Prescription Drug Monitoring Programs
Kristin M. Finklea
Specialist in Domestic Security
Erin Bagalman
Analyst in Health Policy
Lisa N. Sacco
Analyst in Illicit Drugs and Crime Policy
July 10, 2012
Congressional Research Service
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www.crs.gov
R42593
CRS Report for Congress
Pr
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Prescription Drug Monitoring Programs

Summary
In the midst of national concern over illicit drug use and abuse, prescription drug abuse has been
identified as the United States’ fastest growing drug problem. Nearly all prescription drugs
involved in overdoses are originally prescribed by a physician (rather than, for example, being
stolen from pharmacies). Thus, attention has been directed toward preventing the diversion of
prescription drugs after the prescriptions are dispensed.
Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of
prescriptions dispensed for controlled substances (i.e., prescription drugs of abuse that are subject
to stricter government regulation). Information collected by PDMPs may be used to support
access to and legitimate medical use of controlled substances; identify or prevent drug abuse and
diversion; facilitate the identification of prescription drug-addicted individuals and enable
intervention and treatment; outline drug use and abuse trends to inform public health initiatives;
or educate individuals about prescription drug use, abuse, and diversion as well as about PDMPs.
How PDMPs are organized and operated varies among states. Each state determines which
agency houses the PDMP; which controlled substances must be reported; which types of
dispensers are required to submit data (e.g., pharmacies); how often data are collected; who may
access information in the PDMP database (e.g., prescribers, dispensers, or law enforcement); the
circumstances under which the information may (or must) be accessed; and what enforcement
mechanisms are in place for noncompliance.
PDMP costs may vary widely, with startup costs ranging from $450,000 to over $1.5 million and
annual operating costs ranging from $125,000 to nearly $1.0 million. States finance PDMPs using
monies from a variety of sources including the state general fund, prescriber and pharmacy
licensing fees, state controlled substance registration fees, health insurers’ fees, direct-support
organizations, state grants, and/or federal grants. The federal government has established two
grant programs aimed at supporting state PDMPs: The Harold Rogers PDMP grant, administered
by the Department of Justice, and the National All Schedules Prescription Electronic Reporting
Act of 2005 (NASPER) grant, administered by the Department of Health and Human Services.
The Harold Rogers PDMP received $7.0 million in appropriations for FY2012; NASPER last
received appropriations (of $2.0 million) in FY2010.
State PDMPs vary widely with respect to whether or how information contained in the database is
shared with other states. While some states do not have measures in place allowing interstate
sharing of information, others have specific practices for sharing. An effort is ongoing to facilitate
information sharing using prescription monitoring information exchange (PMIX) architecture.
Currently, there are no national level standards for state PDMP information sharing and
interoperability. Legislation has been introduced in the 112th Congress that would take up these
issues (see, for example, Section 1141 of the Food and Drug Administration Safety and
Innovation Act (P.L. 112-144), the Medicare and Medicaid FAST Act (H.R. 3399, S. 1251), and
ID MEDS Act (H.R. 4292, S. 2254)).
The available evidence suggests that PDMPs are effective in reducing the time required for drug
diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and
reducing prescription drug abuse; however, research on the effectiveness of PDMPs is limited.
Assessments of effectiveness may also take into consideration potential unintended consequences
of PDMPs, such as limiting access to medications for legitimate use or pushing drug diversion
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activities over the border into a neighboring state. Experts suggest that PDMP effectiveness might
be improved by increasing the timeliness, completeness, consistency, and accessibility of the data.
Current policy issues that might come before Congress include the role of state PDMPs in the
federal prescription drug abuse strategy and the role of the federal government in interstate data-
sharing and interoperability. While establishment and enhancement of PDMPs enjoy broad
support, stakeholders express concerns about health care versus law enforcement uses of PDMP
data (particularly with regard to protection of personally identifiable health information) and
maintaining access to medication for patients with legitimate medical needs.

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Contents
Introduction...................................................................................................................................... 1
Prescription Drug Monitoring Programs (PDMPs) ......................................................................... 3
Program Operation .................................................................................................................... 4
Interstate Information Sharing and Interoperability .................................................................. 5
Compliance and Enforcement Mechanisms .............................................................................. 7
Program Costs ........................................................................................................................... 7
PDMP Financing ....................................................................................................................... 8
PDMP Effectiveness ........................................................................................................................ 9
Effectiveness Research.............................................................................................................. 9
Limitations of the Research..................................................................................................... 10
Potential Unintended Consequences ....................................................................................... 11
Potential to Increase Effectiveness .......................................................................................... 12
Federal Grant Programs for State PDMPs ..................................................................................... 13
Harold Rogers PDMP.............................................................................................................. 13
Grant Purpose Areas.......................................................................................................... 14
Appropriations................................................................................................................... 14
National All Schedules Prescription Electronic Reporting Act of 2005 (NASPER)............... 15
Grant Purpose Areas.......................................................................................................... 15
Appropriations................................................................................................................... 15
Program Comparison............................................................................................................... 16
Selected Policy Issues.................................................................................................................... 18
Role of PDMPs in the Federal Prescription Drug Abuse Strategy .......................................... 18
Balancing Stakeholder Concerns............................................................................................. 19
Federal Role in Interstate Information Sharing and Interoperability....................................... 20

Tables
Table 1. Harold Rogers Prescription Drug Monitoring Program Funding..................................... 14
Table 2. National All Schedules Prescription Electronic Reporting Act of 2005
(NASPER) Funding through FY2012 ........................................................................................ 16
Table 3. Comparison of the Harold Rogers Prescription Drug Monitoring Program
(PDMP) and the National All Schedules Prescription Electronic Reporting Act of 2005
(NASPER) .................................................................................................................................. 17

Contacts
Author Contact Information........................................................................................................... 21

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Introduction
In the midst of national concern over illicit drug use and abuse, prescription drug abuse has been
identified as the United States’ fastest growing drug problem.1 Seven million individuals aged 12
or older (2.7% of this population) were current nonmedical2 users of prescription—or
psychotherapeutic—drugs in 2010.3 Over 1 million emergency department visits involved
nonmedical use of pharmaceuticals in 2009.4
Leading the spike in prescription drug abuse is an “epidemic of prescription painkiller abuse.
Nearly three out of four prescription drug overdoses are caused by prescription painkillers” or
opiods.5 Prescription drug overdoses caused 20,044 deaths in the United States in 2008; of these,
74% (14,800) involved opioid pain relievers.6 Of those individuals who used prescription
painkillers non-medically in 2010, nearly three-quarters received the drugs from a friend or
relative—either for free, through a purchase, or via stealing the drugs.7 Aside from prescription
painkillers such as oxycodone, other commonly abused medications include benzodiazepines and
amphetamine-like drugs.
Florida has been cited as an epicenter of prescription drug abuse. Florida doctors prescribe “10
times more oxycodone pills than every other state in the country combined.”8 Data indicate that
2,488 individuals in Florida died from prescription drugs in 20099—averaging 6.8 prescription
drug-related deaths per day. Many have cited the burgeoning number of legal pain management

1 Office of National Drug Control Policy, Prescription Drug Abuse, http://www.whitehouse.gov/ondcp/prescription-
drug-abuse. Prescription drugs of abuse are often divided into the categories of pain relievers (e.g., oxycodone), central
nervous system stimulants (e.g., amphetamine), and central nervous system depressants (e.g., benzodiazepines). Pain
relievers that are subject to abuse may be called narcotics or opioids. Central nervous system depressants may be
further divided into tranquilizers (also called anxiolytics, used to reduce anxiety) and sedatives (also called sedative-
hypnotics, used to induce sleep). The term psychotherapeutics is sometimes used to capture all of these categories.
2 Nonmedical use of prescription drugs occurs when the drugs are used without a prescription or solely for the feeling
they cause. Terms such as misuse, abuse, dependence, and addiction are often used interchangeably with nonmedical
use, although each term may have its own definition within a specific context.
3 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration,
Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, September 2011,
http://www.oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.htm#Ch2. Hereinafter: 2010 National Survey on Drug
Use and Health. According to the survey, “current” was defined as using the drug within the past month.
4 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Drug
Abuse Warning Network, 2009: National Estimates of Drug-Related Emergency Department Visits, August 2011,
http://www.samhsa.gov/data/2k11/DAWN/2k9DAWNED/HTML/DAWN2k9ED.htm#High6. These are the most
recent data from the Drug Abuse Warning Network.
5 Centers for Disease Control and Prevention, Policy Impact: Prescription Painkiller Overdoses, December 19, 2011,
http://www.cdc.gov/homeandrecreationalsafety/rxbrief/. Hereinafter: Policy Impact: Prescription Painkiller Overdoses.
6 Centers for Disease Control and Prevention, Vital Signs: Overdoses of Prescription Opioid Pain Relievers - United
States, 1999-2008, November 4, 2011, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm. These are the
most recent data available.
7 2010 National Survey on Drug Use and Health.
8 Greg Allen, “The ‘Oxy Express’: Florida’s Drug Abuse Epidemic,” NPR, March 2, 2011, http://www.npr.org/2011/
03/02/134143813/the-oxy-express-floridas-drug-abuse-epidemic.
9 Florida Department of Law Enforcement, Drugs Identified in Deceased Persons by Florida Medical Examiners, 2009
Report, June 2010, http://www.fdle.state.fl.us/Content/getdoc/742e2162-c1de-4ecd-bce4-857a32c6f42e/2009-Drug-
Report.aspx.
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clinics and illegitimate clinics (or “pill mills”) as contributing to the epidemic.10 While Florida
has been noted for its legitimate and illegitimate prescription drug distribution, states throughout
the nation face the same threats from prescription drug abuse and have taken measures to prevent
and treat the abuse as well as to ensure the operation of legitimate prescription drug dispensaries
and pharmacies.
Nearly all prescription drugs involved in overdoses are originally prescribed by a physician
(rather than, for example, being stolen from pharmacies).11 Thus, attention has been directed
toward preventing the diversion of prescription drugs after the prescriptions are dispensed.
Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of
dispensed prescriptions for controlled substances. PDMP information can aid those in law
enforcement and/or health care in identifying patterns of prescribing, dispensing, or receiving
controlled substances that may indicate abuse.12
For over a decade, Congress has provided financial support for state-level PDMPs using
electronic databases. In 2002, Congress established the Harold Rogers PDMP grant, administered
by the Department of Justice (DOJ), to help law enforcement, regulatory entities, and public
health officials analyze data on prescriptions for controlled substances. Three years later,
Congress passed the National All Schedules Prescription Electronic Reporting Act of 2005
(NASPER) requiring the Secretary of Health and Human Services (HHS) to award grants to states
to establish or improve PDMPs.
The 112th Congress has demonstrated a particular interest in facilitating interoperability among
state-level PDMPs, as well as in establishing national programs.13 While the majority of PDMP-
related proposals in the 112th Congress would focus on enhancing state-level databases and
interstate information sharing, others have suggested establishing a national system. A related
issue that policymakers may consider is whether PDMPs and their interstate information sharing
platforms adequately protect personally identifiable and related health information and whether
they can ensure that patients with legitimate medical needs have access to prescriptions. Congress
may also exercise oversight with respect to the role of PDMPs in the Administration’s action plan
to combat the prescription drug epidemic;14 policymakers may question the extent to which the
Office of National Drug Control Policy (ONDCP), along with the other relevant departments and
agencies, has taken steps to accomplish these PDMP-related goals laid out in the plan.
This report provides an overview of PDMPs, including their operation, enforcement mechanisms,
costs, and financing. It also examines the effectiveness of PDMPs and outlines federal grants
supporting PDMPs. Finally, this report discusses relevant considerations for policymakers, such
as interstate data sharing, interoperability, and protection of health information.

10 Legislation has been introduced in the 112th Congress (e.g., the Pill Mill Crackdown Act of 2011 (H.R. 1065, S.
1760)) that would, among other things, provide specific penalties for operating a pill mill.
11 Policy Impact: Prescription Painkiller Overdoses.
12 Initiatives countering prescription drug abuse range from prevention and treatment to enforcement. These activities
include scheduling chemicals used in certain prescription drugs, supporting public awareness campaigns, bolstering law
enforcement, and providing assistance to states—in part through PDMPs. This report focuses on PDMPs.
13 Legislation has been introduced in the 112th Congress that would take up these issues (see, for example, Section 1141
of the Food and Drug Administration Safety and Innovation Act (P.L. 112-144), the Medicare and Medicaid FAST Act
(H.R. 3399, S. 1251), and ID MEDS Act (H.R. 4292, S. 2254)).
14 Office of National Drug Control Policy, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, 2011,
http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan.pdf.
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Prescription Drug Monitoring Programs (PDMPs)
PDMPs maintain statewide electronic databases of designated information on specified
prescription drugs dispensed within the states. Data are made available to individuals or
organizations as authorized under state law; these may include prescribers, law enforcement
officials, licensing boards, or others. Possible uses of PDMPs include
• supporting patient access to controlled substances for legitimate medical use;
• identifying or preventing drug abuse and diversion;
• facilitating the identification of prescription drug-addicted individuals and
appropriate intervention and treatment;
• outlining use and abuse trends to inform public health initiatives; and
• educating individuals about prescription drug use, abuse, and diversion.15
In addition to uses of PDMPs aimed at drug abuse and diversion, an explicit goal of PDMPs is
supporting access to controlled substances for legitimate medical use. This may best be
understood by viewing PDMPs in comparison to earlier, paper-based programs called multiple-
copy prescription programs. For example, in 1914 a New York state law required physicians to
use state-issued, serialized, duplicate prescription forms for certain drugs.16 Similarly, California
began a multiple-copy prescription program using triplicate forms for specified narcotics in 1939;
it expanded to monitor all schedule II narcotics in 1972 and schedule II non-narcotics in 1981.17
Studies of multiple-copy prescription programs found that many prescribers did not order the
required prescription forms, rendering them unable to prescribe specified controlled substances
even when medically appropriate.18 In addition, the ability to check a patient’s prescription
history using an electronic PDMP might give prescribers more confidence when considering the
use of drugs with high risk of abuse.
As of June 2012, 40 states had operational PDMPs, nine additional states and one territory
(Guam) had enacted PDMP legislation (but the programs were not yet operational), and one state
(Missouri) had pending PDMP legislation. The District of Columbia has neither an operational
PDMP nor PDMP legislation.19

15 National Alliance for Model State Drug Laws, Prescription Drug Monitoring Programs: A Brief Overview, August
17, 2010, http://www.namsdl.org/documents/PMPsBriefOverview8-17-2010.pdf.
16 Scott M. Fishman et al., “Regulating Opioid Prescribing Through Prescription Monitoring Programs: Balancing Drug
Diversion and Treatment of Pain,” Pain Medicine, vol. 5, no. 3 (2004), pp. 309-324.
17 Aaron M. Gilson et al., “Time Series Analysis of California’s Prescription Monitoring Program: Impact on
Prescribing and Multiple Provider Episodes,” Journal of Pain, vol. 13, no. 2 (2012), pp. 103-111.
18 Scott M. Fishman et al., “Regulating Opioid Prescribing Through Prescription Monitoring Programs: Balancing Drug
Diversion and Treatment of Pain,” Pain Medicine, vol. 5, no. 3 (2004), pp. 309-324.
19 Alliance of States with Prescription Monitoring Programs, Status of Prescription Drug Monitoring Programs
(PDMPs), June 13, 2012, http://www.pmpalliance.org/pdf/pmpstatustable2012.pdf. For a map, see
http://www.pmpalliance.org/pdf/pmpstatusmap2012.pdf.
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Program Operation
The entity responsible for administering the PDMP varies by state and may be pharmacy boards,
departments of health, professional licensing agencies, law enforcement agencies, substance
abuse agencies, or consumer protection agencies. Of the 49 authorized PDMPs, two-thirds are
administered by either state pharmacy boards (18) or health departments (15).20
Each state determines which entities dispensing prescriptions for controlled substances are
required to submit data to the PDMP. These entities can include hospitals and facilities, sole
practitioners, or wholesale distributors, among others.21 Some states also have statutory authority
to require out-of-state, mail order, and internet pharmacies to submit data to the PDMP regarding
prescription or controlled drugs dispensed to residents of the state. For instance, if a patient in
Alabama receives a prescription for a monitored drug from an out-of-state mail order pharmacy,
the mail order pharmacy must report the prescription to the Alabama PDMP.22 State laws also
indicate which schedules of controlled substances are monitored under each program (see text
box for a brief explanation of schedules), which information about the substances is submitted,
the means by which dispensers or dispensaries submit the required information, and the
timeframe under which information is submitted.
Access to information contained in the PDMP
Schedules of Controlled
database is determined by state law and varies by
Substances
state. The majority of states allow pharmacists and
The Control ed Substances Act (21 U.S.C. §801
practitioners to access information related to their
et seq.) establishes schedules for control ed
patients, and some also allow other entities—law
substances (including drugs), ranging from
enforcement, licensing and regulatory boards, state
schedule I (most restrictive) to schedule V (least
restrictive). Drugs on schedule I have no
Medicaid Programs, state medical examiners, and
currently accepted medical use in the United
research organization—to access the information
States and are not available by prescription.
under certain circumstances.24 State laws outline the
Drugs with recognized medical uses are on
procedures by which information from the PDMP
schedules II through V, with each successive
may be accessed.
schedule representing a lower risk of abuse.23
With respect to how the states identify and investigate cases of potential prescription drug
diversion or abuse, PDMPs may be classified as reactive or proactive. In essence, “[s]tates with
[r]eactive PDMPs ... generate solicited reports only in response to a specific inquiry made by a
prescriber, dispenser, or other party with appropriate authority” while “[s]tates with [p]roactive

20 Alliance of States with Prescription Monitoring Programs, Prescription Monitoring Frequently Asked Questions
(FAQ), 2012, http://www.pmpalliance.org/content/prescription-monitoring-frequently-asked-questions-faq.
21 Alliance of States with Prescription Monitoring Programs, Prescription Monitoring Program Model Act 2010
Revision, http://www.pmpalliance.org/pdf/PMPModelActFinal20100628.pdf.
22 National Alliance for Model State Drug Laws, States With Statutory Authority to Require Nonresident Pharmacies to
Report to Prescription Monitoring Program, December 28, 2011, http://www.namsdl.org/documents/
ReqmtofMailOrderandNonresidentPharmaciestoReporttoPMP_001.pdf.
23 For more information, please see CRS Report R40548, Legal Issues Relating to the Disposal of Dispensed
Controlled Substances, by Brian T. Yeh.
24 Alliance of States with Prescription Monitoring Programs, Prescription Monitoring Frequently Asked Questions
(FAQ), 2012, http://www.pmpalliance.org/content/prescription-monitoring-frequently-asked-questions-faq.
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PDMPs ... identify and investigate cases, generating unsolicited reports whenever suspicious
behavior is detected.”25
Interstate Information Sharing and Interoperability
State PDMPs vary widely with respect to whether or how information contained in the database is
shared with other states. While some states do not have measures in place allowing interstate
sharing of information, others have specific practices for sharing. These practices may be based
on factors such as agreed-upon reciprocity between states, or whether a request stems from an
ongoing investigation.26 As of February 2012, 28 states allowed for sharing PDMP information on
some level—with PDMPs in other states, with authorized PDMP users in other states, or both.27
Researchers have provided states with guidance in creating Memoranda of Understanding
(MOUs) for interstate data exchange. Questions that states may consider when drafting an MOU
include the following:28
• How is the information to be reported?
• How will the information be used by the relevant states?
• What are the guidelines on data retention?
• What are the state responsibilities in the event of a data breach?
• Are there measures in place for conflict resolution?
• What are the consequences of potential data misuse?
In addition, the Council of State Governments has highlighted four areas as central to the success
of interstate compacts regarding PDMPs and data sharing:
Education—responsibility of providers, data integrity, training requirements (start up versus
ongoing)[;]
Funding—state funding, costs of data sharing, costs of operation[;]
Security and Access—authorized users, authentication, audit trails, Internet access, vendor
security, reporting, privacy, confidentiality, use of data[; and]
Technology—data transfer and exchange, uniformity and standards, cost reduction,
compatibility, quality/error correction[.]29

25 Ronald Simeone and Lynn Holland, Executive Summary: An Evaluation of Prescription Drug Monitoring Programs,
Simeone Associates, Inc., http://www.namsdl.org/resources/PDMP%20Study%20Executive%20Summary.pdf.
26 National Alliance for Model State Drug Laws, Interstate Sharing of Prescription Monitoring Database Information,
February 8, 2012, http://www.namsdl.org/documents/InterstateSharingofPMPInformation02082012.pdf.
27 For a map depicting the interstate sharing of PDMP data, see http://www.namsdl.org/documents/
InterstateSharingofPMPData03142012.pdf.
28 Alliance of States With Prescription Monitoring Programs and Brandeis University’s Training and Technical
Assistance Center, Memorandum Of Understanding: Writing Guide for States with Prescription Monitoring Programs,
funded through a grant (No. 2010-DG-BX-K088) from the Bureau of Justice Assistance.
29 The Council of State Governments, National Center for Interstate Compacts, Prescription Drug Monitoring
Programs: Interstate Compact—National Advisory Panel, November 5-6, 2009, http://www.csg.org/pubs/capitolideas/
(continued...)
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An effort is ongoing to facilitate information sharing using prescription monitoring information
exchange (PMIX) architecture.30 The PMIX program is intended to enable the interstate exchange
of PDMP information, providing information on an individual’s prescription drug history across
states participating in the information exchange. This information can help identify potential
prescription drug abuse or diversion, and can help inform stakeholders such as law enforcement,
health and human services, health practitioners, and public regulatory agencies. A state can
participate in the PMIX program if it has
• legislation allowing it to share information with other states in real time,
• identified at least one other state as a partner in the information exchange, and
• either (1) established an MOU with their identified partner(s) in the information
exchange or (2) ratified the Prescription Monitoring Interstate Compact.31
The infrastructure of the PMIX program is based on the National Information Exchange Model,
which is a data sharing partnership between all levels of government as well as the private
sector.32 To facilitate information security and data privacy, data are encrypted while passing
through “hubs,” and no data are actually stored on these hubs. PMIX allows for hubs to exist at
the state and national levels, and it allows for hub-to-hub information exchange.33
With pharmaceutical industry support, the National Association of Boards of Pharmacy (NABP)
has developed a technology platform to facilitate interstate sharing of PDMP data, called
InterConnect, which NABP has committed to make compliant with PMIX architecture.34 NABP
anticipates that approximately 20 states will be sharing data using NABP InterConnect by the end
of 2012, including 14 that had executed MOUs to participate as of March 2012.35
Currently, there are no national level standards for state PDMP information sharing and
interoperability. Legislation has been introduced in the 112th Congress that would take up these
issues.36 Some bills would, among other things, examine the current interoperability of state level

(...continued)
enews/enewsissue38/21stCenturyHandout.pdf.
30 More information on PMIX can be found at http://www.pmpalliance.org/content/prescription-monitoring-
information-exchange-pmix. A pilot project between Kentucky and Ohio’s PDMPs formed the springboard for the
larger PMIX initiative. Through this pilot, a PMIX hub server was installed in Ohio, and Ohio and Kentucky signed an
MOU for data exchange, http://www.ijis.org/_programs/pdmp.html.
31 Alliance of States With Prescription Monitoring Programs, Prescription Monitoring Information Exchange (PMIX),
http://www.pmpalliance.org/content/prescription-monitoring-information-exchange-pmix. Draft language of the
compact is available at http://www.pmpalliance.org/pdf/PMPCompactLanguageDraft2010.pdf.
32 More information can be found at https://www.niem.gov/.
33 Alliance of States With Prescription Monitoring Programs, Prescription Monitoring Program Information Exchange
(PMIX) Architecture, Version 1.0, April 2012, http://www.pmpalliance.org/pdf/
PMIX%20National%20Architecture%20Document.pdf.
34 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, BJA Policy on Use of Harold
Rogers Prescription Drug Monitoring Program (HRPDMP) Funding to Support Interstate Data Sharing Activities, May
30, 2012, https://www.bja.gov/Programs/PDMPPolicy.pdf. This supersedes interim policy guidance documentation
dated March 21, 2012, and April 17, 2012.
35 National Association of State Boards of Pharmacy (NABP), Fact Sheet: NABP PMP InterConnect, 2012,
http://www.nabp.net/programs/assets/PMPInterconnectFactSheet.pdf.
36 For example, Section 1141 of the Food and Drug Administration Safety and Innovation Act (P.L. 112-144, as passed
both House and Senate) would authorize the Secretary of HHS, consulting with the Attorney General as appropriate, to
facilitate the development of recommendations on interoperability standards for interstate exchange of PDMP
(continued...)
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PDMPs,37 and others would establish national-level standards for the interoperability of state
PDMPs receiving federal funding.38
Compliance and Enforcement Mechanisms
In ensuring that a given state’s PDMP reflects comprehensive data from all relevant pharmacies,
physicians, and other dispensaries, one principal concern is how to ensure that these dispensaries
are reporting prescription data to the program. The laws or rules governing consequences for
failure to report data are determined by each state. For example, one consequence may be
disciplinary action by the appropriate licensing board or commission. Another may be that failure
to report information could trigger the PDMP program office to report the lapse in compliance to
the PDMP governing agency, which may then refer the information to law enforcement.39
Program Costs
PDMP expenses involve startup costs, funds needed to operate and maintain the programs, and
any monies used to enhance program operation and interoperability. Overall program costs can
entail
• hardware such as servers;
• software to run the PDMP database and ensure information security;
• connectivity such that pharmacies and dispensaries can enter data and such that
prescribers and/or law enforcement officials can request and access data;
• staff to administer the PDMP and provide technical assistance; and
• overhead fees.
A 2009 evaluation by the Maryland Advisory Council on Prescription Drug Monitoring assessed
existing state PDMPs on a range of factors including the costs associated with establishing and
maintaining the programs.40 The overarching finding was that costs vary widely, with program
startup costs ranging from $450,000 to over $1.5 million. Further, based on available data from
six operational PDMPs, results from the Maryland Advisory Council’s evaluation indicate that
annual operating costs range from $125,000 to nearly $1.0 million, with an average annual cost of
about $500,000. For example, the state of Florida estimated that it would “cost $480,000 dollars

(...continued)
information by states receiving federal grants to support their PDMPs.
37 See, for example, the Medicare and Medicaid FAST Act (H.R. 3399, S. 1251).
38 See, for example, the ID MEDS Act (H.R. 4292, S. 2254).
39 See, for example, Florida’s PDMP rule states that “Failure to report the dispensing of Schedules II-IV controlled
substances will result in the Program filing a complaint with the Department [of Health] for investigation and a referral
to law enforcement,” Rule 64K-1.004, https://www.flrules.org/gateway/RuleNo.asp?title=
Prescription%20Drug%20Monitoring%20Program&ID=64K-1.004.
40 Maryland Advisory Council on Prescription Drug Monitoring, Maryland Advisory Council on Prescription Drug
Monitoring Legislative Report, December 31, 2009, p. 76, http://dhmh.maryland.gov/laboratories/drugcont/docs/
Final%20Report%20of%20recommendations%20by%20the%20PDM%20Advisory%20Council%2012-31-09.pdf.
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to purchase and initially operate the system for one year” and that “[a]nnual operating costs after
that [would be] $450,000 per year.”41
The Maryland Advisory Council reported that
[c]ost variations are affected by the frequency of data collection (e.g., daily, weekly, bi-
weekly, monthly), the use of third party vendors for data collection and analysis, the number
of prescriptions written and filled in the state, the number of drug schedules (II-V) and drugs
of interest collected, and the use of official forms or other required collection and submission
mechanisms.42
A 2002 Government Accountability Office (GAO) evaluation of PDMP costs in Kentucky,
Nevada, and Utah revealed findings similar to those presented by the Maryland Advisory
Council. GAO noted a number of PDMP design and operational factors driving variations in state
costs for running PDMPs. Specifically, these involved “differences in the PDMP systems
implemented, the number of pharmacies reporting drug dispensing data, and the number of
practitioners and law enforcement agencies seeking information from the systems.”43
PDMP Financing
States finance the startup and operation of PDMPs through a variety of channels. PDMP
financing often involves monies from the state general fund, prescriber and pharmacy licensing
fees, state controlled substance registration fees, health insurers’ fees, direct-support
organizations, state or federal grants, or a combination thereof.44 Guidelines for how states may
fund PDMPs are outlined in each state’s PDMP authorizing legislation. For example, Oregon’s
PDMP has a fund within the state treasury. This fund receives monies, in part, from a proportion
of medical provider fees. These fees are paid to the appropriate medical board, and the board in
turn transmits a portion of these fees to the PDMP fund. The Oregon Department of Human
Services, which administers the PDMP, may also accept and deposit into the fund money from a
variety of additional sources, including grants and donations.45
Some states prohibit the use of certain sources of funding, thus limiting the potential range of
funding mechanisms. For instance, Florida law specifically prohibits the use of state funds or
funds received—directly or indirectly—from prescription drug manufacturers to support the

41 Executive Office of the Governor, Florida Office of Drug Control, Prescription Drug Monitoring Program
Frequently Asked Questions, http://drugcontrol.flgov.com/pdmp/faq.html.
42 Maryland Advisory Council on Prescription Drug Monitoring, Maryland Advisory Council on Prescription Drug
Monitoring Legislative Report, December 31, 2009, pp. 76-77. An earlier (2002) evaluation of PDMPs by the
Government Accountability Office (GAO) found similar reasons for variability in state costs for PDMP operation.
These variations were driven by “differences in the PDMP systems implemented, the number of pharmacies reporting
drug dispensing data, and the number of practitioners and law enforcement agencies seeking information from the
systems.”
43 U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce
Diversion, GAO-02-634, May 2002, p. 3, http://www.gao.gov/assets/240/234687.pdf.
44 Alliance of States With Prescription Monitoring Programs, Prescription Monitoring Programs: Funding
Mechanisms & Business Models, National Legislation & Implementation Meeting 2010, 2010, p. 3,
http://www.pmpalliance.org/pdf/PPTs/LI2010/PMP-FundingBusModels.pdf.
45 Oregon PDMP statute (ORS 431.960 et seq.), available at http://www.orpdmp.com/orpdmpfiles/PDF_Files/
ORS%20431.960%20PDMP.pdf.
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PDMP. As such, the program receives funding from three sources: the Florida PDMP Foundation,
Inc., an organization established in Florida law for the purpose of funding the PDMP; federal
grants; and private grants and donations.46
PDMP Effectiveness
The available evidence suggests that PDMPs are effective in some ways for both law enforcement
and health care purposes; however, research on the effectiveness of PDMPs is limited, especially
in the area of law enforcement. Assessments of effectiveness may also take into consideration
potential unintended consequences of PDMPs. Experts suggest that PDMPs have the potential to
be more effective.
Effectiveness Research
Research on PDMP effectiveness suggests that existence of a PDMP has an impact on both law
enforcement and health care. A 2002 GAO study found that “the time and effort required by law
enforcement and regulatory investigators to explore leads and the merits of possible drug
diversion cases” declined after PDMP implementation.47 The study found that Kentucky
investigations of alleged doctor shoppers took an average of 156 days prior to PDMP
implementation and 16 days after PDMP implementation (a 90% decrease). Nevada and Utah
reported decreases in investigation time of 83% and 80%, respectively. These decreases in
investigation time do not necessarily translate into less prescription drug abuse.
A 2012 review article summarized all peer-reviewed research articles about PDMPs published
between 2001 and 2011, which amounted to 11 articles (not all of which addressed
effectiveness).48 The author concluded that PDMPs reduce “doctor shopping,” change prescribing
behavior, and reduce prescription drug abuse. For example, a 2006 federally funded study
(included in the 2012 review article) found that PDMPs—especially ones that issue reports
proactively—change prescriber behavior in a way that reduces the per capita supply of
prescription pain relievers and stimulants, which in turn reduces the likelihood of abuse.49 A study
published in 2012 (and therefore not included in the review) found that while opioid abuse was
increasing over time, the rate of increase was slower in states with PDMPs than in states
without PDMPs.50

46 Florida Department of Health, Funding the E-FORSCE System, http://www.doh.state.fl.us/mqa/PDMP/funding.html.
47 U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce
Diversion, GAO-02-634, May 2002, p. 3, http://www.gao.gov/assets/240/234687.pdf.
48 Julie Worley, “Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and
Directions for Future Research,” Issues in Mental Health Nursing, vol. 33, no. 5 (2012), pp. 319-328. Note: The GAO
study was not included, because it was not published in the peer-reviewed literature.
49 Ronald Simeone and Lynn Holland, An Evaluation of Prescription Drug Monitoring Programs, Simeone Associates,
Inc., No. 2005PMBXK189, September 1, 2006, http://www.simeoneassociates.com/simeone3.pdf. This study was
commissioned by the U.S. Department of Justice (DOJ), Office of Justice Programs (OJP), Bureau of Justice
Assistance (BJA).
50 Liza M. Reifler et al., “Do Prescription Monitoring Programs Impact State Trends in Opioid Abuse/Misuse,” Pain
Medicine, no. 13 (2012), pp. 434-442.
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Limitations of the Research
Research regarding PDMP effectiveness is limited, at least in part, by the difficulties inherent in
conducting such research. Challenges in conducting high-quality research on PDMP effectiveness
include (but are not limited to) (1) defining effectiveness, (2) accounting for differences among
PDMPs, and (3) considering potential confounding factors.
In order to study effectiveness, researchers must first define effectiveness in a way that can be
systematically measured as a study outcome. PDMPs are statewide programs; thus, researchers
look for outcome measures that are available statewide. Some outcomes that have been measured
in research on PDMP effectiveness are shipment and sales of controlled substances,
benzodiazepine use in a Medicaid population, opioid consumption, substance abuse treatment
admissions, drug overdose mortality, and multiple provider episodes (i.e., doctor shopping).51 On
the one hand, opioid consumption includes both nonmedical use of opioids and medically
appropriate use of opioids to manage pain. On the other hand, a count of substance abuse
treatment admissions fails to capture substance abuse that goes untreated. Each of these measures
presents only a portion of the picture of prescription drug diversion and abuse.
Studies that compare states with and without PDMPs and/or before and after implementation of a
PDMP vary in the degree to which they account for differences among PDMPs. For example,
despite evidence that proactive PDMPs are more effective than reactive PDMPs, most studies do
not distinguish between proactive and reactive PDMPs. Another difference that may influence
PDMP effectiveness is in which drugs are required to be reported to the PDMP, ranging from only
those drugs with the highest potential for abuse to all prescription controlled substances plus other
drugs of concern. Research generally focuses on those controlled substances that are included in
all of the PDMPs being examined. Differences in PDMPs over time may also influence
effectiveness. For example, some states have transitioned from paper-based systems for
monitoring prescriptions for controlled substances to the electronic PDMPs used today.
Effectiveness studies have generally not accounted for such transitions over time, classifying two
different systems as the same PDMP. Accounting for these and other differences between PDMPs
may shed light on factors that influence effectiveness.
Researchers must also consider factors that may confound study results, both when comparing
outcomes across states (i.e., those with and without PDMPs) and when comparing outcomes over
time (i.e., before and after PDMP implementation). For example, the baseline rate of prescription
drug abuse may vary across states; the authors of the federally funded study noted that the
likelihood of abuse was actually higher in states with PDMPs than in states without PDMPs, but
that proactive PDMPs inhibited the rate of increase in prescription drug abuse.52 A PDMP may be
part of a larger effort to reduce prescription drug diversion and abuse, in which case other
initiatives may be responsible for any change in the outcome. A seemingly unrelated event, such
as an economic downturn or upturn, may also affect the outcome. These considerations, among

51 See summaries of several studies conducted between 2001 and 2011 in Julie Worley, “Prescription Drug Monitoring
Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research,” Issues in
Mental Health Nursing, vol. 33, no. 5 (2012), pp. 319-328; see also Liza M. Reifler et al., “Do Prescription Monitoring
Programs Impact State Trends in Opioid Abuse/Misuse,” Pain Medicine, vol. 13, no. 3 (2012), pp. 434-442; and Aaron
M. Gilson et al., “Time Series Analysis of California’s Prescription Monitoring Program: Impact on Prescribing and
Multiple Provider Episodes,” Journal of Pain, vol. 13, no. 2 (2012), pp. 103-111.
52 Ronald Simeone and Lynn Holland, An Evaluation of Prescription Drug Monitoring Programs, Simeone Associates,
Inc., No. 2005PMBXK189, September 1, 2006, http://www.simeoneassociates.com/simeone3.pdf.
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many others, impede the ability of researchers—and therefore policymakers—to draw
conclusions about the effectiveness of PDMPs.
Potential Unintended Consequences
PDMPs may have unintended consequences beyond reducing prescription drug diversion and
abuse.53 Prescribers may hesitate to prescribe medications monitored by the PDMP—even for
appropriate medical use—if they are concerned about potentially coming under scrutiny from law
enforcement or licensing authorities. Studies of paper-based prescription monitoring programs
that preceded the electronic PDMPs found that many prescribers did not order the required
prescription forms, rendering them unable to prescribe specified controlled substances at all.
Their concerns may lead prescribers to replace medications that are monitored by the PDMP with
medications that are not monitored by the PDMP, even if the unmonitored medications are
inferior in terms of effectiveness or side effects. Studies showed that after benzodiazepines were
added to New York’s paper-based program in 1989, a decrease in benzodiazepine prescriptions
was accompanied by an increase in prescriptions for other sedatives. Individuals whose intent is
to use controlled substances for nonmedical purposes may also substitute unmonitored
prescription drugs or street drugs for those that are monitored by the PDMP.
Like prescribers, patients may fear coming under scrutiny from law enforcement if they use
medications monitored by the PDMP, even if they have a legitimate medical need for the
medications. Patients may worry about changes in prescribing behavior, which may limit their
access to needed medications. Patients may worry about the additional cost of more frequent
office visits if prescribers become more cautious about writing prescriptions with refills. Patients
may also have concerns about the privacy and security of their prescription information if it is
submitted to a PDMP.
Another potential unintended consequence of a state PDMP is that it may push drug diversion
activities over the border into a neighboring state with no PDMP. A GAO study, completed in
2002, found evidence of this spillover across state lines.54 This concern is one of the reasons
interstate data sharing and interoperability have become priorities. Similarly, a PDMP may push
drug diversion activities into a neighboring state with a PDMP that does not monitor as many
medications. In any of these cases, the effectiveness of the PDMP may be offset by unintended
consequences.
A PDMP may also have positive unintended consequences. For example, when accessing
information from a PDMP, a prescriber or dispenser may identify a patient who is receiving
legitimate prescriptions for multiple controlled substances and who is therefore at risk of harmful
drug interactions.55 PDMPs may also enable prescribers to monitor their own DEA number to
determine whether someone else is using it to forge prescriptions.56

53 Most of the unintended consequences identified in this section are discussed in Scott M. Fishman et al., “Regulating
Opioid Prescribing Through Prescription Monitoring Programs: Balancing Drug Diversion and Treatment of Pain,”
Pain Medicine, vol. 5, no. 3 (2004), pp. 309-324.
54 U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce
Diversion, GAO-02-634, May 2002, p. 3, http://www.gao.gov/assets/240/234687.pdf.
55 Jeanmarie Perrone and Lewis S. Nelson, “Medication Reconciliation for Controlled Substances—An “Ideal”
Prescription-Drug Monitoring Program,” New England Journal of Medicine, vol. 366, no. 25 (2012), p. 2341-2343.
56 Ibid.
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Potential to Increase Effectiveness
A PDMP is essentially a source of information; its effectiveness depends largely on the quality of
the information and how the information is used.57 The quality of PDMP information depends on
its timeliness, completeness, accuracy, and consistency. Expert recommendations to enhance data
quality include
• collecting data at the point of sale (in real time);
• monitoring all prescribed controlled substances and other drugs of concern;
• integrating electronic prescribing technology;
• sharing data between states;
• standardizing the content across states;
• identifying the person picking up the prescription (which may be someone other
than the patient, such as a family member); and
• linking prescription records for an individual (to avoid confusion if, for example,
an address changes or a name is spelled differently).
In order for PDMP information to be well used, it must be accessible. A survey of prescribers
found that the most common reason given for not using a PDMP was the time required to access
it (73%); two other reasons—difficult navigation of the web portal (29%) and forgetting the
password (28%)—may contribute to the amount of time required to access PDMP information.
More than a third of survey respondents (39%) felt that accessing PDMP information would not
change their practice for that patient, although research suggests PDMP information changes
prescribing behavior. Relatively small numbers of respondents reported that lack of computer
availability (9%) or never having applied for access (11%) were barriers to using a PDMP.58
Expert recommendations to enhance data use include
• providing easy online access;
• issuing automated, unsolicited reports; and
• increasing participation through education and promotional campaigns.
Experts recommend making PDMP information available for research and public health purposes,
which would require permitting access by designated non-prescribers (e.g., researchers and
medical examiners). An example of a public health use of PDMP information is to identify
patients for enrollment in special programs: Washington state used its PDMP to select Medicaid
enrollees for a Patient Review Coordination Program, which decreased emergency department
visits, physician visits, and prescriptions (resulting in an average savings of $6,000 per patient per

57 Unless otherwise indicated, recommendations in this section are drawn from two sources: (1) Prescription
Monitoring Program Center of Excellence at Brandeis University, “A New Generation of Prescription Monitoring
Programs: Adopting Best Practices,” presentation at Harold Rogers PDMP National Meeting, Washington, DC, June 4-
6, 2012; and (2) Jeanmarie Perrone and Lewis S. Nelson, “Medication Reconciliation for Controlled Substances—An
“Ideal” Prescription-Drug Monitoring Program,” New England Journal of Medicine, vol. 366, no. 25 (2012), p. 2341-
2343.
58 Jeanmarie Perrone and Lewis S. Nelson, “Medication Reconciliation for Controlled Substances—An “Ideal”
Prescription-Drug Monitoring Program,” New England Journal of Medicine, vol. 366, no. 25 (2012), p. 2341-2343.
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year).59 PDMP data may also be analyzed to identify geographic areas where interventions (such
as increased law enforcement attention or establishment of a substance abuse clinic) are most
needed. Carefully controlled access to de-identified data for research and public health purposes
may yield other uses.
Federal Grant Programs for State PDMPs
The federal government has established two grant programs aimed at supporting state PDMPs—
the Harold Rogers PDMP and the National All Schedules Prescription Electronic Reporting Act
of 2005 (P.L. 109-60, NASPER). The sections that follow provide an overview of each program.
Harold Rogers PDMP
The Harold Rogers PDMP is a discretionary, competitive grant program administered by the U.S.
Department of Justice (DOJ), Office of Justice Programs (OJP), Bureau of Justice Assistance
(BJA). It was created to help law enforcement, regulatory entities, and public health officials
analyze data on prescriptions for controlled substances.60 Law enforcement uses of PDMP data
include (but are not limited to) investigations of physicians who prescribe controlled substances
for drug dealers or abusers, pharmacists who falsify records in order to sell controlled substances,
and people who forge prescriptions.61
The program assists states (including U.S. territories) in the planning, implementation, and
enhancement of their PDMPs. This involves
• establishing data collection and analysis systems to bolster the drug abuse
prevention efforts of law enforcement, regulatory entities, and public health
officials;
• enhancing existing PDMPs’ use of data in order to identity trends in drug abuse
and sources of diversion as well as increase the number of PDMP users;
• participating in national efforts to evaluate the efficiency and effectiveness of
PDMPs;
• implementing and enhancing the interstate exchange of information to prevent
diversion;
• assessing the efficiency and effectiveness of existing PDMPs and encouraging
other states to implement programs; and
• enhancing collaboration between law enforcement, prosecutors, treatment
professionals, medical community members, and pharmacies to create a
comprehensive PDMP strategy.62

59 Washington state update presented at Harold Rogers PDMP National Meeting, Washington, DC, June 4-6, 2012.
60 More information on this program can be found at from the U.S. Department of Justice, Bureau of Justice Assistance,
Harold Rogers Prescription Drug Monitoring Program, http://www.ojp.usdoj.gov/BJA/grant/prescripdrugs.html.
61 U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control,
http://www.deadiversion.usdoj.gov.
62 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, Harold Rogers Prescription
(continued...)
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Grant Purpose Areas
States may apply for Harold Rogers PDMP grants in one of three categories: planning,
implementation, or enhancement.63
• Planning Grants. States that do not have an operational PDMP may apply for
planning grants of up to $50,000, regardless of whether they have regulations or
legislation requiring a PDMP.
• Implementation Grants. States with legislation or regulations requiring the
centralized collection of prescription drug dispensing data and/or designating the
oversight or implementation of such a PDMP to a state agency may apply for
implementation grants of up to $400,000.
• Enhancement Grants. States seeking to enhance or expand their existing
PDMPs may apply for enhancement grants of up to $400,000.
PDMP conformance to prescription monitoring information exchange (PMIX) architecture is an
explicit goal of BJA, and grant funding may be used for implementation of PMIX architecture-
compliant hub solutions (among other things).64
Appropriations
The program began receiving federal funding in FY2002 through the Departments of Commerce,
Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 2002 (P.L. 107-77).
While the program itself has never been authorized in statute, funding for the program has been
provided to DOJ each year through the annual appropriations process. Annual appropriations
information is listed in Table 1.
Table 1. Harold Rogers Prescription Drug Monitoring Program Funding
(In millions of dollars)
Fiscal Year
Appropriation
2002 $2.00
2003 $7.50
2004 $7.00
2005 $10.00
2006 $7.50
2007 $7.50

(...continued)
Drug Monitoring Program FY 2010 Competitive Grant Announcement, p. 1, http://www.ojp.usdoj.gov/BJA/grant/
10PDMPsol.pdf.
63 Ibid., pp. 2 – 3.
64 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, BJA Policy on Use of Harold
Rogers Prescription Drug Monitoring Program (HRPDMP) Funding to Support Interstate Data Sharing Activities, May
30, 2012, https://www.bja.gov/Programs/PDMPPolicy.pdf. This supersedes interim policy guidance documentation
dated March 21, 2012, and April 17, 2012.
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Fiscal Year
Appropriation
2008 $7.05
2009 $7.00
2010 $7.00
2011 $5.80
2012 $7.00
Source: FY2002 data from P.L. 107-77; FY2003 data from P.L. 108-7; FY2004 data from P.L. 108-199; FY2005
data from P.L. 108-447; FY2006 data from P.L. 109-108; FY2007 data from P.L. 110-5; FY2008 data from P.L.
110-161; FY2009 data from P.L. 111-8; FY2010 data from P.L. 111-117; FY2011 data are based on CRS analysis
of the text of P.L. 112-10; FY2012 data from P.L. 112-55.
National All Schedules Prescription Electronic Reporting Act of
2005 (NASPER)
The NASPER PDMP grant is a formula grant administered by the Department of Health and
Human Services (HHS), Substance Abuse and Mental Health Services Administration
(SAMHSA), Center for Substance Abuse Treatment (CSAT). The National All Schedules
Prescription Electronic Reporting Act of 200565 amended the Public Health Service Act66 to
require the Secretary of HHS to award grants to states67 to establish or improve PDMPs.
Specifically, NASPER is intended to provide grant support to states to establish PDMPs that will
allow health care providers to access prescription history information in order to identify patients
at risk for addiction. It also requires that local, state, and federal law enforcement agencies have
access to the database. Of note, however, the grants to states under NASPER are only for the
PDMP; they do not fund any substance abuse treatment services.
Grant Purpose Areas
The two objectives of NASPER are to (1) foster the establishment of state-administered PDMPs
that providers can access for the early identification of patients at risk for addiction in order to
initiate appropriate interventions, and (2) establish a set of best practices for new PDMPs and
improvement of existing PDMPs.
Appropriations
Funding was authorized for NASPER beginning in FY2006. The program began receiving
appropriations in FY2009. The final continuing resolution for FY2011 (P.L. 112-10) specifically
prohibited the funding of NASPER.68 Annual authorizations of appropriations and actual
appropriations are listed in Table 2.

65 Unless otherwise noted, all information in this section on NASPER comes from the text of P.L. 109-60.
66 42 U.S.C. §280g et seq.
67 States are defined as each of the 50 states and the District of Columbia
68 Department of Defense and Full-Year Continuing Appropriations Act, 2011 (P.L. 112-10 §1815(a)(2)).
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In order to be eligible for NASPER grant funding, states must meet certain requirements, such as
having legal authority to implement PDMPs. All states that submit applications and meet the
requirements receive grants non-competitively. The amount awarded to each state is defined by a
two-part formula:
1. Each state receives a base amount of 1% of the total funding (i.e., $20,000 in
FY2010).
2. The remaining amount is distributed according to the ratio of the number of
pharmacies in the individual state to the number of pharmacies in all states with
approved applications.
Thirteen states received grants under NASPER in FY2010, the last year of funding.69
Table 2. National All Schedules Prescription Electronic Reporting Act of 2005
(NASPER) Funding through FY2012
(In millions of dollars)
Authorization of
Fiscal Year
Appropriation Appropriation
2006 $15.00
$0.00
2007 $15.00
$0.00
2008 $10.00
$0.00
2009 $10.00
$2.00
2010 $10.00
$2.00
2011 NA
$0.00
2012 NA
$0.00
Source: Authorizations of appropriations through FY2010 from P.L. 109-60. Appropriations through FY2010
from Department of Health and Human Services, Fiscal Year 2011, Substance Abuse and Mental Health Services
Administration, Justification of Estimates for Appropriations Committees. Appropriations for FY2011 from P.L.
112-10. Appropriations for FY2012 from P.L. 112-74.
Note: NA = not authorized.
Program Comparison
Table 3 provides an overview and comparison of the Harold Rogers PDMP and the NASPER
PDMP. Basic information is provided on program legislation, administering agencies, program
objectives, performance measures, grant types, authorization of appropriations, and actual
appropriations.

69 U.S. Department of Health and Human Services, TAGGS - Tracking Accountability in Government Grants System,
http://taggs.hhs.gov/AdvancedSearch.cfm.
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Table 3. Comparison of the Harold Rogers Prescription Drug Monitoring Program
(PDMP) and the National All Schedules Prescription Electronic Reporting Act of
2005 (NASPER)
Harold
Rogers
NASPER
Legislation
Departments of Commerce, Justice, and State, the National All Schedules Prescription Electronic
Judiciary, and Related Agencies Appropriations
Reporting Act of 2005 (P.L. 109-60)

Act, 2002 (P.L. 107-77)
Administering Agency
U.S. Department of Justice (DOJ), Office of Justice U.S. Department of Health and Human Services
Programs (OJP), Bureau of Justice Assistance (BJA) (HHS), Substance Abuse and Mental Health

Services Administration (SAMHSA), Center for
Substance Abuse Treatment (CSAT)
Program Objectives
Help states to plan, implement, and enhance their
Two objectives:
PDMPs.

1. Foster the establishment of state-administered
PDMPs that providers can access for the early
identification of patients at risk for addiction in
order to initiate appropriate interventions.
2. Establish a set of best practices for new
programs and improvement of existing programs.
Grant Funding
Discretionary, competitive grants with three
Formula grant program in which each state with
categories: planning, implementation,
an approved application receives funding

enhancement.
according to the fol owing two-part formula:
1. Each state receives a base amount of 1% of the
total funding.
2. The remaining amount is distributed according
to the ratio of the number of pharmacies in the
individual state to the number of pharmacies in all
states with approved applications.
The HHS Secretary may adjust the amount
allocated to a state, after taking into consideration
the estimated cost of the state’s PDMP.
Authorization of
While the program itself has never been
Authorizes to be appropriated $15.00M per year
Appropriations
authorized in statute, funding for the program has
from FY2006–FY2007 and $10.00M per year from
been provided to DOJ each year since FY2002
FY2008–FY2010.

through the annual appropriations process.
Appropriations
Appropriated $2.00M in FY2002, $7.50M in
No funds were appropriated for FY2006–FY2008;
FY2003, $7.00M in FY2004, $10.00M in FY2005,
appropriated $2.00M per year in FY2009 and

$7.50M in FY2006, $7.50M in FY2007, $7.05M in
FY2010; funding prohibited in final continuing
FY2008, $7.00M in FY2009, $7.00M in FY2010,
resolution for FY2011. No funds were
$5.8M in FY2011, and $7.00M in FY2012.
appropriated for FY2012.
Source: CRS summary of information from the following sources:
For the Harold Rogers PDMP, CRS summary of U.S. Department of Justice, Bureau of Justice Assistance, Harold
Rogers Prescription Drug Monitoring Program, http://www.ojp.usdoj.gov/BJA/grant/prescripdrugs.html, P.L. 107-77,
P.L. 108-7, P.L. 108-199, P.L. 108-447, P.L. 109-108, P.L. 110-5, P.L. 110-161, P.L. 111-8, P.L. 111-117, CRS
analysis of the text of P.L. 112-10, and P.L. 112-55.
For NASPER, CRS summary of the National All Schedules Prescription Electronic Reporting Act of 2005 (P.L.
109-60); Department of Health and Human Services, Fiscal Year 2011, Substance Abuse and Mental Health
Services Administration, Justification of Estimates for Appropriations Committees; P.L. 112-10 Sec.1815(a)(2);
and P.L. 112-74.
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Selected Policy Issues
Role of PDMPs in the Federal Prescription Drug Abuse Strategy
In response to the trend in prescription drug abuse, in April 2011 the Obama Administration
released an action plan to respond to the “epidemic.”70 This plan, from ONDCP, outlines four
primary areas that may reduce the abuse of prescription drugs: educating individuals on the safe
use of prescription drugs and risks involved in abusing them; implementing prescription drug
monitoring programs (PDMPs) in the states and encouraging information sharing; developing
programs for proper drug disposal; and providing law enforcement with tools to enforce proper
prescribing practices and disband pill mills.
As part of this plan, the Administration outlined actions to improve the functioning of state
PDMPs and increase interstate PDMP operability and communications. Specific actions offered
include
• working with states to establish effective PDMPs and encouraging research on
PDMP effectiveness and means to improve PDMP effectiveness;
• supporting the NASPER reauthorization;
• ensuring that the Secretaries of the Department of Veterans Affairs (VA)71 and the
Department of Defense (DOD)72 are authorized to share patient information with
state PDMPs;
• encouraging federally funded health care programs to provide controlled
substance prescription information to the state PDMPs (in states where they
operate health care facilities or pharmacies);
• potentially reimbursing prescribers for checking PDMPs before writing
controlled substance prescriptions to patients covered under insurance plans;
• evaluating programs that require certain doctor shoppers or drug abusing
individuals to use one doctor and one pharmacy;
• evaluating the potential for state PDMPs to reduce Medicare and Medicaid fraud;
• issuing a final rule from DEA on electronic prescribing of controlled substances;
• increasing the use of “Screening, Brief Intervention, and Referral to Treatment”
programs to identify and prevent prescription drug abuse;

70 Office of National Drug Control Policy, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, 2011,
http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan.pdf.
71 The Consolidated Appropriations Act, 2012 (P.L. 112-74) authorized the VA Secretary to share prescription
information with state PDMPs.
72 According to Department of Defense, Report to Congress: Medication Management for Physically and
Psychologically Wounded Armed Forces Members In Fiscal Year 2011-2012, RefID: 6-B74CA6F, March 14, 2012,
“DoD providers can access PDMPs for controlled substance prescription histories before generating prescriptions for
controlled substances…. The military specific response to this challenge includes work by the PharmacoVigilence
Center to apply the lessons learned and apply it to the military where relevant.” The report does not indicate whether
DOD dispensers contribute information to state PDMPs; however, if servicemembers fill prescriptions at retail
pharmacies in the private sector (in a state with a PDMP), the prescriptions would be reported just like any others.
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• identifying how health information technologies can enhance prescription drug
information;
• testing the Centers for Disease Control and Prevention’s surveillance system to
generate measures of prescription drug abuse;
• assessing the use of the Drug Abuse Warning Network in the domain of
prescription drug abuse;
• expanding DOJ’s efforts to enhance interstate PDMP interoperability, particularly
though the PMIX program; and
• evaluating existing databases with information on prescription drug access, use,
misuse, and toxicity.73
As noted, supporting PDMPs is just one component in the overall federal efforts against
prescription drug abuse. Research on PDMP effectiveness has yielded sometimes inconclusive
results, though research findings suggest that PDMPs may contribute to reduced doctor shopping
and prescription drug abuse. As such, policymakers may question the extent to which ONDCP,
along with the other relevant departments and agencies, has taken steps to accomplish these
PDMP-related goals laid out in the Administration’s action plan.
Balancing Stakeholder Concerns
While establishment and enhancement of PDMPs (such as interstate data sharing and real-time
data access) enjoy broad support,74 some stakeholders express concerns about (1) health care
versus law enforcement uses of PDMP data, particularly with regard to protection of personally
identifiable health information, and (2) maintaining access to medication for patients with
legitimate medical needs.
Research has demonstrated that PDMPs save law enforcement officials time in investigations, if
law enforcement officials have access to PDMP information. Concerns about potential law
enforcement uses of PDMP data are expressed by stakeholder organizations representing
prescribers. The American Medical Association (AMA), a professional association of more than
200,000 physicians, supports the use of PDMPs and recommends that PDMPs be housed in
health-related agencies (rather than law enforcement agencies).75 AMA further recommends that
information from PDMPs “be used first for education of the specific physicians involved prior to
any civil action against these physicians.”76 The American Society of Addiction Medicine
(ASAM), one of several national medical specialty societies under the AMA umbrella, likewise

73 The White House, Epidemic: Responding to America’s Prescription Drug Abuse Crisis, 2011, pp. 6-7,
http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf.
74 For example, the Pharmaceutical Research and Manufacturers of America (PhRMA)—the industry group
representing pharmaceutical research and biotechnology companies—supports PDMPs and recommends assessing their
effectiveness and exploring enhancements. PhRMA, Prescription Drug Abuse, http://www.phrma.org/issues/
prescription-drug-abuse.
75 American Medical Association (AMA), The AMA Equation: Illustrated. 2011 Annual Report, p. 25, http://www.ama-
assn.org/resources/doc/about-ama/2011-annual-report.pdf; AMA Advocacy Resource Center, Drug Diversion and
Prescription Drug Monitoring Programs, 2012, http://www.ama-assn.org/resources/doc/washington/prescription-drug-
monitoring-issue-brief.pdf.
76 AMA Advocacy Resource Center, Drug Diversion and Prescription Drug Monitoring Programs, 2012,
http://www.ama-assn.org/resources/doc/washington/prescription-drug-monitoring-issue-brief.pdf.
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expresses concern about the use of PDMP data for purposes other than health care: “[L]aw
enforcement, the judiciary, corrections professionals, employers, and others outside of the health
care system should not be granted access to PDMP data except via the means available to them to
secure access to other personally identifiable health information.”77 The fact that PDMPs contain
personally identifiable health information raises concerns about privacy and data security. Both
AMA and ASAM stress the need to subject PDMP information to the same standards applied to
other patient records.78
Limiting access to medication for patients with legitimate medical need is a potential unintended
consequence of PDMP implementation. The prescription drug abuse prevention strategy of the
Center for Lawful Access and Abuse Deterrence (CLAAD), which is endorsed by more than 20
organizations, emphasizes that “efforts to prevent abuse must not impede proper medical practice
and patient care.”79 The American Academy of Pain Medicine (AAPM), a national medical
specialty society under the AMA umbrella, similarly recognizes “the need for policies that
support effective control of drug abuse without harming the appropriate treatment of pain.”80 This
concern may be related to fears about law enforcement uses of PDMP information, if prescribers
are hesitant to prescribe monitored drugs for fear of becoming targets of investigations.
Federal Role in Interstate Information Sharing and Interoperability
In 2012, Administration and congressional attention to PDMPs has largely focused on enhancing
interstate information sharing and the interoperability of state systems. The PDMP component of
the Administration’s action plan to counter prescription drug abuse includes efforts to improve the
functioning of state PDMPs and increase interstate PDMP operability and communications. Some
bills in the 112th Congress would build on the current system of state PDMPs by establishing
standards for information exchange among states.81 Others would direct certain agencies to
examine the current interoperability among state PDMPs.82

77 American Society of Addiction Medicine (ASAM), Public Policy Statement on Measures to Counteract Prescription
Drug Diversion, Misuse and Addiction, January 25, 2012, http://www.asam.org/advocacy/find-a-policy-statement/
view-policy-statement/public-policy-statements/2012/01/26/measures-to-counteract-prescription-drug-diversion-
misuse-and-addiction.
78 AMA Advocacy Resource Center, Drug Diversion and Prescription Drug Monitoring Programs, 2012,
http://www.ama-assn.org/resources/doc/washington/prescription-drug-monitoring-issue-brief.pdf; and ASAM, Public
Policy Statement on Measures to Counteract Prescription Drug Diversion, Misuse and Addiction, January 25, 2012,
http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2012/01/26/
measures-to-counteract-prescription-drug-diversion-misuse-and-addiction.
79 Center for Lawful Access and Abuse Deterrence (CLAAD), National Prescription Drug Abuse Prevention Strategy:
2011-2012 Update, http://www.claad.org/downloads/CLAAD_Strategy2011_v3.pdf. CLAAD is a 501(c)(3) not-for-
profit organization that attempts to foster collaboration among health professionals, law enforcement, businesses,
government, and other organizations involved in the issue of prescription drug abuse. See CLAAD, Overview,
http://www.claad.org/about-claad/overview.
80 American Academy of Pain Medicine (AAPM), Advocacy: Affecting Health Care on Behalf of our Pain Patients,
http://www.painmed.org/advocacy/main.aspx.
81 See, for example, the Interstate Drug Monitoring Efficiency and Data Sharing (ID MEDS) Act (H.R. 4292, S. 2254).
82 For example, Section 1141 of the Food and Drug Administration Safety and Innovation Act (P.L. 112-144, as passed
both House and Senate) would authorize the Secretary of HHS, consulting with the Attorney General as appropriate, to
facilitate the development of recommendations on interoperability standards for interstate exchange of PDMP
information by states receiving federal grants to support their PDMPs. See also, for example, the Medicare and
Medicaid FAST Act (H.R. 3399, S. 1251).
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While the majority of proposals in the 112th Congress would focus on enhancing state-level
databases and interstate information sharing, others have suggested establishing a national
system. For instance, some proposals would establish a national web portal through which
practitioners who prescribe or dispense controlled substances would be required to enter
information.83 Some may argue that monitoring controlled prescription substances is a state level
activity, along with regulation of pharmacies and licensing of health care professionals. Others
may note that with the increasing reliance on mail order prescriptions and online pharmacies that
deliver across state lines, monitoring of controlled prescription substances may be evolving into
more of a federal or shared state-federal activity. Policymakers may debate the role of the federal
government in incentivizing, directing, or establishing PDMP interoperability and information
sharing standards and programs. Such a debate could take place in the context of other federal,
state, and local efforts to reduce prescription drug abuse.

Author Contact Information

Kristin M. Finklea
Lisa N. Sacco
Specialist in Domestic Security
Analyst in Illicit Drugs and Crime Policy
kfinklea@crs.loc.gov, 7-6259
lsacco@crs.loc.gov, 7-7359
Erin Bagalman

Analyst in Health Policy
ebagalman@crs.loc.gov, 7-5345


83 See, for example, the Fraudulent Prescription Prevention Act of 2011 (H.R. 1266). The database that would be
established by this bill might be considered a federal PDMP, although that term is not used in the legislation.
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