Most doctors in South Carolina will soon be required to consult a statewide database of patients’ medical history as a way to combat the state’s rampant prescription painkiller problem.
The changes will direct any doctor who wants to bill either Medicaid or the state health plan to use the database that’s been voluntary since 2008, said Christian Soura, director of the state’s Department of Health and Human Services.
Announcements will likely go out in February on the mandate, which starts April 1, he told The Associated Press.
The South Carolina Medical Association supports the change, but “there will be some doctors unhappy about yet another step thrown into the mix,” said its CEO, state Rep. Todd Atwater.
“Some say it will slow me down another minute and half I don’t have, but really?” said Atwater, R-Lexington. “Sometimes you have to have a little inconvenience to do the right thing and get some of these opioids off the streets.”
The mandate will come three years after Inspector General Patrick Maley recommended it in a report, describing high-prescribers as either motivated by money or naively helping “doctor shoppers.” In response to his report, Gov. Nikki Haley created the Prescription Drug Abuse Prevention Council, which similarly concluded one year ago that mandating the database’s use is key to combatting abuse of OxyContin, Percocet and other opioids.
Similar mandates enacted in New York and Tennessee in 2012 resulted in drops of 75 percent and 36 percent, respectively, a year later in patients seeing multiple doctors for the same drugs, according to the Centers for Disease Control and Prevention’s 2014 Vital Signs report.
That report ranked South Carolina 11th highest nationwide in prescribing painkillers, with 102 prescriptions written for every 100 people.
“When you look at the impact of other states with similar policies, it’s harder to say, `I don’t want to spend another minute or two in front of the computer,”‘ Soura said of doctors’ decreasing resistance.
Technology improvements to the database were also critical to gaining their support and – according to officials – the reason for delaying the mandate.
A law passed in June 2014 required pharmacists to report daily on the controlled substances they sell, to ensure the database is regularly updated. But a clause specified that doctors and pharmacists don’t have to actually consult it before prescribing or dispensing medicine.
According to the council’s report six months later, just 21 percent of South Carolina’s prescribers had registered for the Prescription Monitoring Program and few of them actually used it.
Officials say that’s partly because registering required filling out paperwork, getting it notarized and mailing the application to DHEC. And only the prescribing doctor had a login to access the database.
Under improvements that went live Nov. 23, doctors can register online and set up an account for a delegate, such as a nurse, to run the queries. The new system also summarizes patients’ prescription history, calculates their daily opioid dose and generates an alert if their prescriptions already exceed the recommended amount, said Lisa Thomson, DHEC’s drug control director.
The changes were “about making the system user-friendly and not disrupting work flows,” said Bryan Amick, pharmacy director at the state’s Medicaid agency and a member of the Prescription Drug Abuse Prevention Council.
South Carolina will join 29 states that require doctors or pharmacists to consult a prescription database in at least certain circumstances. Nevada was the first to do so in 2007. Such a database exists in every state except Missouri, according to the National Alliance for Model State Drug Laws.
The decree will affect the vast majority of doctors in South Carolina, though the exact percentage is unclear. About 1 million South Carolinians get their health care through Medicaid, while the state health plan covers more than 460,000 people, when combining public employees, retirees, their spouses and dependents.