistics, 27% of total prescribers are enabled for EPCS and 58% of prescribers are actively transmitting electronic prescriptions in general. That means a lot of prescribers will need to hustle, unless there is a large exceptions process or the deadline is extended again. We think there’s at least even odds of that happening.

In the meantime, pharmaceutical manufacturers and their representatives have an unprecedented opportunity to help physicians before March 27 – and beyond – as they take up ePrescribing or EPCS. For example, I-STOP creates the opportunity for drug manufacturers to assist practices in creating efficiencies with favorites and reducing pharmacy calls with correct prescriptions. Writing electronic prescriptions for non-tablet products – even familiar ones – can be confusing to new ePrescribers and can create a risk to patient safety. Practices need to understand how to use these unfamiliar systems for more difficult-to-prescribe products. Existing materials concerning drug abuse, addiction and patient safety can be leveraged by sales representatives to help physicians comply with I-STOP’s educational requirements.

Learnings from their New York experience can help pharmaceutical manufacturers position themselves to help physicians in other states considering similar legislation. Going forward, it will be imperative to learn how to assist prescribers in adapting to the new ePrescribing technologies. Today, ePrescribing is primarily done via EHRs instead of stand-alone systems.

The war on opioid abuse is far from over, but electronic tools show promise for fighting this deadly epidemic. Point-of-Care Partners (POCP) has been helping pharmaceutical companies prepare as well. We have ready-made seminars for New York sales teams that not only help them understand the regulations but also address the hurdles that new ePrescribing physicians may have in finding and prescribing their products. We also have developed webinars that sales representatives can offer to health care providers and practice staff to help resolve some of the mysteries of ePrescribing.

Let POCP position your firm and sales representatives to take advantage of this unprecedented opportunity to help physicians adapt to EHRs and ePrescribing.