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MAPS Michigan Automated Prescription System
What is MAPS? Michigan Automated Prescription System MAPS requires pharmacists, veterinarians and dispensing physicians to electronically report all controlled substances dispensed in Schedules 2 - 5
Tax Dollars No Tax Dollars used for MAPS $20. 00 from each controlled substance registration SAME AMOUNT AS BEFORE
What Benefit will the Practitioner obtain from MAPS? The ability to access dispensing data – state wide to determine – all substances – dispensed to a particular patient.
Five Schedules l Schedule I: No accepted medical use. l Schedule II Limited use but high abuse. l Severe restrictions on prescribing. No refills l Schedule III and IV: Similar. Most opiates in III in combination with ASA or APAP. l Benzodiazepines in IV. 5 refills/6 months l Cough Syrups and Lyrica in Schedule V
EXEMPT FROM REPORTING MCLA 333. 7333 a 1. 2. 1. MEDICATIONS ADMINISTERED DIRECTLY TO PATIENTS 2. DISPENSING FROM A HEALTH FACILITY OR AGENCY LICENSED UNDER ARTICLE 17 BY A DISPENSING PRESCRIBER FOR NO MORE THAN A 48 HOUR SUPPLY 3. SAMPLES 4. SCHEDULE 5 EXEMPT NARCOTICS
MCLA 333. 7333 a Access to MAPS data l l l Health Professional Boards. Investigation Employee or agent of the Department State, Federal, or Municipal employee or agent whose duty is to enforce drug laws. State operated Medicaid program. Practitioner or pharmacist who certifies info is for treatment of bona fide current patient. Info used for bona fide drug related criminal investigatory or evidentiary purposes.
ON-LINE REQUESTS PROCESSED FIRST. USUALLY WITHIN MINUTES DURING BUSINESS HOURS l FAXED REQUESTS TAKE LONGER. l GENERALLY 1 -2 BUSINESS DAYS. l REQUIRES US TO CREATE PAPER. l RECORDS SAVED ON PAPER VS DIGITAL RECORDS FOR ON-LINE
Requires internet access Requests and reports may be mailed.
FAXED REQUESTS ARE NOT AS SECURE AS ON-LINE REQUESTS USE 128 BIT ENCRYPTION SSL WHICH IS SAME AS THAT USED FOR FINANCIAL TRANSACTIONS FAX MAY BE ACCESSABLE TO ANYONE IN THE PHARMACY OR PHYSICIAN OFFICE. DIGITAL REPORTS MAY BE VIEWED ON SCREEN. PASSWORD AND LOGIN REQUIRED
MAPS Reports l Patients with common names. l Almost 60 million records. l Identifiers missing or inaccurate. l Requires multiple reports. l Possibility of combining records. l All counted as one report.
ABILITY TO GENERATE SYSTEM WIDE ALERTS AND MESSAGES (PATIENTS) l ON-LINE ANALYTICAL PROCESSING l ABILITY TO SPOT TRENDS l ABILITY TO DRILL DOWN TO SPECIFIC DATA. l ABILITY TO SEARCH BY ANY COLLECTED CRITERIA.
Patient Benefits Pain experts estimate as many as 20% of patients not honest about drug use. But, that means that 80% are honest (majority)
Over 300 “doctor shoppers” identified since 2004 Majority involve hydrocodone (Schedule 3) which was due to old program monitoring only Schedule 2
October 15, 2006 «Company» «First. Name» «Last. Name» «Address 1» «City» , «State» «Postal. Code» Dear «Title» : The Michigan Automated Prescription System (MAPS) program has identified your patient «Patient» , «DOB» , «Address 2» , who appears to be seeking treatment from multiple physicians and obtaining controlled substance prescriptions of a similar nature from these practitioners. It is suggested that you obtain controlled substance prescription data on the patient identified above and communicate with other health care providers who are treating this patient. You may access MAPS data via a link on our website at: www. michigan. gov/healthlicense and click on the MAPS link. Enclosed please find a listing of physicians in Michigan that provide an office based treatment program for opiate addiction that may be shared with the patient. There are other options available in addition to opiod treatment such as referral to a pain specialist, or requiring the patient to enter into an agreement which limits their treatment to a specific physician and pharmacy. Please consider all of the options that are available to you and your patient. If you have any questions or need additional information, please contact our office at the phone number listed below, or at our e-mail address: [email protected] gov. Sincerely, Bureau of Health Professions Health Investigation Division (517) 373 -1737 Enc.
Scripts Reported in 2003, 2004, 2005 l 12, 498, 338 l 13, 689, 728 l 14, 355, 989
Scripts Reported Monthly: 1. 2 to 1. 3 MILLION
Total Data Requests. For 2004: 34, 000 Average of 190 Daily
Requests for 2005 Averaged over 200 daily. >60, 000 Majority are physicians
MAPS REQUESTS 2006 >90, 000 CURRENTLY AVERAGING > 400 DAILY OVER TWO-THIRDS ON LINE
2006 MAPS DATA l Average of 400 requests daily l Capture over 1. 2 million scripts/month l 75% of requests are done on-line l On-line turnaround time < hour l During business hours. l Number 1 reporting pharmacy? l Medco Health in Las Vegas Nevada
Schedule 2 scripts increased under MAPS No more serialized forms for Schedule 2. Patients probably received Schedule 3 analgesic (hydrocodone) instead before MAPS
Increase in Schedule 2 scripts linked to improved patient care regarding pain. Diversion of Schedule 2 doesn’t appear to have increased. Increased incidence of “prescription mills” of 1970’s.
MAPS 2004 l Schedule 2 increased 15. 8% l Schedule 3 increased 11. 6% l hydrocodone increased 16. 2% l Schedule 4 increased 9. 4% l Schedule 5 decreased 2. 2% (2. 2%) l Grand Total Increase of 9. 5% l Almost 14 million prescriptions.
MAPS 2005 l Schedule 2 increased 7. 7% l Schedule 3 increased 5. 3% l hydrocodone increased 10. 09% l Schedule 4 increased 1. 05% l Schedule 5 increased 9. 18% (Lyrica) l Overall increase of 4. 87% l Stadol decreased 12. 65%
hydrocodone/acetaminophen l Schedule 3 l Vicodin, Lorcet, Lortab, Norco, Anexsia l 2003: 3, 174, 922 l 2004: 3, 689, 073 increase of 16. 2% l 2005: 4, 061, 462 increase of 10. 09%
hydrocodone/acetaminophen • Total 2005 prescriptions: 14, 355, 989 hydrocodone accounts for 28. 29% l All prescriptions increased 9. 5% in 2004 l All prescriptions increased 4. 87% in 2005 l hydrocodone increased at more than twice the rate of increase for all others in 2005.
DATA: Drug Abuse And Treatment Act of 2000 office based substance abuse treatment with buprenorphine (Subutex, Suboxone) Danger to patient when buprenorphine mixed with benzodiazepines or other analgesics
Physician registered with DEA and issued DEA registration beginning with X l Eight hours of training. l Initially limited to 30 patients. l Recently increased to 100. l Records subject to same confidentiality as methadone and alcohol treatment records. l Title 42 of the CFR
Subutex: Scripts in 2005 1, 104 vs. 685 in 2004 *Suboxone: Scripts in 2005 25, 798 vs. 11, 919 in 2004 *naloxone
Suboxone/Subutex in 2005 l Subutex: 1, 104 scripts l Suboxone: 25, 798 scripts l Overall increase of 123% in 2005 l Why large disparity? l Reckitt Benckiser does not detail Subutex.
Update of DATA 2000 for office based substance abuse treatment with buprenorphine (Subutex, Suboxone) Law changed in December 2006 and now allows practitioner to treat up to 100 patients instead of 30.
Bureau taking over MAPS from contractor l Bureau will be uploading disks and paper forms. l Obtained 350 K grant from Feds. l Bureau will correct data or return to pharmacy. l Normally would require minimum of 1 FTE.
Bureau operating MAPS l Labor will be shifted from viewing and approving reports in the next few months. l MAPS will become automated and provide a limited amount of data 24/7. l Estimated savings to Bureau of greater than $600, 000 annually.
Recently installed new software on state owned equipment l GREATER EMPHASIS ON-LINE REPORTS. l W-GET PROGRAM FOR UPLOADING RECORDS IF PHARMACY CHAIN HAS IT DEPARTMENT. l TRACK PATIENTS AND PRESCRIPTIONS BY METHOD OF PAYMENT.
MAPS UPGRADES l Eliminate Social Security Numbers l No identifier required if under 16 y/o l Twice monthly reporting (near time) l Require “positive identification” if patient not known to pharmacist or staff. l Proposed Rules published on Bureau Web Site: www. mi. gov/healthlicense.
Prescribing controlled substance for self or family. Long term prescribing of controlled substance considered by experts to be below minimal standards. Short term or emergency deemed acceptable. May cause concern for pharmacist.
Pharmacist professional responsibility Rule 338. 490 prohibits pharmacist from dispensing prescription if: Prescription appears improperly written, multiple interpretations, possible harm to patient, nonlegitimate purpose.
Scope of practice MCLA 333. 17751(3) Pharmacist or prescriber shall dispense a prescription only if the prescription falls within the scope of practice of the prescriber.