Rx debate

OLYMPIA, WASH. — A new prescription-monitoring program that went into effect in early October is already causing so many headaches for Washington practitioners that the state veterinary medical association is pushing for an exemption for the veterinary profession.

"This is a very, very difficult program that's creating a huge burden for veterinarians," says Candace Joy, executive vice president of the Washington State Veterinary Medical Association.

The program was created by legislation several years ago but only recently became effective for all health professionals sanctioned to write prescriptions, including veterinarians. The program mandates electronic reporting for all dispensed medications for schedule II, III, IV and V controlled substances within one week of the dispensing date.

Veterinarians must report the name of the client for whom the prescription is ordered, client's date of birth, address, gender, drug dispensed, date of dispensing, quantity and days supply dispensed, refill information, prescriber identifier, prescription issued date, dispenser identifier, prescription fill date and number, and source of payment. Pharmacies must also include the name of the person who picked up the prescription, along with photo verification of their identity.

Local, state and federal law enforcement agencies will have access to the program data. Practitioners and pharmacists will have secure 24/7 access to review patient prescription histories.

"This helps determine appropriate medical treatment and referral needs," state officials say.

The new program began data collection on October 7 and follows two public hearings on the new rules this summer.

"We're just really concerned about the impact to veterinarians," Joy says, adding many practices will have to use staff time and possibly purchase new hardware and/or software in order to fulfill the requirements of the new program. "I'm sure it's going to drive up the cost of veterinary care, so that's going to affect pet owners who already have a difficult time affording veterinary care for their pets."

Joy says the WSVMA had scheduled a meeting with the Washington Department of Health to discuss an exemption for veterinarians. She says legislation for the program was "lumped in" to a report by the Blue Ribbon Health Commission at the last minute and included all dispensers—from veterinarians to optometrists. Electronic reporting is not difficult for human pharmacies, but it is for veterinarians, she says. Until an exemption is granted, Joy says WSVMA is doing its best to help veterinarians navigate the new system. If it has to, WSVMA will seek an exemption legislatively, she adds.

Forty-nine states have enacted prescription-drug monitoring programs, according to the National Alliance for Model State Drug Laws. Missouri and the District of Columbia are the exceptions. But only 36 states' prescription-monitoring programs are operational, according to the group. At least 13 states exempt veterinarians from participation, says Adrian Hochstadt, assistant director of state legislative and regulatory affairs for the American Veterinary Medical Association (AVMA). Enforcement for veterinary participation is "spotty" in states that offer veterinarians no exemption, he says.

"Personally, I think veterinarians are an afterthought," he says. "Legislators don't consider vets, then regulators have to figure out the enforcement."

AVMA generally supports state VMA efforts to seek exemptions or adaptations to prescription monitoring programs, he adds.

Another recent scuffle over a prescription-monitoring program occurred in Kansas in 2008. The Kansas Veterinary Medical Association (KVMA) lobbied for an exemption and won, with the stipulation that a Veterinary Prescription Monitoring Program Task Force be established to study whether to require licensed DVMs to report to the program. The study, due in 2013, will include methods and procedures of reporting by veterinarians and necessary database field information. KVMA Executive Director Gary Reser says the task force has met three or four times, and he is hopeful that the 2013 report will confirm that there is no need for veterinarians to participate in the program.