9.2 Prospective Drug Utilization Review
Key Takeaways
- Rule 6800.3110 requires every Minnesota pharmacy to maintain a patient medication profile designed for immediate retrieval of previously dispensed medication when a new order is presented.
- Prospective DUR must identify over/underutilization, therapeutic duplication, drug–disease contraindications, drug–drug interactions, incorrect dose or duration, drug–allergy interactions, and clinical abuse or misuse.
- Upon recognizing a problem, the pharmacist shall take appropriate steps to avoid or resolve it, including prescriber consultation when necessary—DUR is action, not only an on-screen alert.
- Computerized profile review may be used if it includes medications dispensed by the pharmacy for at least the preceding six months; only a pharmacist or a pharmacist-intern under immediate and direct supervision may override alerts.
- Electronic data processing systems under Rule 6800.3950 need written policies, backup/audit controls, and PIC procedures for handling computerized DUR alerts as part of the pharmacy’s operational procedures.
9.2 Prospective Drug Utilization Review
Quick Answer: Under Rule 6800.3110, Minnesota pharmacies must maintain patient medication profiles and, upon receiving a prescription or refill request, conduct a prospective drug review for problems such as therapeutic duplication, interactions, allergies, incorrect dose/duration, over/underuse, and abuse/misuse. The pharmacist must resolve identified problems (including prescriber consultation when needed). Computer review is allowed if it covers at least the preceding six months of medications dispensed by the pharmacy; only a pharmacist or a pharmacist-intern under immediate and direct supervision may override alerts. Rule 6800.3950 requires written electronic-system procedures that support these safeguards.
Prospective DUR is both a federal OBRA-era concept and a Minnesota operational duty. On the MPJE, treat it as Area 3 Dispensing work that overlaps Area 2 Practice: you evaluate the order before the patient walks away with a bag that can cause harm.
Patient Profiles: The DUR Infrastructure (Rule 6800.3110)
System required (Subp. 1)
A patient profile record system must be maintained in all pharmacies for persons for whom filled prescription drug orders are dispensed. The system must allow immediate retrieval of information needed to identify previously dispensed medication when a prescription is presented. One profile may cover family members living at the same address with the same family name.
Minimum information (Subp. 2)
A reasonable effort must be made to obtain, record, and maintain at least:
| Category | Examples from the rule |
|---|---|
| Demographics | Name, address, telephone, date of birth or age, gender |
| Clinical history | Significant disease states, known allergies and drug reactions, comprehensive medication/device list (Rx number, name/strength, quantity, date received, prescriber) |
| Pharmacist comments | Pharmaceutical care needs, services rendered, impression of drug therapy (with nursing-home consultant-review nuance for documentation) |
If someone other than the pharmacist obtains history information, the pharmacist must review that information with the patient. Profiles are kept for not less than two years from the date of the last entry (hard copy or computerized).
Interaction screen on every order (Subp. 3)
Upon receiving a prescription drug order, a pharmacist shall examine the profile before dispensing to determine the possibility of a harmful drug interaction or reaction. Upon recognizing a potentially harmful interaction or reaction, the pharmacist shall take appropriate steps to avoid or resolve the problem, including consultation with the prescriber if necessary.
Prospective Drug Review Elements (Subp. 4)
Upon receiving a prescription drug order or refill request, a pharmacist shall examine the profile and conduct a prospective drug review to identify:
| DUR problem (MN rule language) | Plain-language exam example |
|---|---|
| A. Overutilization or underutilization | Early refill chasing vs. chronic nonadherence |
| B. Therapeutic duplication | Two full-dose NSAIDs; duplicate SSRIs |
| C. Drug–disease contraindications | NSAID in decompensated heart failure |
| D. Drug–drug interactions | Warfarin + new high-risk interactant |
| E. Incorrect drug dosage or duration | Pediatric dose math error; unlimited PPI duration without plan |
| F. Drug–allergy interactions | Documented penicillin anaphylaxis + amoxicillin |
| G. Clinical abuse or misuse | Escalating opioid/benzo patterns, doctor shopping red flags |
These elements mirror the classic OBRA prospective DUR set and are expressly codified for Minnesota practice. Memorize the list and the duty to act.
Resolution duty
Upon recognizing any of these problems, the pharmacist shall take appropriate steps to avoid or resolve the problem, which shall, if necessary, include consultation with the prescriber. An ignored red alert that is overridden without clinical thought is not “efficient workflow”—it is a patient-safety and Board problem.
Computers, Six-Month Lookback, and Alert Overrides
For meeting Subpart 4, a pharmacist may rely on computerized medication profile review, provided it includes all medication dispensed by the pharmacy for the patient during at least the preceding six months.
Critical control points:
- The pharmacist-in-charge must develop procedures for handling alerts generated by computerized review and include those procedures in the written procedures required under Rule 6800.3950.
- Only a pharmacist or a pharmacist-intern working under the immediate and direct supervision of a pharmacist may override the alerts.
- Technicians may process workflow around the system, but they do not hold override authority for clinical DUR alerts under this rule language.
Electronic Data Processing Support (Rule 6800.3950)
Rule 6800.3950 is the electronic backbone of profiles, refill trails, and auditability. High-yield operational themes (not every sub-item must be memorized verbatim, but the safety logic must):
- Written policy and procedures for system operation, downtime, backup, audit, and personnel responsibilities
- Input controls: if non-pharmacist/non-prescriber personnel enter orders, a pharmacist or prescriber must certify accuracy and verify the order before dispensing; unique identifiers retained
- Confidentiality, freedom of pharmacy choice, reconstruction after malfunction
- Ability to produce patient profiles and controlled-substance audit trails, with at least two-year retrievability expectations in the computer rules
- Quality-assurance comparison of original prescription information to computer entry (with timing rules for the QA check)
- Board notification within 72 hours if dispensing information is lost due to unscheduled system interruption
Link the rules in your head: 6800.3110 says what clinical review must catch; 6800.3950 says how the computer system must be governed so that review is reliable.
Counseling Connection
Prospective DUR and counseling are sequential safety gates:
- Profile + DUR finds the problem.
- Resolution (patient education, dose change with prescriber, refuse to dispense when appropriate) fixes the problem.
- Rule 6800.0910 counseling communicates the safe plan to the patient when therapy proceeds.
A perfect counseling monologue on a therapeutically duplicated regimen that nobody reviewed is still a DUR failure. A perfect computer alert that a tech overrides without pharmacist authority is still a rule violation.
Exam Traps
| Trap | Better answer |
|---|---|
| “DUR is only for new Rxs” | Subp. 4 applies to orders or refill requests |
| “Computer alert = automatic cancel” | Pharmacist must resolve; some alerts are false positives after clinical review |
| “Any staff can clear alerts to keep lines moving” | Pharmacist or supervised intern only |
| “Six months of claims from every pharmacy in Minnesota” | Computer reliance standard is medications dispensed by the pharmacy for at least six months—know the rule’s scope |
| “Profile is optional for cash patients” | Profile system is required for persons for whom filled Rxs are dispensed |
Study Checklist
- Recite the seven DUR problem categories in 6800.3110 subp. 4.
- State the resolve / consult prescriber duty.
- Remember six-month computerized lookback and pharmacist/intern-only overrides.
- Tie alert procedures to 6800.3950 written policies.
- Keep profile minimum data and two-year retention in your Area 3 toolkit.
Which set correctly lists prospective drug-review problems a Minnesota pharmacist must look for under Rule 6800.3110, subpart 4?
A computerized DUR alert fires in a Minnesota community pharmacy. Who may override the alert under Rule 6800.3110?
For computerized medication profile review to meet Rule 6800.3110 prospective-review expectations, what minimum lookback must the system include?
Upon recognizing a potentially harmful interaction on prospective review, what is the pharmacist’s duty under Rule 6800.3110?