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Feb 2026
When a High Texas Prescription Monitoring Program Score Doesn’t Mean Misuse
Note: This article provides general information to support reflection and continued learning about integrating PMP checks and results review into practice.
Prescription monitoring tools are not foolproof but are essential for safe prescribing. High scores in the Texas Prescription Monitoring Program (PMP) may reflect circumstances unrelated to misuse, including:
- Dose or formulation changes.
- Pharmacy changes during drug shortages.
- Having multiple physician specialists.
- Paying cash due to insurance changes or personal preference.
- Using mail order and in-store pharmacies or specialty pharmacies.
Recognizing these factors helps you see the full picture and provide care that fits each patient’s situation.
Seeing the Human Behind the Number
NarxCare calculates Narx Scores using an algorithm that looks at the number of prescribers, controlled substance prescriptions filled at pharmacies (for example, early refills or high-risk combinations) and dosage over time. However, numbers alone don’t always tell the full story.
Commonly flagged examples include:
- Filling prescriptions at multiple pharmacies over 90 days.
- Seeing more than five prescribers in a year.
- Having an average daily dose greater than 40 morphine milligram equivalents (MME).
- Medications for opioid use treatment (especially short-fill prescriptions).
Each of these can raise a Narx Score, even when there’s a reasonable explanation such as moving, temporarily switching pharmacies or using different providers for different health needs. High scores can be misleading without context. Pairing the data with a conversation helps you understand the circumstances behind the numbers.
Click here to learn more about how the Narx Score is calculated.
Using Scores to Start Conversations
Reviewing the patient’s history in the Texas PMP alongside their medical history and current circumstances provides a more accurate picture. Open-ended questions can uncover more helpful information. Explore the Texas PMP Prescriber Toolkit for communication guidelines and talking points to support productive conversations with patients about their Texas PMP data and the safe alleviation of pain.
