A method for evaluating or reviewing the use of drugs in order to determine the appropriateness of the drug therapy.
complex manage care process that occurs as part of the reimbursement process. A review conducted before the drug is dispensed by the pharmacy or administered by the physician is a pre-authorization review. A review conducted afterward is a retrospective review. A failure to pass either type of review will result in a failure to secure drug reimbursement. Some aspects of drug utilization review are designed to protect patients from dangerous reactions to medications. For example, one aspect of the review process seeks to protect patients from drug-to-drug interactions. Other aspects seek to make sure that doctors follow specific prescribing guidelines for specific diseases. The drug utilization review process can also be used as a way for health plans to avoid - or at least delay - having to pay for an expensive drug a doctor wants to use or prescribe. When doctors and patients have access to the right information, they can work most effectively with health plans on a level-playing field - making what is good about drug utilization review work for everybody.
An evaluation of prescribing patterns or targeted drug use to specifically determine the appropriateness of drug therapy.
Review of an insured population's drug utilization with the goal of determining how to reduce the cost of utilization. Reviews often result in recommendations to practitioners, including generic substitutions, use of formularies, use of copayments for prescriptions and education. In some cases, practitioners are now penalized or rewarded depending on their drug prescription related costs and utilization. Some speculate that these incentives can adversely effect doctor decisions.
a type of analysis of prescription patterns often used by insurers to identify risky or inappropriate practices and to reduce expenses
A review program that evaluates whether drugs are being used safely, effectively and appropriately.
Efforts to control drug utilization and costs by a facility or a health plan. Common methods include the use of a formulary (see above), substitution of generic products for more expensive name brands and encouraging use of drugs that will trigger rebates or discounts.
is a program designed to measure and to assess, both on a prospective and retrospective basis, the proper use of outpatient drugs in the Medicaid program. The primary objectives of the DUR systems are to improve the quality of care and to assist in containing health care costs.
a process whereby a variety of medications the elder takes everything from over-the-counter products and herbal remedies to prescriptions are examined to see if they interact with each other in ways which cause bad side effects or alter the effectiveness of the medication.
Drug Utilization Review (DUR) is the process by which prescribed medications are evaluated against explicit criteria to improve the quality of drug therapy and reduce unnecessary expenditures.
A process undertaken by the PBM of systematically evaluating drug use to identify areas of opportunity to improve utilization patterns.
a quantitative evaluation of prescription drug use, physician prescribing patterns, or patient drug utilization to determine the appropriateness of drug therapy. Return to Acronyms
