Legislative audit: State’s drug monitoring program in disarray

Monitor staff
Saturday, December 16, 2017

A New Hampshire program intended to keep tabs on opioid prescription patterns is falling far short of its intended goals, according to a legislative audit released Friday.

In a lengthy report, the Office of Legislative Budget Assistant (LBA) found that the state’s Prescription Drug Monitoring Program has been poorly managed by the Board of Pharmacy since its creation in 2012, wracked by weak planning and insufficient reporting practices. 

The audit, presented to the Fiscal Committee found that five years in, the program is

stuck in an “initial phase of maturity.” Data collected by the program was incomplete and not consistently tracked, “nor was progress made towards achieving outcomes envisioned in State Law,” according to the audit.

The reports produced by the board – intended to inform future laws and practices around opioid prescriptions – instead have been misleading and uninformative, laden with figures presented out of context, the audit said. And there has been little oversight; an advisory council intended to implement it never properly got off the ground, and the Board itself has spurned right-to-know requests and failed to resolve 19 out of 20 issues identified in previous audits.

Legislators called for immediate action.

“We need to make sure that this report, which was frankly quite shocking, is resolved and resolved quickly,” said Rep. Neal Kurk, R-Weare, who chairs the committee. Kirk called for the Board of Pharmacy to submit a report detailing a roadmap ahead for how it would restructure itself to meet the program’s need.

First signed into law in 2012 by Gov. John Lynch, New Hampshire’s program is meant to keep track of prescriptions of Schedule II to IV drugs, and identify patterns of “doctor shopping” among patients and potential fraudulent prescribing methods by physicians.

The program – supported by federal funds and donations – uses an electronic system to confidentially share prescription information from prescribers and dispensers, who are required to participate.

Included in the data: patient names, addresses, dates of birth, and detailed information on the supply length, dispensation date and quantity of the prescribed drug. The information is available by request to patients, providers, law enforcement officials with a court order and medical boards, and can be shared with interstate programs.

But the LBA’s audit found that the program fell significantly behind its statutory aims.

“The systems and subsystems necessary for effective operations were either mis-oriented, poorly structured, or altogether absent, and significant management controls were not implemented,” read one part of the 146-page report’s Executive Summary.

“I think all of us agree we’re all very disappointed,” said Sen. Andy Sanborn, R-Bedford. “We’re all struggling to understand why the program has not and has not been administering data.”

Speaking at the hearing, administrators for the program admitted its shortcomings.

Michael Bullek, chief of compliance at the N.H. Board of Pharmacy, said the board agrees “with the majority of the audit.” One factor initially driving the dysfunction, he said, was statutory. Initial laws governing the program prevented providers and dispensers from storing personal data longer than six months. That barrier was lifted in 2016, Bullek said, which should make the reports more comprehensive.

Kirk asked that the Board submit a report with a timeline of planned improvements ahead of the Fiscal Committee’s February meeting, to be followed up with subsequent monthly reports, Kirk added.

Meeting the deadline will allow the Legislature time to pass any bills necessary to fix the program, Kirk said. Unanimously, the committee voted the request through.

For his part, Bullek said he and program administrators plan to comply with the demands.

“We have our work cut out for us, he said. “And we will meet the deadline to present them with a plan for action.”

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)