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 (Omnibus Budget Reconciliation Act of 1990) mandated prospective DUR for all Medicaid patients, and most pharmacy computer systems now perform DUR screening on all prescriptions.
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) |
| Drug-gender conflict | Finasteride prescribed to female patient |
| 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 must offer to counsel on new prescriptions |
| Record keeping | Patient profiles must be maintained |
| Applies to | All states for Medicaid prescriptions |
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 both the Overview/Laws and Dispensing Process 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.
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Related 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 all Medicaid prescription recipients.
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.
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