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Sheriffs' target 'prescription pill loophole'

CHARLESTON, W.Va. -- The State Sheriffs Association is asking the federal government to close a "prescription pill loophole" that fails to track cash payments made to pharmacists.

The sheriffs want to know who's paying with cash in hopes of identifying the users and doctors contributing to the prescription pill abuse epidemic in the state.

Prescription pills paid with insurance are logged into a system that could be used to track the cash payments, they said.

However, there are state systems already monitoring those transactions and it's a matter of dispute if police's access to it would violate federal health privacy laws, said Richard Stevens, executive director of the West Virginia Pharmacist Association.

Rudi Raynes-Kidder, executive director of the State Sheriffs Association, held a press conference Wednesday asking the federal government to change how Pharmacy Benefit Manager works. PBMs are third-party administrators that process and pay for prescription drug claims in real-time. Cash payments are not entered into the system.

Kanawha County Sheriff Mike Rutherford said he's heard of cases in which one person paying with cash got the same prescription filled multiple times and then held a "pill party."

If cash payments were entered into the PBM system, the pharmacist would be notified instantly that a prescription has already been filled, said Amy Bricker, executive director of Express Scripts, one of the nation's largest PBMs.

Bricker said the pharmacist would then notify police about possible fraud. About 40 states have PBM systems and all are in favor of adding the cash payments to the already existing procedures, she said.

Raleigh County Sheriff Steve Tanner said sheriffs need access to those paying with cash to identify the abusers. The data also will also show which doctors are writing too many prescriptions for controlled substances, he said.

The West Virginia Pharmacists Association maintains the state's PBM system. Stevens was not at the press conference but heard about it on the radio. He said his group is in favor of creating a real-time way to track cash payments but there's no technology in place to support it. Cash payments are tracked on a 24-hour time scale, he said.

A bill signed into law by Gov. Earl Ray Tomblin earlier this year established two systems to track cash payments and identify abusers. One tracks pseudoephedrine purchases, a common ingredient in methamphetamine production, and another tracks narcotics, Stevens said.

"It records the name of the patient, the name of the drug, the name of the physician who prescribed it and the name of the pharmacy that dispensed it," he said.

Importantly, there are also records of how the patient paid for it, he said. 

He said the "prescription pill loophole" doesn't exist under the new law because certified police officers can access the data to identify abusers. Those police officers, particularly State Police troopers, are trained in federal health privacy laws. Recently, he said sheriffs have expressed interest in gaining access to the data.

"We have some concern with that, not for the intent but from a patient confidentially perspective," Stevens said. "We don't want to allow too many individuals to have access to that data."

Bricker said the PBM data would be used to identify doctors who prescribe too many narcotics and wouldn't seek to target individuals.

More than 152,000 West Virginians have a prescription pill addiction and drug overdose is the leading cause of death for residents under 45, according to data compiled by the West Virginia Department of Health and Human Resources.

Earlier this year, a proposal to make pseudoephedrine prescription-only was defeated in the state Senate. Retailers and the pharmaceutical industry opposed the proposal because they say the restriction would burden consumers and drive up health-care costs.

Reach Travis Crum at travis.crum@wvgazette.com or 304-348-5163.


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