MAPS

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MAPS Michigan Automated Prescription System
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What is MAPS?Michigan Automated Prescription
System

• MAPS requires pharmacists, veterinarians and
  dispensing physicians to electronically report
  all controlled substances dispensed in Schedules
  2 - 5

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Tax Dollars

• No Tax Dollars used for MAPS
• 20.00 from each
• controlled substance registration
• SAME AMOUNT AS BEFORE

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What Benefit will the Practitioner obtain from
MAPS?

• The ability to access dispensing data state
  wide to determine all substances dispensed
  to a particular patient.

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Five Schedules

• Schedule I No accepted medical use.
• Schedule II Limited use but high abuse.
• Severe restrictions on prescribing. No refills
• Schedule III and IV Similar. Most opiates in III
  in combination with ASA or APAP.
• Benzodiazepines in IV. 5 refills/6 months
• Cough Syrups and Lyrica in Schedule V

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EXEMPT FROM REPORTINGMCLA 333.7333a

• 1. MEDICATIONS ADMINISTERED DIRECTLY TO PATIENTS
• 2. DISPENSING FROM A HEALTH FACILITY OR AGENCY
  LICENSED UNDER ARTICLE 17 BY A DISPENSING
  PRESCRIBER FOR NO MORE THAN A 48 HOUR SUPPLY
• 3. SAMPLES
• 4. SCHEDULE 5 EXEMPT NARCOTICS

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MCLA 333.7333a Access to MAPS data

• Health Professional Boards. Investigation
• Employee or agent of the Department
• State, Federal, or Municipal employee or agent
  whose duty is to enforce drug laws.
• State operated Medicaid program.
• Practitioner or pharmacist who certifies info is
  for treatment of bona fide current patient.
• Info used for bona fide drug related criminal
  investigatory or evidentiary purposes.

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ON-LINE REQUESTS PROCESSED FIRST. USUALLY WITHIN
MINUTES DURING BUSINESS HOURS

• FAXED REQUESTS TAKE LONGER.
• GENERALLY 1-2 BUSINESS DAYS.
• REQUIRES US TO CREATE PAPER.
• RECORDS SAVED ON PAPER VS DIGITAL RECORDS FOR
  ON-LINE

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Requires internet accessRequests and reports
may be mailed.
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FAXED REQUESTS ARE NOT AS SECURE AS ON-LINE

• ON-LINE REQUESTS USE 128 BIT ENCRYPTION SSL WHICH
  IS SAME AS THAT USED FOR FINANCIAL TRANSACTIONS
• FAX MAY BE ACCESSABLE TO ANYONE IN THE PHARMACY
  OR PHYSICIAN OFFICE.
• DIGITAL REPORTS MAY BE VIEWED ON SCREEN. PASSWORD
  AND LOGIN REQUIRED

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MAPS Reports

• Patients with common names.
• Almost 60 million records.
• Identifiers missing or inaccurate.
• Requires multiple reports.
• Possibility of combining records.
• All counted as one report.

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ABILITY TO GENERATE SYSTEM WIDE ALERTS AND
MESSAGES (PATIENTS)

• ON-LINE ANALYTICAL PROCESSING
• ABILITY TO SPOT TRENDS
• ABILITY TO DRILL DOWN TO SPECIFIC DATA.
• ABILITY TO SEARCH BY ANY COLLECTED CRITERIA.

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Patient BenefitsPain experts estimate as many
as 20 of patients not honest about drug
use.But, that means that 80 are honest
(majority)
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Over 300 doctor shoppers identified since 2004

• Majority involve hydrocodone (Schedule 3) which
  was due to old program monitoring only Schedule 2

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 October 15, 2006   Company FirstName
LastName Address1 City, State
PostalCode Dear Title   The Michigan
Automated Prescription System (MAPS) program has
identified your patient Patient, DOB,
Address2, who appears to be seeking treatment
from multiple physicians and obtaining controlled
substance prescriptions of a similar nature from
these practitioners.   It is suggested that
you obtain controlled substance prescription data
on the patient identified above and communicate
with other health care providers who are treating
this patient. You may access MAPS data via a link
on our website at www.michigan.gov/healthlicense
and click on the MAPS link. Enclosed please find
a listing of physicians in Michigan that provide
an office based treatment program for opiate
addiction that may be shared with the patient.
There are other options available in addition to
opiod treatment such as referral to a pain
specialist, or requiring the patient to enter
into an agreement which limits their treatment to
a specific physician and pharmacy. Please
consider all of the options that are available to
you and your patient.   If you have any questions
or need additional information, please contact
our office at the phone number listed below, or
at our e-mail address mapsinfo_at_michigan.gov.
  Sincerely,   Bureau of Health
Professions Health Investigation Division (517)
373-1737   Enc.

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Scripts Reported in 2003,2004,2005

• 12,498,338
• 13,689,728
• 14,355,989

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Scripts Reported Monthly

• 1.2 to 1.3 MILLION

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Total Data RequestsFor 2004

• 34,000
• Average of 190 Daily

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Requests for 2005Averaged over 200 daily.
60,000Majority are physicians
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MAPS REQUESTS 200690,000

• CURRENTLY AVERAGING 400 DAILY
• OVER TWO-THIRDS ON LINE

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2006 MAPS DATA

• Average of 400 requests daily
• Capture over 1.2 million scripts/month
• 75 of requests are done on-line
• On-line turnaround time
• During business hours.
• Number 1 reporting pharmacy?
• Medco Health in Las Vegas Nevada

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Schedule 2 scripts increased under MAPS

• No more serialized forms for Schedule 2. Patients
  probably received Schedule 3 analgesic
  (hydrocodone) instead before MAPS

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Increase in Schedule 2 scripts linked to improved
patient care regarding pain.

• Diversion of Schedule 2 doesnt appear to have
  increased. Increased incidence of prescription
  mills of 1970s.

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MAPS 2004

• Schedule 2 increased 15.8
• Schedule 3 increased 11.6
• hydrocodone increased 16.2
• Schedule 4 increased 9.4
• Schedule 5 decreased 2.2 (2.2)
• Grand Total Increase of 9.5
• Almost 14 million prescriptions.

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MAPS 2005

• Schedule 2 increased 7.7
• Schedule 3 increased 5.3
• hydrocodone increased 10.09
• Schedule 4 increased 1.05
• Schedule 5 increased 9.18 (Lyrica)
• Overall increase of 4.87
• Stadol decreased 12.65

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hydrocodone/acetaminophen

• Schedule 3
• Vicodin, Lorcet, Lortab, Norco, Anexsia
• 2003 3,174,922
• 2004 3,689,073 increase of 16.2
• 2005 4,061,462 increase of 10.09

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hydrocodone/acetaminophen

• Total 2005 prescriptions 14,355,989
• hydrocodone accounts for 28.29
• All prescriptions increased 9.5 in 2004
• All prescriptions increased 4.87 in 2005
• hydrocodone increased at more than twice the rate
  of increase for all others in 2005.

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DATA Drug Abuse And Treatment Act of 2000 office
based substance abuse treatment with
buprenorphine (Subutex, Suboxone)

• Danger to patient when buprenorphine mixed with
  benzodiazepines or other analgesics

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Physician registered with DEA and issued DEA
registration beginning with X

• Eight hours of training.
• Initially limited to 30 patients.
• Recently increased to 100.
• Records subject to same confidentiality as
  methadone and alcohol treatment records.
• Title 42 of the CFR

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Subutex Scripts in 2005 1,104 vs. 685 in
2004Suboxone Scripts in 2005 25,798vs.
11,919 in 2004naloxone
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Suboxone/Subutex in 2005

• Subutex 1,104 scripts
• Suboxone 25,798 scripts
• Overall increase of 123 in 2005
• Why large disparity?
• Reckitt Benckiser does not detail Subutex.

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Update of DATA 2000 for office based substance
abuse treatment with buprenorphine (Subutex,
Suboxone)

• Law changed in December 2006 and now allows
  practitioner to treat up to 100 patients instead
  of 30.

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Bureau taking over MAPS from contractor

• Bureau will be uploading disks and paper forms.
• Obtained 350K grant from Feds.
• Bureau will correct data or return to pharmacy.
• Normally would require minimum of 1 FTE.

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Bureau operating MAPS

• Labor will be shifted from viewing and approving
  reports in the next few months.
• MAPS will become automated and provide a limited
  amount of data 24/7.
• Estimated savings to Bureau of greater than
  600,000 annually.

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Recently installed new software on state owned
equipment

• GREATER EMPHASIS ON-LINE REPORTS.
• W-GET PROGRAM FOR UPLOADING RECORDS IF PHARMACY
  CHAIN HAS IT DEPARTMENT.
• TRACK PATIENTS AND PRESCRIPTIONS BY METHOD OF
  PAYMENT.

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MAPS UPGRADES

• Eliminate Social Security Numbers
• No identifier required if under 16 y/o
• Twice monthly reporting (near time)
• Require positive identification if patient not
  known to pharmacist or staff.
• Proposed Rules published on Bureau Web Site
  www.mi.gov/healthlicense.

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Prescribing controlled substance for self or
family.

• Long term prescribing of controlled substance
  considered by experts to be below minimal
  standards. Short term or emergency deemed
  acceptable. May cause concern for pharmacist.

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Pharmacist professional responsibility

• Rule 338.490 prohibits pharmacist from dispensing
  prescription if Prescription appears improperly
  written, multiple interpretations, possible harm
  to patient, non-legitimate purpose.

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Scope of practice MCLA 333.17751(3)

• Pharmacist or prescriber shall dispense a
  prescription only if the prescription falls
  within the scope of practice of the prescriber.