ore than two years after it was signed into law, the National All Schedules Prescription Electronic Reporting Act (NASPER) is still nonoperational. Disappointingly, despite its passage and strong support throughout Congress and physician communities, NASPER has received no federal funding.

On August 11, 2005, after three years of congressional consideration, President George W. Bush signed into law H.R. 1132, the NASPER bill. With the president’s signature came statutory authorization of a new system of federally funded, interoperative, state-based prescription drug monitoring programs and the promise of an important tool for physicians to use in addressing patient abuse and diversion of pain-related prescription drugs. Yet, despite the potential benefits of NASPER to physicians and patients alike, to date, the program remains a promise unfulfilled.

First introduced in 2002 during the 107th Session of Congress by Rep. Ed Whitfield (R-KY), the original NASPER bill was based upon the congressman’s home state “Kentucky All Schedule Prescription Electronic Reporting” (KASPER) program, a state-based tracking program of controlled substance prescriptions dispensed within Kentucky. This early version of NASPER (H.R. 5503) proposed the establishment of a real-time, national electronic system for monitoring the dispensing of any schedule II, III or IV controlled substance. While receiving some attention during the 107th Congress, H.R. 5503 lacked sufficient support to move through both houses of Congress. Subsequently, Rep. Whitfield reintroduced a modified version of his legislation in 2004 during the 108th Session of Congress. This version passed the U.S. House of Representatives, but the session came to an end before the bill could be considered by the U.S. Senate. In 2005, Rep. Whitfield introduced a further refined version of his NASPER bill, H.R. 1132. A Senate companion measure, S. 518, was also introduced in the U.S. Senate by Sen. Jeff Sessions (R-AL).

The 2005 version of NASPER (H.R. 1132/S.518) was the subject of significant discussion in the physician community and among congressional negotiators (see August 2005 ASA NEWSLETTER article by Timothy R. Deer, M.D., and Ronald Szabat, J.D., LL.M.). However, bipartisan and bicameral agreement was ultimately reached and the legislation moved forward, easily passing both the U.S. House and U.S. Senate with the endorsement of ASA and other physician groups.
At congressional passage, NASPER sought to 1) foster the establishment of state-administered controlled substance monitoring systems to ensure that health care providers have access to accurate, timely prescription history information that can be used for the early identification of patients at risk for addiction and 2) establish, based on the experiences of existing state prescription monitoring programs, a set of best practices that can be used to guide the establishment of new state programs and the improvement of existing programs.

Of particular interest to physicians, the program would be based in the U.S. Department of Health and Human Services (HHS) and serve as a tool for physicians working with their patients.

Reflecting the goals of the NASPER bill, in his July 5, 2005, letter of endorsement to key House and Senate negotiators, ASA President Eugene P. Sinclair, M.D., wrote:

“[NASPER] builds upon the success of existing PDMPS [prescription drug monitoring programs] by encouraging the creation of and bolstering support for state-based, PDMPs through which schedule II, III or IV drugs could be tracked by state regulatory agencies. Through these secure, HIPAA-standard protected databases, physicians would have access to important information regarding their patient’s prescription drug histories. Of great importance, the bill’s interoperability requirements assure that the databases would, for the first time, make possible tracking across state lines by state entities. The availability to physicians of important patient drug information represents a significant step forward in improving patient care and reducing the abuse and misuse of pain-related controlled substances.”

President Bush’s endorsement of H.R. 1132/S. 518 followed less than a month later.

With broad bipartisan and bicameral support for NASPER and the support of interested physician groups, most observers held expectations of timely implementation of the program and the resulting growth in the number of state-based drug monitoring programs in operation. That was not to be the case.

Since the enactment of NASPER, no funding has been provided to implement the law. In late 2005, $5 million was provided to fund NASPER for the 2006 fiscal year as part of a funding bill for HHS. However, as the funding bill moved through the U.S. House and Senate, the NASPER funds were dropped. Despite the strong efforts of proponents of NASPER, this funding could not be replaced for 2006, and no funding was provided for the program for 2007.
Advocates of NASPER have continued to push for funding of the program for the 2008 fiscal year but, to date, have not succeeded. Indeed, in lieu of funding for NASPER, some in Congress and in the Bush Administration have been seeking and receiving funding for the Harold Rogers Prescription Drug Monitoring Program, which unlike the HHS-based NASPER bill, is a law enforcement-centered program operated under the auspices of the U.S. Department of Justice.

In an effort to draw attention to the funding disparity, a committee of the U.S. House of Representatives, Energy and Commerce Subcommittee on Oversight and Investigations, recently held a hearing titled “NASPER, Why Has the National All Schedules Prescription Electronic Reporting Act Not Been Implemented?”

Numerous committee members raised strong concerns about the Bush Administration’s position to support the Department of Justice program apparently in lieu of the NASPER program. Rep. Gene Green (D-TX) urged the Administration to provide funding for the NASPER program, arguing that the authors of the NASPER law “purposefully housed NASPER grants within the Department of HHS [Health and Human Services] to strike the appropriate balance between law enforcement activities and public health safeguards.” He further pointed out that the Department of Justice program provides only “half a loaf” to physicians working to address patient abuse and diversion. “Within the DOJ programs, there is no real strategy for interoperability [among state-based monitoring programs], which is critical if we want to stop folks from hopping across state lines to obtain prescription drugs illegally and escape detection from their home state monitoring programs” said Rep. Green. He added that “the DOJ programs also have none of the safeguards for patient privacy and pay little to no attention to public health ramifications.”

Other members of the committee raised similar concerns about the funding of the Department of Justice program — a program that emphasizes the law enforcement aspects of prescription drug abuse and diversion over the public health aspects of the physician/patient-centered NASPER program.

Representatives of HHS, H. Westley Clark, M.D., Director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, and Len Paulozzi, M.D., of the Centers for Disease Control and Prevention, testified that they were unable to explain the Bush Administration’s decisions to request funding for the Department of Justice program over the NASPER programs.

At the conclusion of the hearing, key congressional supporters of the NASPER bill pledged to meet with the Hon. Jim Nussle, Director of the Office of Management and Budget, the President’s principal budget advisor, to further investigate the Administration’s rationale in making funding decisions for prescription drug monitoring programs.
ASA and its pain physicians continue to closely follow efforts to operationalize NASPER. With proper funding already authorized by Congress, this program could serve as an important tool in helping physicians address prescription drug abuse and diversion throughout the United States.

Manuel Bonilla, M.S., is ASA Associate Director for Congressional and Political Affairs.