Drug Utilization Review (DUR)
Drug utilization review (DUR) is a systematic process of evaluating prescription drug use to ensure medications are used appropriately, safely, and effectively, as mandated by OBRA-90 for Medicaid patients.
Exam Tip
Three types of DUR: prospective (before dispensing), concurrent (during therapy), retrospective (after). OBRA-90 mandates prospective DUR for Medicaid patients. Technicians refer DUR alerts to the pharmacist.
What Is Drug Utilization Review?
Drug utilization review (DUR) is a quality assurance program that evaluates prescription drug therapy before, during, and after dispensing. OBRA-90 established Medicaid DUR requirements, implemented through state plans with specified exceptions. Prospective review occurs before dispensing, while retrospective review examines prior utilization. State laws and pharmacy practice often extend safety screening beyond Medicaid.
Types of DUR
| Type | When It Occurs | Description |
|---|---|---|
| Prospective DUR | Before dispensing | Real-time screening at point of sale for interactions, duplications, allergies |
| Concurrent DUR | During therapy | Ongoing monitoring of drug therapy while patient is taking medication |
| Retrospective DUR | After dispensing | Analysis of prescribing patterns and outcomes over time |
What Prospective DUR Screens For
| Alert Type | Example |
|---|---|
| Drug-drug interactions | Warfarin + aspirin (increased bleeding risk) |
| Drug-allergy conflicts | Penicillin prescribed to penicillin-allergic patient |
| Therapeutic duplication | Two SSRIs prescribed simultaneously |
| Incorrect dosage | Dose exceeds maximum recommended |
| Drug-disease contraindication | NSAID prescribed to patient with renal failure |
| Drug-age precaution | Benzodiazepine prescribed to elderly patient (Beers Criteria) |
| Pregnancy-related risk | A drug with embryo-fetal toxicity prescribed to a patient who may be pregnant; pharmacist evaluates the individual situation |
| Over/underutilization | Refilling too early or too late |
| Duration of therapy | Antibiotic prescribed for longer than recommended |
OBRA-90 Requirements
| Requirement | Details |
|---|---|
| Prospective DUR | Must be performed before dispensing for Medicaid patients |
| Patient counseling | Pharmacist offers counseling under applicable state standards; the federal rule is not limited to new prescriptions |
| Record keeping | Patient profiles must be maintained |
| Applies to | Medicaid covered outpatient drug use, subject to the federal exceptions and state implementation rules |
Pharmacy Technician's Role in DUR
- Entering prescription data accurately to trigger appropriate DUR alerts
- Recognizing DUR alerts flagged by the computer system
- Referring DUR alerts to the pharmacist for clinical review
- Documenting pharmacist override decisions
Exam Alert
DUR is a key topic in the ExCPT Laws, Dispensing Process, and Medication and Patient Safety and Quality Assurance domains. Know the three types (prospective, concurrent, retrospective), that OBRA-90 mandates prospective DUR for Medicaid, and that pharmacy technicians must refer all DUR alerts to the pharmacist for resolution.
Study This Term In
Free CE RadioThird-party resources · We may earn a commission from purchases.
ExCPT Study Guide 2026-2027: Complete CPhT Review + 1440 Questions and Detailed Answer Explanations for the NHA Certified Pharmacy Technician Exam (12 Full-Length Exams)
By Test Prep, Newstone
$24.99 · 
Practice exams on ExamEdge
Study resources on Achievable
Study guide on MometrixFree CE RadioThird-party resources · We may earn a commission from purchases.
PTCB Exam Prep 2026-2027: Complete Study Guide + 6-Week Study Plan + 3060 Questions and Detailed Answer Explanations for the Pharmacy Technician Certification Exam (E-Learning Access)
By Test Prep, Newstone
$34.99 ·
Take courses on UdemyPrep course on AchievablePractice exams on ExamEdgeRelated Terms
OBRA-90 (Omnibus Budget Reconciliation Act of 1990)
OBRA-90 is a federal law that mandated prospective drug utilization review (DUR), patient counseling by pharmacists, and maintenance of patient medication profiles for Medicaid covered outpatient prescriptions under state implementation rules and specified federal exceptions.
Adjudication (Pharmacy)
Adjudication is the real-time electronic process by which a pharmacy submits a prescription claim to a patient's insurance plan and receives an immediate approval, rejection, or request for additional information.
Formulary
A formulary is a list of prescription drugs approved for coverage by a health insurance plan, pharmacy benefit manager (PBM), or healthcare institution, organized into tiers that determine patient cost-sharing.
Your AI study companion · 10 free interactions a day
Stay Updated
Get free exam tips and study guides delivered to your inbox.