Monitoring Prescriptions, Third-Party Healthcare Payers, Prescription Benefit Managers, and Private-Sector Policy Options

This chapter discusses how opioids are diverted from legitimate to illegitimate channels and examines the systems that have been developed to keep track of these drugs by monitoring their prescribing and dispensing. Also covered are the regulations that enable authorities to scrutinize manufacturers and distributors for anomalous transactions that might signal diversion. The chapter also discusses potential strategies involving the private sector, which has a corresponding interest in curtailing waste, fraud, and abuse in the third-party healthcare payer systems that each year process billions of prescriptions for drugs, including controlled substances. The chapter looks at the role of pharmacy benefit managers in the dispensing of controlled substances. The potential benefits of adding pharmacy benefit managers to the present classes of business activities regulated by the Drug Enforcement Administration are explored.