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 consultants develop, implement, and support DUR plans for state Medicaid plans and managed care organizations across the U.S.

We develop detailed drug reviews and conduct both prospective and retrospective prescription pattern analyses for our clients in order to:

  • Prevent adverse drug reactions
  • Avoid therapeutic duplications
  • Determine if a more cost-effective alternative is available
  • Verify that the medication is effective and appropriate
  • Make changes to prescriptions if clinical guidelines have changed
  • Identify abuse or fraud problems
  • Support Pharmacy & Therapeutics (P&T) and DUR Boards

Our drug reviews include market comparisons featuring data on other organizations’ coverage practices. In addition, our customized reports include analyses of topics such as:

  • Formulary management
  • Generic drug use
  • Prior authorization decisions
  • Prescribing pattern and outcomes analyses
  • Clinical call center statistics
  • Prescriber education outcomes

Backed by this objective clinical data, we help our clients make the most cost-effective and clinically sound coverage decisions for their members and organizations.