What is drug use review?
The Office of Pharmacy Services ensures Medicaid participants use medications safely and appropriately.
Prospective Drug Use Review (ProDUR): The office reviews pharmacy claims individually before a pharmacist dispenses the drugs. ProDUR messages alert the pharmacist when a situation requires an intervention, a consultation with the prescriber or patient counseling.
Retrospective Drug Use Review (RDUR): The RDUR program analyzes aggregated claims data to find patterns of fraud, abuse, gross overuse or medically unnecessary care. Through this analysis, the office identifies patients at risk for adverse outcomes from drug-drug interactions, overutilization, non-adherence or therapeutic duplication. Staffers review drug history profiles and send non-confrontational, educational letters to help providers manage patient therapy.
The RDUR program also flags patients who may be receiving excessive quantities of controlled substances. This includes patients who use multiple pharmacies or prescribers to obtain drugs. The office sends intervention letters to both providers and patients. If the patient does not reduce excessive use, the office may place them in the Corrective Managed Care Program and restrict them to a single pharmacy.
Resources
DUR Board Code of Conduct
Contact
Email [email protected].
