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.
Exam Tip
OBRA-90 Medicaid standards address prospective DUR, pharmacist counseling, and patient profiles. State law determines who may make the counseling offer and its new/refill scope. Technicians do not independently provide clinical counseling.
What Is OBRA-90?
The Omnibus Budget Reconciliation Act of 1990 (OBRA-90) is a landmark federal law that significantly expanded the role of pharmacists and pharmacy technicians by requiring specific patient care standards for Medicaid prescriptions. Its DUR provisions apply through Medicaid state plans, subject to specified exceptions. State pharmacy laws can impose counseling and review duties for other patients as well.
Three Key OBRA-90 Requirements
| Requirement | Description |
|---|---|
| Prospective Drug Utilization Review (DUR) | Pharmacist must review each prescription before dispensing for potential problems |
| Patient Counseling | Pharmacist offers counseling to patients or caregivers under state standards; state law determines new/refill scope and who may make the offer |
| Patient Medication Profiles | Pharmacy must maintain records of each patient's medications, allergies, and relevant health information |
Prospective DUR Requirements Under OBRA-90
The pharmacist must screen for:
| Screen Type | What It Checks |
|---|---|
| Therapeutic duplication | Two drugs in the same class |
| Drug-drug interactions | Harmful combinations |
| Incorrect dosage/duration | Over/underdosing |
| Drug-allergy reactions | Known patient allergies |
| Clinical misuse/abuse | Patterns of inappropriate use |
| Drug-disease contraindications | Medications inappropriate for patient's conditions |
Patient Counseling Under OBRA-90
| What Must Be Offered | Details |
|---|---|
| Drug name and description | What the medication is |
| Route, dosage form, dose | How to take it |
| Duration of therapy | How long to take it |
| Common side effects | What to watch for |
| Interactions | Food, drug, and disease interactions |
| Storage instructions | How to store properly |
| Refill information | When and how to refill |
| Action if dose missed | What to do for missed doses |
Important OBRA-90 Distinctions
| Point | Details |
|---|---|
| Applies to | Medicaid covered outpatient prescriptions, with federal exceptions; state duties can extend to other patients |
| Clinical counseling provided by | Pharmacist; an authorized intern may counsel under applicable state supervision rules |
| Technician role | May communicate an offer where state rules permit, but cannot independently provide clinical counseling |
| State laws | Many states have expanded OBRA-90 to cover all patients |
Exam Alert
OBRA-90 is a high-yield topic in the Laws domain (15% of ExCPT scored items). Key points: it mandates DUR, counseling, and patient profiles for Medicaid. Technicians refer clinical questions to the pharmacist. State rules determine whether auxiliary staff may make the counseling offer and whether it covers new prescriptions, refills, or both.
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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.
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