A Performance Audit
An Audit Report on the Prescription Monitoring Program at the Board of Pharmacy
The Board of Pharmacy (Board) administers the Prescription Monitoring Program (PMP), which is designed to help prescribers and pharmacists identify and deter potential prescription drug misuse, diversion, and overdose. The PMP provides prescribers and pharmacists access to patients’ controlled-substance prescription history.
The Board has implemented processes and controls to help ensure that the data submitted to the PMP was sufficiently complete. However, the Board should strengthen certain controls to confirm that PMP data continues to be complete, reported within the required timeframe, and secured.
The Prescription Monitoring Program (PMP) provides prescribers and pharmacists access to a patient’s controlled-substance prescription history. PMP is designed to help prescribers and pharmacists identify, deter, or prevent potential prescription drug misuse, diversion, and overdose. PMP collects outpatient prescription data on all Schedule II through Schedule V controlled substances that pharmacies dispense in Texas or that pharmacies in another state dispense to a Texas resident . Pharmacies are required to report all dispensed controlled substance information to PMP AWARxE, the system used to manage PMP data. To strengthen patient prescription history, Texas shares PMP data with other states/entities to help monitor prescriptions dispensed to Texas patients across state lines.
PMP AWARxE Data Is Sufficiently Complete; However, the Board Should Continue to Strengthen Its Processes for Monitoring Pharmacies Not Submitting Prescription Records as Required
The Board implemented processes that ensured the information pharmacies reported to PMP was sufficiently complete. However, it should strengthen its processes for following up with pharmacies not submitting controlled-substance prescription records to PMP AWARxE as required.
While the Board Implemented a Clinical Alert to Help Identify Patients at Risk of Potential Drug Abuse, It Does Not Monitor to Determine Whether Pharmacists Reviewed Patients’ History as Required
The Board implemented a clinical alert notification process to help prescribers and pharmacists identify potentially harmful prescribing practices and to help mitigate the risk of controlled-substance misuse or abuse by patients. However, the Board did not immediately provide clinical alert notifications to the licensing agencies responsible for monitoring prescribers’ activity as required by statute. In addition, the Board had not implemented a monitoring process to verify that pharmacists reviewed patients’ prescription histories prior to dispensing certain controlled substances.
The Board Had Sufficient Contract Fiscal Controls; However, It Should Comply with Its Records Retention Policy and Vendor Performance Reporting Requirements
The Board had sufficient fiscal controls in place to process PMP AWARxE contract payments. However, it should maintain all contract documentation in accordance with records retention policy and report vendor performance as required by statute.
The Board had significant weaknesses in the controls to protect its data, which contains sensitive medical and other confidential information. To minimize security risks, auditors communicated details separately to the Board’s management in writing.
Pursuant to Standard 9.61 of the U.S. Government Accountability Office’s Generally Accepted Government Auditing Standards, certain information was omitted from this report because that information was deemed to present potential risks related to public safety, security, or the disclosure of private or confidential data. Under the provisions of Texas Government Code, Section 552.139, the omitted information is also exempt from the requirements of the Texas Public Information Act.
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