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.
Exam Tip
OBRA-90 mandates 3 things: prospective DUR, patient counseling, and patient profiles for Medicaid. Only PHARMACISTS can counsel patients. Technicians can offer but not provide counseling on the ExCPT.
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. While it technically applies only to Medicaid patients, most pharmacies apply OBRA-90 standards to all patients as best practice.
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 must offer to counsel patients (or their caregivers) on new prescriptions |
| 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 patients (most pharmacies apply to all) |
| Counseling must be offered by | The pharmacist (NOT the technician) |
| Technician role | Can alert patient that counseling is available; cannot 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 Overview and Laws/Regulations domain (25% of ExCPT). Key points: it mandates DUR, counseling, and patient profiles for Medicaid. Only pharmacists can counsel -- technicians can offer counseling but cannot perform it.
Study This Term In
Related Terms
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.
HIPAA in Pharmacy
HIPAA (Health Insurance Portability and Accountability Act) in pharmacy governs the protection of patients' protected health information (PHI) during prescription processing, counseling, insurance claims, and all pharmacy operations.
Controlled Substance Schedules
Controlled substance schedules are the DEA's five-tier classification system (Schedule I through Schedule V) that categorizes drugs based on their accepted medical use, abuse potential, and likelihood of causing dependence.
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