PDMP

Prescription Drug Monitoring Program

PDMP systems monitor the use of controlled substances, including prescription drug history, prescription drug usage, and demographic information of prescribing providers.

CMS-Required Outcomes (6)

Ref	Outcome	Sources
PDMP1 Qualified PDMP	Covered providers have near real-time access to: a. Information regarding Medicaid beneficiary’s prescription drug history. b. The number and type of controlled substances prescribed to and filled for the covered individual during at least the most recent 12-month period. c. The name, location, and contact information (or other identifying number selected by the state, such as a national provider identifier issued by the CMS National Plan and Provider Enumeration System) of each covered provider who prescribed a controlled substance to the covered individual during at least the most recent 12-month period.	Section 1944(b) of the ActSection 5042 – Medicaid PARTNERSHIP ActCMS FAQs-SUPPORT for Patients and Communities Act
PDMP2 Workflow Integration	Providers can easily use the PDMP information through workflow integration, which may include electronic prescribing system for controlled substances.	Section 1944(b) of the ActSection 5042 – Medicaid PARTNERSHIP ActCMS FAQs-SUPPORT for Patients and Communities Act
PDMP3 Data-sharing Agreements	The state has data-sharing agreements with all contiguous states to track patients, prescribers, and prescriptions across state lines.	Section 1944(b) of the ActSection 5042 – Medicaid PARTNERSHIP ActCMS FAQs-SUPPORT for Patients and Communities Act
PDMP4 Medicaid Program Access to PDMP (if applicable)	The state medical and pharmacy directors and any designee has access to the PDMP information in an electronic format based on data-sharing agreements in place (subject to state law).	Section 1944(b) of the ActSection 5042 – Medicaid PARTNERSHIP ActCMS FAQs-SUPPORT for Patients and Communities Act
PDMP5 Required Reporting	The state produces data for the reports that are required to be submitted in the Annual Report to HHS.	42 CFR 433.112(b)(15)Section 1944(e) of the ActSection 5042 – Medicaid PARTNERSHIP ActCMS FAQs-SUPPORT for Patients and Communities Act
PDMP6 Utilization and Quality Reports	The system produces reports to contribute to reports to HHS by the State Drug Utilization Review (DUR) Board and for program evaluation, continuous improvement in business operations, transparency and accountability, as well as identify patterns of fraud, abuse, gross overuse, excessive utilization related to limitations identified by the state, inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization among Medicaid physicians, pharmacists and enrollees associated with specific drugs or groups of drugs.	42 CFR 433.112(b)(15)Section 1944 (e)(1) of the ActSection 1927(g)(2)(B) and (g)(3)(D) of the ActSection 1004 of the SUPPORT ActCMS FAQs-SUPPORT for Patients and Communities ActCenters for Disease Control