Drug Utilization Review

Drug utilization review (DUR) provides health plans with internal controls to ensure their members receive prescription drug therapy that is safe, medically necessary, and cost-effective. Our Clinical Pharmacy Services consultants develop, implement, and support DUR plans for our clients.

We typically examine claims data for three key conditions:

  • Inappropriate prescribing of drugs
  • Abnormal prescribing and dispensing patterns
  • Adverse drug interactions

Prospective drug utilization review

Our pharmacy consultants assist health plans in setting up prospective DUR programs. These are used when providers prescribe a new medication for a member.

The prospective DUR systems we develop are designed to

  • Evaluate the safety of the medication
  • Prevent adverse drug reactions
  • Avoid therapeutic duplications
  • Determine whether a more cost-effective alternative is available

Retrospective drug utilization review

Our retrospective DUR service looks at patients’ medical histories and the medications that they have been taking. This information provides the opportunity for our clients to

  • Verify that the medication is still effective and appropriate
  • Make changes to prescriptions if clinical guidelines have changed
  • Identify abuse or fraud problems

Support for DUR Board and P&T Committee activities

Our Clinical Pharmacy Services team runs and facilitates Drug Utilization Review Board and Pharmacy & Therapeutics Committee meetings for clients. We also supply the information their providers need to make clinically sound, cost-effective coverage decisions.

Additional services

Our DUR services can be supplemented with prescribing pattern analysis, medication regimen review, and medication therapy management.