Nebraska Moves to Change PDMP

Nebraska is the first state to leverage the capabilities of a Prescription Drug Monitoring Program (PDMP) to require pharmacies to report all prescriptions using the ASAP standard format.  A PDMP helps healthcare providers identify patients at risk of drug misuse or abuse, prevent drug overdoses due to taking multiple prescriptions for the same condition, and flag patients who have been prescribed multiple drugs with abuse potential.  Most states currently only utilize PDMPs for tracking controlled substance prescriptions.

Nebraska’s PDMP, a public health model focusing on patient safety, is a statewide tool that collects dispensed prescription medication information that is housed on the CyncHealth (formerly known as the Nebraska Health Information Initiative or NeHII)[1] Health Information Exchange (HIE) platform.  DrFirst, an electronic health records (EHR) and health information systems IT company, manages the pharmacy data by capturing it and moving it to the PDMP.[2]

The Nebraska PDMP was launched in the beginning of 2017 as a stand-alone medication query platform.  Starting January 1, 2018, all dispensed prescriptions filled in the state have been reported to the PDMP so that clinicians can better monitor the care and treatment of their patients.  The PDMP is integrated within the CyncHealth HIE with the query platform to facilitate improved workflow for providers.[3]  DrFirst has focused efforts on integration with EHRs in Nebraska.[4]  This information is housed in a secure database and is available to healthcare professionals as authorized by law.  The PDMP allows prescribers and pharmacists to view those prescriptions to prevent the misuse of controlled substance prescriptions.[5]

If a prescription is dispensed by a pharmacy, it will be reported to the PDMP and show for other healthcare providers with access to review.  However, pharmaceuticals administered in a healthcare provider’s office or in the hospital will not be on the PDMP.  Also, anything administered in the pharmacy, such as vaccines, will not be on the PDMP.  Medical marijuana, CBD, and illicit drugs will also not be on the PDMP.[6]  Patients cannot opt out of the PDMP, and all prescriptions must be entered into the PDMP, even if the patient pays cash for the prescription and does not use a third-party payer.[7]

For healthcare providers, the PDMP provisioning and related registration processes may take approximately two weeks to complete.  Registration requires that all correct information is received and mandatory PDMP training is completed.[8]  In addition, healthcare providers must complete one-half hour of continuing education covering PDMP.  This requirement can be satisfied by watching the PDMP video on the Nebraska Department of Health and Human Services’ website and completing the training acknowledgment form and prescriber CME assessment.[9]


CyncHealth cites that the overall value of their PDMP process is in providing a comprehensive medication history of dispensed prescriptions from all dispensers within one day of dispensing.  The database will contain ten times the data compared to a normal PDMP used only for controlled substances.  This could allow healthcare providers to identify potential drug interactions involving medications from multiple prescribers filled in multiple pharmacies, although the ease of accessing this information will play a key role in its use.  There is no cost for healthcare providers to access and query the PDMP.  Its ease of access and the ability to integrate the PDMP into workflow will promote informed decisions by healthcare providers and encourage better conversations with patients to improve patient safety.[10]

In 2019, lawmakers in Nebraska began work to allow sharing patient prescription data between states and to improve interoperability between EHRs.  They also were working to add information like the number of refills to the data, which would benefit pharmacists.[11]

Based on the success of Nebraska’s PDMP expansion, PHSL expects that additional states could follow suit in the future, but data storage space requirements and patient privacy concerns may be a limiting factor.  Nebraska mentioned that they expect to use ten times more storage space for the PDMP expansion; for more populous states, this may be prohibitive.  Furthermore, getting all stakeholders to trust each other with access to this information will be a challenge.  Based on how the PDMP is configured and what safeguards are implemented, retailers may have concerns that the data they share could be used to identify their customers or what products they are dispensing.  Before more widespread PDMP usage is adopted, users will want to ensure their data is protected and cannot be used by competitors.



Posted August 18, 2021

2021 Summer Newsletter:

340B Market Dynamics: Role of Systems and Strategic Tactics presented at ASAP by Ann Johnson