Expanding Access to State Prescription Drug Monitoring Programs (AS73)

The National Association of Boards of Pharmacy PMP InterConnect Steering Committee and the National Association of State Controlled Substances Authorities (NASCSA) express general support for the VA's efforts to expand access to state Prescription Drug Monitoring Programs (PDMPs). However, they raise significant concerns regarding the breadth of "delegate" access, the definition of PDMPs, data storage, and federal preemption, urging the VA to collaborate with state administrators to protect patient privacy and state authority.

The American Pharmacists Association (APhA) supports the proposed rule to expand access to State Prescription Drug Monitoring Programs (PDMPs) to promote safer prescribing practices. They advocate for mandatory reporting by all controlled substance dispensers and emphasize that VA pharmacists must have access to this data to ensure patient safety and prevent medication diversion.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) supports the proposed rule to expand access to State Prescription Drug Monitoring Programs (PDMPs). They argue that the rule provides necessary regulatory clarity, improves patient safety by reducing the risk of drug interactions, and supports coordinated care for veterans.

The Veteran Benefit Desk, a veteran-founded educational resource, supports the proposed rule to expand access to State Prescription Drug Monitoring Programs. They recommend specific language updates to clarify the interaction with 38 U.S.C. 7332 and provide better guidance on the definition of "delegate" for practical implementation.

The American Academy of Hospice and Palliative Medicine (AAHPM) supports the VA's proposed rule to disclose data to State Prescription Drug Monitoring Programs (PDMPs) and to improve access for VA health care providers and their delegates. They emphasize that these changes are critical for patient safety, clinical efficiency, and ensuring that veterans receiving palliative care have access to necessary data.

The American Academy of Family Physicians (AAFP) supports the proposed rule to improve access to State Prescription Drug Monitoring Programs (PDMPs) to enhance patient safety and care coordination. They request specific clarifications to ensure that providing delegates with PDMP access does not inadvertently expand their prescribing authority or modify existing professional scopes of practice.

The Kansas State Board of Pharmacy opposes the proposed rule because it conflicts with state law, poses significant risks to patient privacy, and includes an unnecessary and overbroad federal preemption provision. While they support interstate data sharing, they argue the rule lacks sufficient oversight, fails to protect against unauthorized access, and requests a more narrowly tailored approach that preserves state regulatory authority.

The Washington State Department of Health supports the proposed rule to expand access to state Prescription Drug Monitoring Programs (PDMPs) for VA health care providers. However, they recommend specific safeguards to ensure access remains tied to direct clinical care, maintain state confidentiality protections, and limit the scope of federal preemption and "interoperability" definitions.

The New York State Department of Health opposes the proposed rule because it expands access to sensitive Prescription Drug Monitoring Program (PDMP) data to a broad range of non-clinical users and lacks sufficient protections for non-veteran patient privacy. The Department argues that the rule should narrow the definition of authorized users, exclude researchers from real-time data access, and establish strict parameters for data interoperability and retention.

The commenter opposes the proposed rule because it allows for overly broad access to Prescription Drug Monitoring Programs (PDMPs) by non-clinical delegates and automated systems, which they argue creates a "surveillance architecture." They express concern that PDMP data could be combined with subjective behavioral records to unfairly target veterans and request specific safeguards, including narrowed delegate definitions, audit trails, and veteran notice/correction rights.