1. Prescription Electronic Reporting System (KASPER)
An Update on the
Kentucky All Schedule
Prescription Electronic Reporting System
(KASPER)
David R. Hopkins
KASPER Program Manager
Office of Inspector General
Kentucky Cabinet for Health and Family Services
Kentucky Osteopathic Medical Association
June 9, 2017

2. Disclosure David R. Hopkins No relevant financial relationships
No conflicts of interest

3. Contents
KASPER Program Update
A Review of KASPER Requirements
Legislative Update and Planned KASPER Enhancements

4. KASPER Program Update

5. KASPER

6. KASPER Data KASPER tracks:
Retail pharmacies dispensing into KY (in-state, mail order, Internet)
Hospital pharmacies if dispensing any Schedule II or more than a 48 hour supply of a Schedule III through V
All C-II through C-V effective June 29, 2017
Physician administering or dispensing a controlled substance in the office
Dispensing from Department for Veterans Affairs pharmacies

7. KASPER Data KASPER does not track:
Methadone administered at a federally regulated methadone clinic
Controlled substances dispensed for administration to a patient in a hospital, long-term care facility, jail, correctional facility or juvenile detention facility
Pseudoephedrine (tracked separately via NPLEx)
Dispensing by military pharmacies
Schedule I or other illegal drugs

8. Status of Prescription Drug Monitoring Programs (PDMPs)VT ME WA MT ND
NH MA RI CT NJ DE MD DC MN NY OR WI SD ID MI WY PA IA NE OH IL IN NV WV UT VA CO KS KY CA MO NC TN OK SC AZ NM AR GA MS AL TX LA AK FL
Operational PDMPs
Enacted PDMP legislation, but
program not yet operational
Legislation pending HI GU
Research is current as of February 1, 2012

9. 2011 KASPER Reports Requested

10. Controlled Substance Records Total/Per Person
Number of Controlled Substance Prescriptions per Person

11. KASPER Report Requests

12. Top Prescribed Controlled Substances by Therapeutic Category based on Number of Doses - 2016
Diazepam 4.0%
Valium
Pregabalin 3.2%
Lyrica
Zolpidem 3.3%
Ambien
Lorazepam 4.2%
Ativan
Hydrocodone 36.0%
Lortab
Vicodin
Amphetamine 4.2%
Adderall
Clonazepam 7.2%
Klonopin
Tramadol 10.2%
Ultram
Alprazolam 10.4%
Xanax
Oxycodone 17.3% OxyContin, Percocet

13. KASPER Stakeholders
Licensing Boards – to investigate potential inappropriate prescribing by a licensee.
Practitioners and Pharmacists – to review a current patient’s controlled substance prescription history for medical or pharmaceutical treatment; for the birth mother of an infant being treated for neonatal abstinence syndrome or prenatal drug exposure.
Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution.
Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients.
A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines.
Medical Examiners engaged in a death investigation

14. A Review of KASPER Requirements

15. eKASPER Prescriber Usage - KRS 218A.172
Query eKASPER for previous 12 months of data:
Prior to initial prescribing or dispensing of a Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone
No less than every three months
Review data before issuing a new prescription or refills for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone
Additional rules/exceptions included in licensure board regulations

16. eKASPER Review – 201 KAR 9:260
Initial prescribing to treat acute, non-cancer pain. Including in Emergency Department.
Commencement of long term prescribing (after 90 days) to treat non-cancer pain.
Continued long term prescribing for non-cancer pain: every three months. More frequently or immediately if indicated.
Initial treatment of non-pain conditions.

17. eKASPER Query Exceptions
In an emergency situation (disaster or mass casualties)
Patients in hospitals and long term care facilities (C-III through C-V)
Patients in Hospice care or being treated for cancer pain
Single doses of anxiety medicine prior to a procedure
Schedule V controlled substances

18. What if I cannot “Query” eKASPER?
If eKASPER indicates “manual process”
Record the eKASPER report request number in the patient’s chart
If the eKASPER system is unavailable or Internet access unavailable
Document circumstances why eKASPER could not be queried
If eKASPER outage, record the date and time, and eKASPER system outage logs will confirm lack of system availability

19. Legislative Update and Planned KASPER Enhancements

20. House Bill 333
Simplifies the process to make illicit fentanyl analogs Schedule I controlled substances in KY
Legalizes cannabidiol products if they are FDA approved
Limits Schedule II controlled substance prescribing to a three day or less supply for acute medical conditions with exceptions:
Chronic or cancer pain
Hospice or end of life treatment
As part of a licensed narcotic treatment program
Treatment of pain following major surgery or significant trauma
In-patient treatment
If the practitioner believes it is medically necessary
Requires CHFS to conduct quarterly reviews to identify patterns of improper, inappropriate or illegal controlled substance prescribing or dispensing

21. Upcoming KASPER Changes
A practitioner or pharmacist may access KASPER data for the mother of an infant being treated for Neonatal Abstinence Syndrome or suspected pre-natal drug exposure (HB 314)
Effective June 29, 2017
Authorized practitioners and pharmacists can access available positive drug toxicity screen results related to a patient’s suspected drug overdose treated in an ED as well as all controlled substances dispensed out of an ED (HB 314)
ED controlled substance reporting effective July 2017
Drug toxicity screen results estimated to be available December 2017 and will be available through the Governor’s Office of Electronic Health Information (Kentucky Health Information Exchange)

22. Upcoming KASPER Changes
Gabapentin will be a Schedule V controlled substance in Kentucky (905 KAR 55:035)
Effective July 1, 2017
Enhanced prescriber “report card”
Estimated to be available in early 2018
KASPER will allow authorized users to access data on a patient’s drug convictions as provided by the Administrative Office of the Courts (SB 32)
Estimated to be available June 2018

23. Gabapentin Fact Sheet

24. Drug Enforcement and Professional Practices Branch
DEPPB Phone Number:
Paula York
Jill Lee
Stephanie Johnson
Carrie Gentry
Laura Beth Wells
Duncan McCracken
Chris Johnson

25. Photo by Fox 2 Detroit, May 8, 2017
Gray Death
Combination of heroin, fentanyl, carfentanil and “pink” (U-47700) that can kill with a single dose
Photo by Fox 2 Detroit, May 8, 2017

26. QUESTIONS? KASPER Web Site: www.chfs.ky.gov/KASPER David R. Hopkins
Kentucky Cabinet for Health and Family Services
275 East Main Street, 5ED
Frankfort, KY
ext. 3333
KASPER Web Site: