Mandatory Prescriber Usage of the Kentucky All Schedule Prescription Electronic Reporting System (KASPER)

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1 Mandatory Prescriber Usage of 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 BJA PDMP South Region Meeting April 29, 2014

2 The Political Climate Opioid abuse a national epidemic Controlled substance abuse increasing Kentucky opioid misuse rate tied for 2 nd highest in nation Opioid overdose deaths increasing Kentucky opioid overdose death rate 6 th highest in nation Legislators viewed medical community as not addressing the problem Cabinet for Health and Family Services

3 Total Number Drug Overdose Deaths in Kentucky Kentucky Resident Drug Overdose Deaths, ,022 1, Produced by the Kentucky Injury Prevention and Research Center, January Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. Cabinet for Health and Family Services

4 Drug Overdose Death Rates in Kentucky Cabinet for Health and Family Services

5 Controlled Substance Usage 2013 Cabinet for Health and Family Services

6 KASPER Usage December 31, 2011 Pharmacists = 3.5% (26% of KY pharmacists had accounts) Law Enforcement = 1.5% (13% of KY LE had accounts) Judges, Other =.1% Prescribers = 94.9% (32% of KY prescribers had accounts) Cabinet for Health and Family Services

7 The Legislature Passed mandatory KASPER registration and usage legislation: 2012 House Bill 1 Pill Mill Bill 2013 House Bill 217 Cabinet for Health and Family Services

8 ekasper Reporting KRS 218A.202 Controlled substance administration or dispensing must be reported within one day effective July 1, 2013 Cabinet for Health and Family Services

9 ekasper Accounts KRS 218A.202 ekasper registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans. Cabinet for Health and Family Services

10 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 Cabinet for Health and Family Services

11 KASPER Regulations Licensure Boards 201 KAR 5:130 Kentucky Board of Optometric Examiners KASPER requirements 201 KAR 8:540 Kentucky Board of Dentistry KASPER requirements 201 KAR 9:260 Kentucky Board of Medical Licensure KASPER requirements 201 KAR 20:057 Kentucky Board of Nursing KASPER requirements 201 KAR 25:090 Kentucky Board of Podiatry KASPER requirements. Justice & Public Safety Cabinet

12 Exceptions After surgery Patients in hospitals and long term care facilities Hospitals and long term care facilities can establish facility accounts and request reports on behalf of the facility Patients in Hospice care or being treated for cancer pain Single doses of anxiety medicine prior to a procedure As a substitute within 7 days of initial prescribing Cabinet for Health and Family Services

13 Implementation Challenges

14 Prescriber and Pharmacist Registration Implemented temporary paperless registration process Increased administrative staff to handle s and calls Went from one to three administrative staff Engaged four temps Cabinet for Health and Family Services

15 KASPER Master Accounts 12/31/ /24/ /20/ /24/2014 Doctor* 5,470 5,680 11,923 17,807 APRN ,523 2,150 Pharmacist 1,385 1,450 3,602 5,363 Total 7,545 7,911 17,048 25,320 *Includes physicians, dentists, optometrists and podiatrists Cabinet for Health and Family Services

16 Technology Challenges Less than three months to prepare Had to rely on existing system capacity Initial system outages Increased technology Help Desk staff from one to four Created web-based KASPER tutorial Cabinet for Health and Family Services

17 Cabinet for Health and Family Services KASPER Reports

18 Cabinet for Health and Family Services Policy Challenges Complexity of 2012 licensure board regulations Simplified in 2013 Confusion on who to contact with questions/issues KASPER Licensure Boards Proliferation of misinformation HB1 Legislative Oversight Committee

19 Results

20 Controlled Substance Dispensing One Year Comparison Drug August 2011 through July 2012 Cabinet for Health and Family Services August 2012 through July 2013 Change Hydrocodone 239,037, ,349, % Oxycodone 87,090,503 77,022, % Oxymorphone 1,753,231 1,138, % Alprazolam 71,669,411 62,088, % Methylphenidate 10,659,840 11,454, % Amphetamine 13,795,147 15,065, % All Controlled Substances 739,263, ,303, % Figures shown in doses dispensed

21 Cabinet for Health and Family Services Hydrocodone

22 Cabinet for Health and Family Services Oxycodone

23 Cabinet for Health and Family Services Alprazolam

24 Cabinet for Health and Family Services Methadone

25 Cabinet for Health and Family Services Oxymorphone

26 Cabinet for Health and Family Services Tramadol

27 Cabinet for Health and Family Services Buprenorphine

28 Cabinet for Health and Family Services Buprenorphine

29 House Bill 1 Impact Study Comprehensive assessment of HB1 s impact on patients, prescribers, and other stakeholders Overall goals: Evaluate the impact of HB1 on reducing prescription drug abuse and diversion in Kentucky Identify unintended consequences associated with implementation of HB1 that impact patients, providers and citizens of the Commonwealth Develop recommendations to improve effectiveness of HB1 and mitigate identified unintended consequences Final study report planned for July 2014 Cabinet for Health and Family Services

30 David R. Hopkins Kentucky Cabinet for Health and Family Services 275 East Main Street, 5ED Frankfort, KY ext KASPER Web Site:

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