pharmacy.medicaid.ohio.gov

Drug Utilization Review (DUR)

The Ohio Drug Utilization Review (DUR) program is a provider-oriented, educational outreach program designed to alert physicians and pharmacists to inappropriate or medically unnecessary care. The purpose of the program is to safeguard the health of Medicaid consumers, to assess the appropriateness of drug therapy, and to reduce the frequency of fraud, abuse and gross overuse.

Objectives:
The primary objectives of the DUR program are to improve health care through educational intervention. Such intervention should seek to eliminate or reduce drug-induced illness, hospitalizations, and the need for remedial care or treatment.

The Three Phases Of DUR

Prospective

Ohio pharmacy law (OAC § 4729-5-20) requires that all pharmacists perform Prospective Drug Utilization Review (ProDUR) counseling services to all patients prior to dispensation of any medication. The Ohio Department of Medicaid (ODM) utilizes a real-time, web-based Point-of-Sale (POS) system to exchange electronic information with network pharmacies to assist pharmacies with the ProDUR requirements. ProDUR can help ensure potential medication problems are avoided before they occur.

Retrospective

Retrospective DUR (RetroDUR) evaluates patterns of drug therapy on medications already dispensed to the patient. Interventions are aimed at patients who are at risk for a drug-related problem such as drug-induced illness, potential drug overutilization and medication misuse. There is also monitoring of physicians' prescribing activities to ensure patients are receiving appropriate care.

By utilizing patient profiles generated from Medicaid paid claims data, monthly reviews are performed by the DUR Committee according to criteria approved by the DUR Board. After a review, intervention letters and response forms are mailed to selected providers. Additional guidelines and publications may be included along with the consumer's profile for the provider to review. Follow-up letters are sent to all responding physicians while a second letter is sent to all physician non-responders. An outcomes-based review is conducted 12 months after the original review to calculate cost savings. Ohio Medicaid contracts with Change Healthcare to administer the Fee-for-Service RetroDUR program.

Concurrent

Concurrent DUR involves evaluation of drug therapy and intervention, if necessary, while the patient is undergoing therapy.

Ohio’s DUR program identifies Medicaid recipients who are at high risk of drug-induced illness requiring possible hospitalization, communicates those risk factors to the physicians and pharmacists involved in the drug therapy, and recommends evaluation of drug therapy when appropriate.

Drug Utilization Review Committee

The Committee meets monthly to review consumer claims profiles as part of a focused review.

The Committee helps determine specific review criteria for each intervention. Selected consumer profiles are reviewed by the DUR committee and chosen for intervention. Intervention letters may then be sent to the physician and/or pharmacy. In addition, DUR committee members may select cases they feel should be referred for a more detailed review of either the recipient or provider. Those profiles are then referred to the Coordinated Service Program (CSP) or to the Surveillance and Utilization Review Section.

DUR Committee Members

  • Sheriff Benson, Pharm.D.
  • Benjamin Michaels, Pharm.D.
  • Kayla Petkus, Pharm.D.
  • Jeffrey Michael Rabe, Pharm.D.
  • William R. Casee Seibert, Pharm.D.
  • Jill Wellmeier, R.Ph.
  • Janee Whitner, Pharm.D.

Drug Utilization Review Board

The DUR Board consists of four physicians and four pharmacists who each serve a two-year term. The board members have three responsibilities:

  • an advisory role providing medical and pharmaceutical expertise to the Ohio DUR program;
  • the development of standards and criteria for retrospective drug utilization review; and
  • the development of educational outreach programs for physicians and pharmacists.

The Board meets quarterly to approve criteria, guidelines, research activities and promote educational outreach activities.

DUR Board Members

  • Michael Dietz, D.O., Vice Chair
  • Michael K. Farrell, M.D.,
  • Jason Martinez, Pharm.D.
  • A. Mehran Mostafavifar, M.D., MBA, Chair
  • Kayla Petkus, Pharm.D.
  • Lenard G. Presutti, D.O.
  • Stacey Rexrode-Brewer, Pharm. D,
  • Donald L. Sullivan, Ph.D., R.Ph.

DUR Board Meeting Schedule and Minutes

Year 2022
Quarter 1 Quarter 2
Meeting Date: February 8, 2022
Location: GoToMeeting
After you click the link and register, you will receive an email containing information about joining the webinar.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Meeting Date: May 10, 2022
Location: GoToMeeting
After you click the link and register, you will receive an email containing information about joining the webinar.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Quarter 3 Quarter 4
Meeting Date: September 20, 2022
Location: GoToMeeting
After you click the link and register, a dial in number will be provided.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Meeting Date: November 8, 2022
Location: TBA
Agenda: Currently unavailable
Minutes: Currently unavailable
Year 2021
Quarter 1 Quarter 2
Meeting Date: February 9, 2021
Location: GoToMeeting
After you click the link and register, a dial in number will be provided.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Meeting Date: May 11, 2021
Location: GoToMeeting
After you click the link and register, a dial in number will be provided.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Quarter 3 Quarter 4
Meeting Date: September 21, 2021
Location: GoToMeeting
After you click the link and register, you will receive an email containing information about joining the webinar.
Agenda: DOWNLOAD
Minutes: DOWNLOAD
Meeting Date: November 9, 2021
Location: GoToMeeting
After you click the link and register, you will receive an email containing information about joining the webinar.
Agenda: DOWNLOAD
Minutes: DOWNLOAD