Missouri will no longer be the only state without a prescription drug monitoring program after Gov. Eric Greitens issued an executive order Monday creating one.
Greitens’ order directs the Department of Health and Senior Services to build the database, which will be designed to help identify suspicious patterns of prescriptions of controlled substances, including opioids. The announcement was made at the St. Louis headquarters of Express Scripts, a pharmacy benefits management company.
“Like the plague, opioids kill the young, the old, the healthy, the sick, the virtuous and the sinful,” Greitens said in a prepared statement. “There’s not a corner of our state that hasn’t been visited by this curse.”
Forty-nine other states use monitoring programs to identify people who acquire excess prescriptions for addictive painkillers and tranquilizers, as well as the physicians who overprescribe them.
In every other state, doctors and pharmacists can access the database as they write and fill prescriptions, to see where else their patients are getting medications. Alexandra Dansicker, a policy analyst for the Missouri Foundation for Health, said that won’t be the case under Greitens’ order.
“Dispensers will be required to submit information, but the order does not seem to give dispensers access to the information,” Dansicker said by email. “The intent is to help identify the issues from the supply side of the equation, rather than looking at patient demand and doctor shopping.”
Greitens’ order instructs the health department to contract with pharmacy benefits managers, who work with insurers to hold down prescription costs, to use their prescriber data to look for inappropriate dispensing of controlled substances. It also instructs pharmacies to report to the states when they dispense controlled substances.
U.S. Sen. Claire McCaskill, a Missouri Democrat who has repeatedly called on elected leaders in Jefferson City to enact a statewide prescription drug monitoring program, questioned the effectiveness of Greitens’ order.
“While I certainly welcome the governor’s attention to this crisis, I have serious questions about how meaningful this action will be if doctors writing prescriptions — and pharmacists filling those prescriptions — don’t have access to this database,” she said in a statement. “The welcome mat is still out for drug dealers to shop for prescriptions in our state.”
Instead of an executive order, McCaskill said, state lawmakers should “get off the sidelines and pass a robust statewide program into law that gives law enforcement, pharmacies, and doctors the tools they need.”
Jeff Howell, the Missouri State Medical Association’s legislative liaison, said the governor had not consulted with his association, which represents the state’s physicians.
“It’s a surprise to everyone,” Howell said.
In a statement later Monday, Howell said the association was concerned doctors would not be able to access the prescription database.
“That is a very important component that we hope is part of the governor’s executive order,” Howell said. “If not, it will rob physicians of important information that is needed at the point-of-care to assist physicians in making treatment decisions.”
While longtime proponents of a prescription drug monitoring program were voicing concerns, one of the idea’s fiercest critics praised the governor’s order.
Opponents of a drug monitoring program in the Missouri General Assembly have argued that in other states with a database, patient privacy has been breached. They say a drug database infringes on personal liberty.
Sen. Will Kraus, a Lee’s Summit Republican who helped derail legislation this year that would have established a drug monitoring program, said the government should not be in the business of “creating databases to track law-abiding citizens.”
“This executive order focuses on the prescribers and distributors of medications, such as doctors and pharmacists, who are already regulated by the state,” Kraus said. “I appreciate the governor’s efforts to find a solution to the drug monitoring issue within our state without violating the rights of everyday citizens.”
Republican leaders in the Missouri House and Senate contacted by The Star Monday morning said they had not seen the governor’s executive order and were trying to track down a copy before offering a comment.
Later Monday afternoon, a spokesman for House Speaker Todd Richardson, a Poplar Bluff Republican, said he had no comment on the governor’s executive order.
Other lawmakers questioned the constitutionality of Greitens’ action.
“The executive branch cannot unilaterally allocate spending, so even if (the governor) has the power to create the program, which is highly in doubt, the legislature will have to fund its implementation,” said Sen. Jason Holsman, a Kansas City Democrat who sits on the legislative committee that will review any rules established by state agencies to implement the governor’s executive order.
Rep. Shamed Dogan, a St. Louis County Republican, said, “Governing by executive order because you couldn’t get a bill passed was wrong under Obama and it’s wrong today.”
It’s unclear how Greitens’ proposed drug database will affect local drug monitoring programs. Among the localities that set up their own databases are some of the state’s largest counties and cities: Jackson County, Kansas City, Independence, St. Louis and St. Louis County.
Howell also said the medical association didn’t want any statewide program that would weaken the county and city standards.
“If it is not at least as effective as that program, or if it turns out to be an impediment to that effort, then it will be a disservice,” Howell said.