RX TRACKING PLAN FUNDED

Changes to old system designed to stop abuse, but some are skeptical

The legislature has funded improvements to a statewide system that tracks
prescriptions. And though generally praised by doctors and law enforcement
officials, some still have questions about the system going to the Internet.

Under the old system, dubbed KASPER -- Kentucky All Schedule Prescription
Electronic Reporting -- pharmacists and doctors would fax requests for
information to the Cabinet for Health and Family Services, which often took
hours to fax back responses.

The system is designed to allow doctors, pharmacists and police to access
prescription records to stop drug abuse and improve health care. The new
program allows medical personnel and police to search for information
online so they can get answers at any time.

Verlon Pierce, owner and pharmacist at Medicine Arts Pharmacy, said he was
concerned that the information would not be secure enough on the Internet,
but the provision of the law that most concerns him actually involves secrecy.

"The law says that the patient and patient's attorney have no access to the
KASPER report," Pierce said. "It is kind of like a credit report that
everybody but you can get."

He said he is concerned that some errors could get into the system and a
patient wouldn't have any way of knowing it and that there are real
concerns about the basic security of the data.

"I got a letter from the (federal) Department of Justice the other day,"
Pierce said. "It said that the only way to keep kids from getting
prescription drugs over the Internet is to limit their access. If we can't
keep kids from ordering drugs off the Internet, then how do we keep the bad
guys from getting your information from KASPER?"

Civil libertarians and other health experts are concerned about the privacy
of the system and question whether it will end up discouraging doctors from
writing necessary prescriptions.

Dr. Bob Esterhay of the University of Louisville School of Public Health
said the availability of the information is both helpful and a cause for
concern.

While medical personnel can get useful data and drug abuse can be
interrupted, Esterhay wondered whether doctors might somehow be dissuaded
from writing some prescriptions for needy patients, knowing they may be
scrutinized. And as an individual, Esterhay said he wondered about all that
personal information available to so many people.

"There are always issues in terms of an individual's privacy," Esterhay said.

Dave Sallengs, one of the officials who oversees the day-to-day workings of
the KASPER system, said the new system will have higher security than what
is used by banks.

He added that of the 500 to 600 requests a day his office receives most, 87
percent are from physicians who are trying to make sure their patients are
not taking drugs the physician is unaware of.

"Most of the interventions are at the doctor level," Sallengs said. "And
that is preventing some of these people from developing a problem with
prescription drugs."

Law enforcement officers and pharmacists make up most of the rest of the
requests, but there is another group that has the power to ask for reports
- -- the licensing bodies for physicians and pharmacists.

For more than five years, Kentucky has tracked prescriptions for certain
drugs, from the extremely powerful, addictive and often abused narcotics
like OxyContin to cough medicines with codeine.

Bowling Green physician John Gover, in internal medicine practice here for
19 years, said the KASPER system is a great thing for Kentucky and having
computerized access is going to be even better.

He said he just wishes a regional or nationwide system like it was available.

"The use and abuse of medications is going to be an ongoing problem and
requires the physician to be vigilant," Gover said. "We use it all the
time. It is very good for making sure that patients aren't receiving
prescriptions from other physicians."

He said the increase in the number of patients who require long-term use of
pain medication has necessitated a system that allows doctors to make sure
that patients aren't getting those drugs from another doctor.

"With a new patient, we use it just to make sure the person is on the up
and up with you," Gover said. "People might mislead a health care provider
about the prescriptions they are receiving."

Then there is the other, less well known use of KASPER -- making sure
doctors and pharmacists aren't misusing drugs themselves.

Gover said he considers that another benefit of the program. He compared a
drug-addicted person who has prescriptive authority as being similar to an
alcoholic working at a liquor store. He said those people need to receive
appropriate help and KASPER reports could help ensure that.

Jeffrey L. Osman, pharmacy inspections and investigations coordinator with
the state, said addiction is not a real common problem among Kentucky's
pharmacists. On an annual basis, his office follows about 30 pharmacists in
the commonwealth that are in their addiction recovery program.

"We have a pharmacist recovery network for those who are suffering from
addiction," Osman said. "They typically suspend the license -- put that
person in drug treatment program and after they have fulfilled all the
requirements, usually takes six months, they can ask for license back."