The vendor is required to provide for the state prescription drug monitoring program in accordance with the support act and Medicaid requirements.
- The awarded contractor will be responsible for collecting, analyzing, and reporting data on prescription drug use and controlled substance prescriptions in compliance with federal and state guidelines.
- Contractor reporting requirements:
• The contractor shall provide agency the reportable data from the prescription monitoring program (PMP) in an aggregate format to meet the requirements of the support act. agency shall provide patient and provider rosters to be linked to state PMP data to create the report(s).
• Agency cannot provide access to the PMP for the awarded contractor.
• The vendor must already have data access and provide documentation of authorization from the state board of pharmacy.
• Agency cannot provide any data stored on the PMP database but will provide Medicaid rosters containing member and provider information.
- The reporting metrics must include the following:
1. Summary reporting deliverable
• Percentage of covered providers – the percentage of covered providers who checked the prescription drug history of a beneficiary through a PMP before prescribing a controlled substance to such individual.
• MME per covered individuals – average daily morphine milligram equivalents (MME) prescribed for controlled substances per covered individuals.
• MME per covered individuals receiving opioids – average daily MME prescribed for controlled substances per covered individuals who are receiving opioids.
2. Controlled substance reporting deliverable
a. Opioid-controlled substances
• Age group in years (0-18, 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+)
• Individuals with disabilities utilizing state eligibility categories
• Total number of beneficiaries in each age group
• Total number of unique beneficiaries within each age group who received an opioid controlled substance in the 12-month reporting period
• Percentage of unique beneficiaries within each age group receiving an opioid in the 12-month reporting period
• Top 3 opioids, by generic ingredient, identified as received in each age group, in the 12-month reporting period
• Number of unique beneficiaries within each age group, receiving opioid controlled substances in the 12-month reporting period
• Percentage of unique beneficiaries within each age group receiving the top 3 opioid controlled substances in the 12-month reporting period
b. Sedative and benzodiazepines-controlled substances
• Age group in years (0-18, 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+)
• Individuals with disabilities utilizing state eligibility categories
• Total number of unique beneficiaries within each age group who received a sedative/benzodiazepine-controlled substance in the 12-month reporting period
c. Stimulant/ attention-deficit/hyperactivity disorder (ADHD) controlled substances
• Age group in years (0-18, 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+)
• Number of individuals with disabilities utilizing state eligibility categories
• Total number of beneficiaries in each age group
• Total number of unique beneficiaries within each age group who received a stimulant/ADHD controlled substance in the 12-month reporting period
d. Populations using 2 or more controlled substances
• Age group in years (0-18, 19-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+)
• Individuals with disabilities utilizing state eligibility categories
• Total number of beneficiaries in each age group
• Total number of unique beneficiaries within each age group who received two or more controlled substances per month in the 12-month reporting period
• Percentage of age group receiving two or more controlled substances per month in the 12-month reporting period
3. Report schedule:
• The contractor shall provide the first report to agency by may 1st annually. delivery of agency patient and provider rosters to the contractor by January 31st annually.
• Ongoing delivery of agency patient and provider rosters to the contractor may occur monthly to prepare for future reports.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: May 12, 2025