Wrangling over coverage areas and big data, including how long private medical information would be preserved online, doomed the latest and one of the longest-lived iterations of Missouri’s statewide Prescription Drug Monitoring Program (PDMP).
State lawmakers have debated enacting a PDMP for around 12 years, differing before over privacy as well and continuing to leave Missouri the only state without a statewide version.
Key developments this spring — chiefly, a push among cities and counties to enact their own versions, and a break in statehouse opposition from longtime critic Sen. Rob Schaaf (R-St. Joseph) — gave this year’s measure serious legs.
Schaaf had filibustered against Rep. Holly Rehder’s (R-Sikeston) bill in previous years and put forth his own version. But he agreed in April to end his opposition provided her bill, House Bill 90, enacting the Narcotics Control Act, was amended with a provision that physicians be required to use the online database it would create.
This looked like HB 90’s year, until it wasn’t.
Among its provisions, the bill would have kept all prescription information confidential and not subject to public disclosure, with specified exceptions; made unlawfully and knowingly accessing or disclosing private information — regardless of whether a person was authorized to handle such information — a Class E felony; and kept dispensation information from being used to deny anyone the right to get or own a firearm.
But after Rehder’s bill cleared the House, the state Senate amended it to include a mandatory data purge every 180 days to preserve privacy; a six-year sunset; and restricted its application from all Schedule 2 through Schedule 4 drugs to only opioids and benzodiazepine drugs like Xanax.
On Wednesday, May 10, the House rejected the idea of approving the amended version simply to have a starting point from which to work, Rehder said.
The amendments were sticking points for the Missouri State Medical Association as well, according to Jeff Howell, its director of government relations.
Concerned that if the statewide PDMP passed as amended, county PDMPs — now set to cover more than half the state’s population — would be taken over by the state and subject to its less-stringent regulations, the association withdrew its support on Thursday, May 11.
Also lining up in opposition were the Missouri Pharmacy Association and St. Louis County, a major force behind county PDMPs. The county's director of communications told Government Technology the agency would have no comment on the statewide PDMP effort.
Lawmakers, whose legislative session ended at 6 p.m. Eastern Daylight Time on Friday, May 12, ran out of time to discuss the Senate-amended version of Rehder’s bill — and on the session's final day, its legs buckled under the weight of those amendments.
“The overarching position was, we didn’t want to jeopardize county programs that were robust and patient-friendly. The county doesn’t have a purge at all. Someone might lapse after three years or two years. A physician or subscriber would have been better able to see that,” Howell said, noting that the prescriber mandate Schaaf called for was not the breaking point.
County PDMPs cover Schedule 2 through Schedule 4 substances and don't come with a data purge, Howell pointed out.
“You don’t want to pass something just to put it in your trophy case and say ‘Hey, we’re not the last state any more.’ You can pass that if you want but it’s not going to be a good tool for doctors,” he added.
Rehder, some of whose family members have grappled with addiction, pronounced them “very disappointed” by the bill’s failure and said: “It’s definitely something a lot of people are counting on me for.” She called the 180-day data purge “hugely problematic,” but held out hope the Legislature, which does not reconvene until 2018, might be recalled sooner into a special session.
Minutes after the regular session ended, Gov. Eric Greitens hinted at that possibility, telling reporters "for these politicians, round 2 begins sooner than they think” according to The Associated Press.
Rehder said she’ll likely wait until December before deciding whether to bring forward a version of her bill for the 2018 legislative session — a choice largely informed by how county PDMPs are performing. No fan of the state Senate’s amendments, Rehder said one option might be to present a new version of the Narcotics Control Act that is more similar to the original, rather than pursue one closer to the failed amended version.
“I think that if it looks like we might be able to continue with the statewide path, then I’ll introduce a bill similar to what I introduced this year with the hope … that maybe they’ll look at the fact that the county program is functioning and more robust without these precautions,” Rehder said.
St. Louis County, which spans more than 500 square miles and is home to around 1 million people, went live on April 25, with the first phase of its PDMP, with second and third phases scheduled to be approved by local legislation and go live on July 1 and Oct. 1, respectively.
A total of 26 other county and municipal agencies have signed on as subscribers and enacted their own legislation and user agreements to join. Combined, these cover more than 3 million Missourians, Howell said, or more than half the state’s 2015 population, according to the U.S. Census Bureau.