Sidestepping state lawmakers, Missouri governor's executive order establishes unique PDMP

Hydrocodone opioid pills
Instead of allowing physicians to check prescribing data, a new Missouri PDMP would contract with pharmacy benefit managers.

Missouri became the latest state in the country to create a prescription drug monitoring program (PDMP) after its governor circumvented state lawmakers and signed an executive order that requires pharmacy benefit managers to analyze prescriber data.

Calling opioids a “modern plague,” Gov. Eric Greitens used his executive power to establish a “multiphase” PDMP that requires the state to contract with pharmacy benefit managers (PBMs) to analyze opioid prescribing and dispensing data. The state Department of Health and Human Services will use that analysis to identify patterns of inappropriate prescribing, with a specific focus on rooting out pill mills.


The move garnered praise from Department of Health and Human Services Secretary Tom Price, who commended him for “taking a strong step in fighting the opioid epidemic.” The GOP-led House and Senate in Missouri had failed to pass a measure that would establish a PDMP amid a debate over privacy concerns.

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However, Missouri’s PDMP would be different from the majority of states where PDMP data is accessible to providers. Instead, the state would work exclusively with PBM companies to track and analyze prescribing data. That prompted a columnist from the St. Louis Post-Dispatch to point out the large campaign donation Greitens received from Express Scripts, one the country’s largest PBMs.

There are also concerns about how the order will impact St. Louis County, which established its own PDMP. St. Louis County Executive Steve Stenger told the St. Louis Post-Dispatch the program would continue “with the hope that whatever the governor proposes does nothing to hinder our progress.”

Although every other state in the country has established a PDMP, a debate has surfaced over whether to mandate that providers check the database before prescribing opioids. While some states that have mandatory PDMP participation have reported significant declines in opioid prescribing, physicians have argued that better integration with EHRs would incentivize them to use PDMPs more consistently.

Michigan officials adopted that approach last month, using a $2.1 million grant to integrate the systems PDMP into hospital EHR systems.