Hartford Business Journal

www.HartfordBusiness.com • July 30, 2018 • Hartford Business Journal 9 Q&A CT regulators hone in on prescription tracking T he deadly opioid crisis has weighed on state and federal lawmakers and regulators. The situation has pushed the National Institutes of Health to nearly double its pain and addiction research funding this year, and here in Connecticut, where more than 1,000 people died from overdoses in 2017, the overdose reversal drug Naloxone has become more accessible. Meanwhile, the legislature has enabled Connecti- cut's drug and pharmacy regula- tor, the Depart- ment of Consumer Protection, to boost its moni- toring of opioid prescriptions in recent years. This Q&A speaks with DCP Commis- sioner Michelle Seagull about the effort. Q. What are the aims of the state's prescription monitoring program? A. The Prescription Drug Monitor- ing Program (PDMP) is a database that contains information on controlled substances that are provided to pa- tients in the state. It is an important tool that aims to assist prescribers and pharmacists in making the best medi- cal decisions possible for patients. With the information in the PDMP, practitioners have a more complete pic- ture of their patient's medical condition and the other controlled substances the patient is taking. Q. It's important to note that Connecti- cut has been increasing its efforts to track prescriptions of opioids, benzo- diazepines and other controlled sub- stances for years now. Can you briefly explain how these efforts have evolved between 2013 and the present? A. While the PDMP has been collecting data since 2008, over the past several years, legislation has been passed to increase the usefulness of this tool by requiring that information be uploaded more quickly and utilized more regularly. In 2013, legislation was passed that required prescribers to register in the system, and pharmacies to upload dispensing information, activity that was previously optional. In 2015, new legislation required prescribers to review a patient's PDMP record prior to prescribing greater than a 72-hour supply of any controlled substance. In 2016, legislation required pharma- cies to upload dispensing information by the next business day, rather than within a week as was previously required. In addition to legislation, DCP has launched a number of educational programs and engaged in outreach to practitioners to increase the medical community's un- derstanding and use of the PDMP. Q. While the number of controlled- substance prescriptions tracked by the monitoring system has grown by more than 700,000 over the past four years, the number of opioid and benzodiaz- epine prescriptions has fallen. To what do you attribute those declines? A. There have been a lot of differ- ent efforts through- out the state to decrease opioid dependency. The declines in opioid and benzodiazepine prescriptions are in large part attrib- utable to increased awareness in the prescriber and pharmacist community about the dangers of high-risk prescrib- ing behavior. In addition, the greater availability of information through the PDMP has made it easier for prescribers to track the amount of these products that a patient may already be receiving. The state, medi- cal employers and nonprofits have all worked very hard to promote educational programs to address the opioid epidemic, and to make sure the PDMP is as easy as possible for practitioners to use. Q. Recently, DCP announced that Walmart's pharmacies were the first to integrate their data systems with the state's drug monitoring program. What does that entail? A. Integration of a pharmacy's software program or electronic health records and the monitoring program allows a healthcare professional to ac- cess PDMP information without leaving the software they are using for the rest of the patient interaction. This means pharmacists only need to log in to one program and can obtain a patient's con- trolled substance prescription history more rapidly. Ultimately, this should allow for more time to be spent focusing on the patient's healthcare needs. Q. Is connecting to the drug monitoring program mandatory? A. Connecting is not mandatory, but is a great step being taken by a number of facilities because it allows the informa- tion in the monitoring program system to become a seamless part of a patient's medical record. Many prescribers and pharmacies have been inquiring about integration so we anticipate seeing more in the near future, and are excited about those developments. Michelle Seagull Commissioner, Department of Consumer Protection FOCUS heart failure medication. That death rate is still quite high, according to Dr. Francis Kiernan, who holds an identical title to McKay at Hartford Hospital. But the high- est-risk patients are often very frail and sick. "Usually, most medical trials show a relatively small overall benefit in terms of survival, but this one showed a huge benefit," Kiernan said of the comparison between TAVR and non-surgical options. Hartford Hospital has been in- volved in TAVR trials with the two companies that make approved valves, Edwards Life Sciences and Medtronic, registering more than 120 patients over the past six years. "We've been involved in this from the very beginning as early adopters," said Dr. Robert Hagberg, Hartford Hospi- tal's chief of cardiothoracic surgery, who performs open-heart surgery. Participating in trials is a lot of work, but it allows the hospital to offer new options to patients, and raises the institution's overall profile, McKay said. Yale New Haven Health, too, has been involved in TAVR trials since the early days, and continues to study medical devices that would reduce the procedure's stroke risk, according to Dr. John Forrest, director of interven- tional cardiology and the structural heart disease program at YNNH. He said the system is now doing upwards of 250 procedures a year. Forrest says the improved qual- ity of life that frailer patients can achieve through TAVR should not be overlooked. "They just want to be able to play with their grandkids without not be- ing able to breathe," Forrest said. Proof is in the pudding An estimated 2.5 million people over the age of 75 have aortic steno- sis, and the large majority are male. Depending on the patient, TAVR could be a better choice than surgery. While doctors now know quite a bit about the procedure and its pros and cons, there's plenty left to learn before it can be adequately compared to open-heart surgery. For one, doctors can't say for certain yet if TAVR valves will last as long as those used in open-heart procedures. While the valves appear identical to the untrained eye, the TAVR process requires the valve to be crimped and compressed, which could have structural implications down the line. "There are early studies showing that longevity could be good, but all surgeons know you don't look at any valve durability data until it hits 10 years," Hagberg said. He said medical-device companies have been known to be aggressive in Continued on next page >> Dr. Mohiuddin Cheema, a cardiovascular and endovascular surgeon at Hartford Hospital.

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