Illinois Prescription Monitoring Program’s New Efforts Against Overprescribing

The Illinois Prescription Monitoring Program (ILPMP) is an electronic database that tracks controlled substances prescriptions that are dispensed within Illinois. All licensed prescribers in Illinois should be familiar with this system as they are required by statute to not only register with the ILPMP but also check it regularly when prescribing controlled substances to patients. What prescribers may not be familiar with is a new effort by the ILPMP to crack down on potential overprescribing within Illinois.

Peer Review Subcommittee

In a 2015 amendment to the Illinois Controlled Substances Act, the ILPMP Advisory Committee was tasked with creating a Peer Review Subcommittee. This subcommittee, which is made up of ten members chosen by the PMP Advisory Committee, has several distinct purposes, including establishing a formal peer review of professional performance of prescribers and dispensers. In basic terms, the ILPMP is now checking to see which practitioners are prescribing outside of acceptable guidelines.

Per the Controlled Substance Act, the Peer Review Subcommittee must be composed of the following licensed professions: three physicians, one dentist, one advanced practice nurse, one physician assistant, and one optometrist. Depending on the profession of the prescriber under review, the subcommittee member within the same profession will be the reviewing party of the records. This means that if a licensed dentist’s prescribing history is under review, the single dentist sitting on the subcommittee will be the party responsible for all record review and determining the proper next steps in the process.  

Who are they looking at?

The scope of the Peer Review Subcommittee’s review includes every licensed prescriber and dispenser within Illinois, hence why the subcommittee is statutorily required to have members from every licensed profession with potential prescribing ability. However, it appears that the current focus of the subcommittee is on physicians. There is no publicly available timeline on when the subcommittee will begin to expand their review to encompass the other licensed professions, but it will occur at some point in the future.

What are they looking at?

The Peer Review Subcommittee periodically reviews data within the ILPMP to see who may be prescribing and/or dispensing outside of the current standards and guidelines. Specifically, they are looking into prescribers who are routinely prescribing more than 90 MME per day in the span of three months to at least 10  patients to whom they prescribe opioids. This specific data excludes patients within oncology, palliative care, and hospice care. 

What are the steps after they ID someone?

Once a prescriber or dispenser who meets the criteria listed above catches the attention of the subcommittee, a letter will be sent requesting information regarding their prescribing or dispensing that is identified as being outside of the currently accepted medical standards and guidelines. This letter should come through the US Postal Service as Certified Mail, but there is a chance it may be received via email as well.

Once the letter has been received, the prescriber has 30 days to respond to the letter by logging into their ILPMP account and providing information requested by the subcommittee. The range of information requested may include the following:

  • Details surrounding the practice or patient population as it relates to prescribing certain medications;
  • Rationales for certain prescribing decisions and patterns;
  • The current utilization of the ILPMP by the prescriber and their staff;
  • Current use of any risk mitigation strategies;
  • Professional information about the prescriber, such as taxonomy details and Board Certifications.

What to do if you receive a letter?

Remain calm. The ILPMP’s stated purported intentions with these information requests are not to impede any professional practice, but rather aid in the care of patients.

Log into your ILPMP account to verify the accuracy of the information being presented by the ILPMP. Before you respond or react in any way, it is important to confirm that the information being focused on is entirely correct.

Draft a response that provides all information and details requested by the PMP. While this can be done by the prescriber, it is in the prescriber’s best interests to obtain the help of legal counsel. Take the necessary amount of time and preparation when responding to the letter, as the outcome of this process is determinative on your response.

What not to do if you receive a letter?

Do not ignore this information request. The ILPMP has statutory authority to refer any prescribers who fail to respond to the Illinois Department of Financial and Professional Regulation (IDFPR). This may lead into an investigation and potentially prosecution by the state against a licensed professional’s ability to practice and/or prescribe.

Do not make any rash decisions. This includes responding too quickly without confirming the accuracy of the information, responding without fully providing all requested information, or instantly changing patients’ care and treatment in reaction to the request for information. Doing any of these may also result in referral to the IDFPR.

What happens following the response?

The information provided to the ILPMP will be reviewed by the Peer Review Subcommittee. They have three options following their review:

  1. No further action. This would occur when the responses to the questions satisfy any concerns the ILPMP previously held regarding prescribing and/or dispensing.
  2. Further request for information. This would occur if the responses do not satisfy the ILPMP’s concerns or if the responses may reveal additional potential issues.
  3. Referral to the IDFPR. This would occur in three instances:
    1. If a prescriber or dispenser fails to respond to three successive requests for information;
    2. In the opinion of a majority of members of the subcommittee, the prescriber or dispenser does not have a satisfactory explanation for the practices identified by the ILPMP; or
    3. Following communications with the subcommittee, the prescriber or dispenser does not sufficiently rectify the practices identified in the request for information in the opinion of a majority of the members of the subcommittee.

What is the takeaway?

Above all else, it is a prescriber’s responsibility and duty to provide care to their patients that meet currently accepted medical standards and guidelines. In regard to the current standards for opioid-prescribing, the ILPMP and many other entities look to the CDC Guidelines for Prescribing Opioids for Chronic Pain published in 2016. That being said, these Guidelines have been going through a reevaluation process and a new set of Guidelines is scheduled to be published in late-2022. There is a strong likelihood that these new Guidelines will contain some major changes compared to the 2016 Guidelines, some of which may even disrupt the ILPMP’s criteria they use when identifying prescribers and/or dispensers of concern.

In addition, it is important to make sure that all contact information contained within the ILPMP profile is correct. An easy way not to miss any ILPMP Requests for Information and risk being referred to the IDFPR is keeping all address and contact information, including email addresses, updated with the ILPMP.

Finally, reach out for legal assistance. Receiving a Request for Information can be daunting. Please feel free to contact us with any questions regarding this process or if you need any assistance responding to a Request for Information. In addition, please make sure to check back in with our blog as we will make sure to provide all the important updates as the Peer Review Subcommittee’s focus expands to all prescribers and dispensers, and the newest version of the CDC Guidelines are released later this year. 

Disclaimer: This web site is addressed to those who hold professional licenses issued by the Illinois Department of Financial and Professional Regulation and by similar licensing agencies in other states. Suggestions herein are, in most circumstances, valid for any type investigation, whether administrative, criminal, or civil. However, it should be noted that in some other states, one who holds a professional license may be required to submit to an investigative interview as a condition of being licensed. Whatever the circumstances, a licensed professional who becomes the subject of an investigation would be wise to immediately retain legal counsel. No content, whole or in part, is to be considered as “legal advice,” and by reading this document, no attorney-client relationship is formed with the Crick Walanka Law Group, Ltd.