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.
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
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 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 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.