DrugBuyers.Com: Gov. Bush lobbies for drug-tracking database

Gov. Bush lobbies for drug-tracking database

By Mark Hollis
Tallahassee Bureau
Posted April 10 2004

TALLAHASSEE -- A proposal Gov. Jeb Bush is championing to create a massive electronic tracking system of who is prescribing and who is using prescription drugs is in trouble in the Florida Legislature.

With three weeks left in the 2004 lawmaking session, Bush is doing high-pressure lobbying to persuade leaders of his own party about the merits of the database.

It could allow doctors, designated medical assistants and pharmacists to look up online the pharmacy records of patients over the age of 17 to ensure they haven't been shopping for multiple prescriptions.

Every pharmacy record for certain classes of potentially addictive drugs, such as anxiety-fighting Xanax, mood-changing Valium and painkilling OxyContin, would be monitored.

But key Republican legislators still see the measure as costly, intrusive and potentially ineffective as a tool for combating drug abuse and Medicaid fraud.

Because of that skepticism and unanswered questions about how the state will pay for the estimated $2.8 million annual costs of running the database, the Florida House and state Senate have yet to bring an idea the governor has called a first-rank priority up for a full vote.

Bush warns that if legislators don't approve the monitoring system by July, Florida risks losing nearly $2 million that Purdue Pharma, the manufacturer of OxyContin, pledged toward the creation of the database.

The financial offer, with that deadline, was made as part of a 2002 decision by the state attorney general to drop an investigation into the company's marketing of OxyContin.

The agreement allows the drug maker to claim credit for funding the creation of a new computerized system that will be made available to every other state in the nation -- without charge.

The proposal (in HB 397 and SB 580) has strong support not just from Bush but also from other advocates this year as a response to 3,324 prescription-drug overdose deaths in Florida last year. The South Florida Sun-Sentinel revealed the problems in investigations last year on prescription drug abuse and Medicaid fraud.

Proponents describe the database as a major new weapon against Medicaid fraud, drug abuse and so-called "doctor shopping" for pills and say it could stem the rise in overdose deaths -- some five fatalities each day in Florida.

"It will save money, but more importantly, it will stop the abuse of legal prescription drugs," Bush said Thursday, acknowledging that he is interested in part because of his daughter's arrest in 2002 on a felony prescription fraud charge.

Pharmacist organizations, doctor groups, drug manufacturers, House Speaker Johnnie Byrd support the measure this year.

Critics, though, see in the database the possibility of unprecedented invasion of patient privacy even in the face of privacy safeguards built into the proposal.

Police and state health regulators would be able to tap into the Web-based database only for investigations already begun. Tapping into it illegally would be a third-degree felony. In addition, the pharmacy records would be stored for only two years. And the system will shut down after two years unless another Legislature reauthorizes it.

House Appropriations Committee Chairman Bruce Kyle, R-Fort Myers; Health Appropriations Chairwoman Carole Greene, R-Fort Myers; and Palm Beach County Delegation Chairman Joe Negron, R-Stuart, have been among key legislators blocking action.

The governor has visited, written and phoned them, but they continue to raise concerns that the database could give government too big of a glimpse into the legal drug use of law-abiding citizens.

"This is not an area where the government needs to be involved," said Negron. "My constituents aren't asking for more government, more regulation, less freedom and less privacy. This [database] does all that."

Negron says "Orwellian dimensions" to the proposal have prompted other lawmakers to tell him about concerns over "the erosion of civil liberties that this bill represents."

House sponsor Republican Rep. Gayle Harrell, of Stuart, says private insurance companies already collect prescription information in large databases.

"We live in a world of databases, and there are no protections in [insurance company systems] like we've put in this one," Harrell said. "We have really gone above and beyond to protect the patients' information."

Another problem is that Harrell and the proposal's Senate sponsor, Sen. Mike Fasano, R-New Port Richey, don't agree on how the state can pay to run the system once it's up.

Harrell suggests that the state could tap into a fund that pharmaceutical companies pay into for the benefit of having their drugs on the state's preferred provider list for Medicaid patients. Fasano says the state ought to require pharmaceutical manufacturers to pay the operating costs directly.

"I'm hoping the companies that make narcotics will be willing to step up to the plate," he said. "Three million dollars a year to companies like them is like a spit in the ocean. Besides, they should be eager to make sure people don't die from prescription overdoses. It gives their narcotic a bad name."

Aside from the government's costs, many pharmacists say the database plan would require them -- and their companies -- to face more expense and do more work filling prescriptions. They also will be responsible for submitting all the data that will go into the database. Yet, they won't get any extra state compensation.

Perhaps most damning of all, some opponents doubt the database will be all that useful in stopping "doctor shopping" and prescription drug fraud.

For instance, doctors and pharmacists won't be required to use the system. It would be optional for the health professionals to check if they suspect prescription abuse or fraud.

Others note that pharmacies won't have to submit prescription information to the state more than once a month. Data could be at least 30 days old before any user sees it, allowing time for abusers to sneak through.

In addition, the Web-based system won't work in "real time" because of extraordinary costs and technological obstacles. Queries for information from the database may take hours or even days to get answered.

"The database would be of value to the pharmacist having to make a clinical judgment on a drug therapy if they could get the information right away," said Michael Jackson, vice president of the Florida Pharmacist Association.

State officials in charge of designing the database acknowledge the shortcomings, but say it will have tremendous benefits nevertheless.

Bush said it will at least be helpful in tracking "chronic" abusers and "the most serious cases."

"It will be much more than we have now, which is nothing," said Amy Jones, director of the Department of Health's Medical Quality Assurance Division. "We know it will stand up as a great [drug-abuse] prevention tool, and will prevent the over prescribing of medicines."

Mark Hollis can be reached at or 850/224-6214.