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

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

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

KASPER Program Update

KASPER

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

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

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

2011 KASPER Reports Requested

Controlled Substance Records Total/Per Person 2.43 2.65 2.65 2.72 2.72 2.47 2.44 2.41 2.37 Number of Controlled Substance Prescriptions per Person

KASPER Report Requests

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

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

A Review of KASPER Requirements

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

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. http://kbml.ky.gov/hb1/Pages/House-Bill-1-Ordinary-Regulations.aspx http://www.lrc.ky.gov/kar/201/009/260.htm

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

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

Legislative Update and Planned KASPER Enhancements

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

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)

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

Gabapentin Fact Sheet www.chfs.ky.gov/KASPER

Drug Enforcement and Professional Practices Branch DEPPB Phone Number: 502-564-7985 Paula York Jill Lee Stephanie Johnson Carrie Gentry Laura Beth Wells Duncan McCracken Chris Johnson

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

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 40621 502-564-2815 ext. 3333 Dave.Hopkins@ky.gov KASPER Web Site: www.chfs.ky.gov/KASPER