Tucked within President Donald Trump’s latest proposal to address the opioid epidemic – unveiled Monday in Manchester – is support for a somewhat obscure initiative: prescription drug monitoring programs.
The programs, administered by states, collect prescription information for patients. Pharmacists and doctors are required to participate; the resulting database allows physicians and administrators to screen for patients abusing prescriptions, “doctor shoppers” and complicit doctors.
It’s an approach with wide backing in the medical community, and Trump is hoping to expand it. A written version of the president’s plan – released by the White House on Sunday – seeks to leverage federal money to build a state-to-state, “nationally interoperable prescription drug monitoring program network.”
In New Hampshire, though, that might be easier said than done. The state’s program, approaching its sixth year, is still working to find its footing.
A critical audit by the Legislative Budget Assistant in December found a range of shortcomings from the nascent program. The program is performing its most basic function – collecting and storing prescription data – but it isn’t meeting its loftier goals of analyzing and reporting trends to guide policy, the audit found. Reports so far have been incomplete or misleading, and oversight is poor.
After becoming law under Gov. John Lynch in 2012 and four more years under Gov. Maggie Hassan’s watch, the program was stuck in an “initial phase of maturity,” the audit concluded.
Now, leadership at the state Board of Pharmacy is scrambling to implement changes. In a compliance report presented to the legislative Fiscal Committee on Friday, the board said it was rushing to meet the budget assistant’s recommendations, 26 in all.
Policies are being rewritten. Software is being brought up to speed. “We’ve moving right along with the audit response,” said Michael Bullek, administrator of the board.
But even with a newfound focus, the program is far from up to snuff. Actually building the infrastructure to meet its statutory obligations – the analyses and reports – could take up to 18 months.
Exactly what went wrong with the program’s development has been tough to narrow down. According to operators involved, troubles for the program began early. Initiated in the final months of Gov. John Lynch’s tenure, the program was from the outset “underfunded, understaffed and overregulated,” Bullek said.
“I’ve been involved in every step of the way with the process, and there’s been a lot of pitfalls and roadblocks with the legislation,” Bullek said.
One of them was a provision preventing the program from holding prescription records longer than six months, severely hampering its abilities to analyze, he said.
A spokeswoman for Sen. Maggie Hassan – who as governor oversaw four of the program’s first six years – pointed to financial constraints.
“When the program was established in law under Governor Lynch, the Legislature failed to provide sufficient funds to implement it, setting up the program for challenges,” spokeswoman Ricki Eshman said. Eshman added that Hassan had pressed for technological upgrades for the program as governor, as well as improved prescription training for physicians.
“Over the last several years, New Hampshire’s program has been expanded a number of times, and it is clear from the report that it still has work to do to reach full maturity,” she said.
And there was a simpler problem, according to Bullek: “We didn’t buy the right software program initially. It didn’t meet the need.”
Regardless of the cause of the deficiencies, the consequences have been sharp. Presented with the audit in December, lawmakers on the Fiscal Committee were openly frustrated.
“We’re all struggling to understand why the program has not been administering data,” Sen. Andy Sanborn, R-Bedford, said at the time.
Now, Bullek says much has changed since the program began. For one, the Legislature lifted its six-month cap in 2016, freeing the Pharmacy Board to begin carrying out effective data analysis. And the program took on a new software vendor last summer, expanding its ability to process data, Bullek said.
And on Friday, the Fiscal Committee approved the addition of a new staff position: a data analyst.
Presented with the updates, Rep. Neal Kurk, chairman of the Fiscal Committee, appeared encouraged – to a point.
“I think you’re making very important strides in terms of the issues that the audit brought up,” he said Friday. “We’re looking for more, with respect.”
(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)