What is Dur and how does it affect pharmacies?
DUR first appeared with the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90). Its goals: Reduce Medicaid fraud and ensure that patients receive appropriate medications. DUR has been used in various practice settings to cut costs in hospital pharmacies. Some pharmacies turn to DUR to help reduce medication errors.
What does Dur stand for?
The Medicaid Drug Utilization Review (DUR) Program promotes patient safety through state-administered utilization management tools and systems that interface with the Centers for Medicare & Medicaid's (CMS) Medicaid Management Information Systems (MMIS).
What is the purpose of the drug use unit (Dur)?
The purpose of DUR is to ensure drugs are used appropriately, safely and effectively to improve patient health status. Predetermined criteria for appropriate drug therapy are compared against a patient’s or a population’s records. Non-adherence to criteria results in drug therapy changes.
What does Dur mean in Medi Cal RX?
January 7, 2022 Medi-Cal Rx has identified a large volume of pharmacy claims denials related to Drug Utilization Review (DUR). If you are a pharmacy provider whose claim was denied with a Reject Code 88 (DUR Reject Error) or, specifically for opioid claims, a Reject Code 76 (Plan Limitations Exceeded), please review the following guidance.
What does DUR mean at pharmacy?
Drug Utilization ReviewDrug Utilization Review (DUR)
What is a DUR code?
Drug Utilization Review Codes DUR codes are sometimes required to override specific rejections. These codes change from prescription to prescription, so it is usually safer to call the insurance company and get the appropriate sequence of codes from them.
What is the difference between due and DUR?
Here is their generally accepted differentiation of the terms: "In some cases, authors have distinguished the two by stating that DUR uses pharmacy claims data, whereas DUE includes use of patient chart data."
What is drug utilization evaluation due?
Drug Utilization Evaluation (DUE): A qualitative evaluation of drug use, prescribing, and member fill patterns to determine the appropriateness of drug therapy.
What is drug utilization management?
Utilization management is a collection of treatment review and cost reduction techniques used by health insurers and health plans. Health plans frequently employ utilization management techniques in their prescription drug benefit, particularly for high-cost specialty medications.
What does DUR PPS stand for?
DUR/PPS Level Of Effort. Definition: Code indicating the level of effort as determined by the complexity of decision making or resources utilized by a pharmacist to perform a professional service.
What is a drug regimen review?
Drug Regimen Review – a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy.
What are high alert medications?
igh-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients.
What is medication use guidelines?
What are Medication Guides? Medication Guides are paper handouts that come with many prescription medicines. The guides address issues that are specific to particular drugs and drug classes, and they contain FDA-approved information that can help patients avoid serious adverse events.
What is a DUR?
Drug Utilization Reviews (DUR), also referred to as Drug Utilization Evaluations (DUE) or Medication Utilization Evaluations (MUE), are defined as an authorized, structured, ongoing review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication.
What is a DUR review?
Drug utilization review (DUR) is defined as an authorized, structured, ongoing review of prescribing, dispensing and use of medication. DUR encompasses a drug review against predetermined criteria that results in changes to drug therapy when these criteria are not met.
What is a DUR program?
Medicaid DUR is a structured, ongoing program that interprets patterns of drug use in Medica id ...
What is 42 CFR subpart K?
42 CFR Subpart K – Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims Section 456.700-456.725 provides the requirements for the DUR program.
What is the purpose of the Dur?
Its goals: Reduce Medicaid fraud and ensure that patients receive appropriate medications. DUR has been used in various practice settings to cut costs in hospital pharmacies. Some pharmacies turn to DUR to help reduce medication errors.
What is a Dur program?
The Pharmaceutical Care Management Association (PCMA) says DUR is a "structured, ongoing program that interprets patterns of drug use in relation to predetermined criteria and attempts to prevent or minimize inappropriate prescribing. DUR may be conducted retrospectively or prospectively, and OBRA ’90 mandated both types.".
Why did pharmacists override the alerts?
Fulda says the reasons pharmacists gave in this study for overriding the alerts included: 1) the pharmacist already knew about the potential danger but didn’t believe it to be significant, and 2) the pharmacist didn’t believe the alert to be of any clinical significance to a particular patient.
What is prospective DUR?
Prospective DUR occurs before a prescription is dispensed. The U.S. Pharmacopeia (USP) and the American Pharmaceutical Association (APhA) have put their heads together to help enhance the effectiveness of prospective DUR. Their effort was born from discussions in 1996 detailing situations, mostly outpatient, in which pharmacists were presented with "test" prescriptions. Pharmacists were given two prescriptions for one patient, for two drugs that interact with one another. In some cases, pharmacists overrode the drug interaction alerts from their computers and still filled the prescriptions.
What is a Dur review?
The phrase drug utilization review, or DUR, takes several different shapes and meanings, depending on the situation and whom you’re talking to. Its purpose varies too, often swaying with current issues and problems in pharmacy. DUR first appeared with the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90).
Is prospective DUR difficult?
While important to patient care, prospective DUR can be difficult to perform in any practice setting, Browne says. "Pharmacists are only as empowered as the information available to them. Comprehensive prospective DUR can be limited to the hospital pharmacist who doesn’t yet have lab data. The community pharmacist can be limited by not having full patient medical history or by simply not being aware of other drugs that patients might be taking that they buy from other pharmacies across town."
Does OBRA 90 require retrospective DUR?
1. OBRA ’90 did indeed mandate both prospective and retrospective DUR. As a result of OBRA ’90, every state is to offer patient drug counseling to all Medicaid patients and provide a DUR program for covered outpatient prescriptions "in order to assure that prescriptions (i) are appropriate, (ii) are medically necessary, ...
What is DUR in Medicaid?
On an annual basis, states are required to report on their practitioners prescribing habits, cost savings generated from their Drug Utilization Review (DUR) programs and their program’s operations, including adoption of new innovative DUR practices via the Medicaid Drug Utilization Review Annual Report Survey.
What is 42 CFR subpart K?
42 CFR Subpart K – Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims Section 456.700-456.725 provides the requirements for the DUR program.
Ultimately, It Should Provide A Path
- The phrase drug utilization review, or DUR, takes several different shapes and meanings, depending on the situation and whom you’re talking to. Its purpose varies too, often swaying with current issues and problems in pharmacy. DUR first appeared with the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90). Its goals: Reduce Medicaid fraud and ensure that patient…
Mue
- "There are two very distinctive types of retrospective drug evaluation," Barry Browne, PharmD, coordinator of drug information at Scott and White Hospital and Health Plan in Temple, TX, tells Drug Utilization Review. "There is the MUE, or medication use evaluation, which many used to call DUE. An MUE is truly a medication use evaluation. It can be conducted prospectively, although t…
Dur
- "When I think of DUR," Browne says, "I think of a retrospective review of pharmacy trends in overuse of a particular drug or drug class.These trends often appear as a result of direct-to-consumer advertising campaigns or from heavy detailing from pharmaceutical reps. I think of dredging through pharmacy claims data. DUR involves more patient care a...
Prospective Dur
- Prospective DUR occurs before a prescription is dispensed. The U.S. Pharmacopeia (USP) and the American Pharmaceutical Association (APhA) have put their heads together to help enhance the effectiveness of prospective DUR. Their effort was born from discussions in 1996 detailing situations, mostly outpatient, in which pharmacists were presented with "test" prescriptions. Pha…
Goals of Dur
- Browne tells DUR, "Cost is not part of the equation we use in determining which drugsto evaluate for DUR or MUE. In fact, Joint Commission said several years ago that it did not want cost entering into the equation at all." As stated by the Kansas Medicaid DUR Board, the goal of DUR for its Medicaid recipients is to improve "drug therapy, patient outcomes, and quality of care."4 O…
Professional Duty
- The benefits of DUR are not restricted just to patients. Pharmacist and attorney, Nicholas J. Lynn, writes in a continuing education lesson: "One of the better known developments in the 1990s that signaled society’s recognition and acceptance of the pharmacist as a unique and vital member of the health care team was the enactment of the patient counseling and drug utilization review (D…
References
- 1. Just the Facts: Q&A. Pharmaceutical Care Management Association. www.pcmanet.org/fcts_ai.html 2. Conference Report to Accompany H.R. 5835, the Omnibus Budget Reconciliation Act of 1990, U.S. Government Printing Office, Oct. 27, 1990. 3. Malone PM, Mosdell KW, Kier KL, et al, eds. Drug Information: a Guide for Pharmacists. Stamford, CT: Applet…
Sources
- • Barry Browne, PharmD, Coordinator of Drug Information, Scott and White Hospital and Health Plan, 2401 S. 31st St., Temple, TX 76508. Telephone: (254) 724-5287. • Thomas Fulda, USP Program Director for DUR, U.S. Pharmacopeia, 12601 Twinbrook Parkway, Rockville, MD 20852. Telephone: (301) 816-8596.