5.2 Prospective Drug Utilization Review & Patient Medication Profiles
Key Takeaways
At the time of dispensing, a Utah pharmacist must review the patient's medication record for inappropriate use, duplication, drug-disease and drug-drug interactions, incorrect dose or duration, drug-allergy interactions, and abuse or misuse (R156-17b-611(2)).
If the review finds a clinically significant problem, the pharmacist must take appropriate steps to avoid or resolve it, including consulting the prescriber (R156-17b-611(3)).
A Utah patient profile must include name, address, phone, date of birth or age, gender, significant history including allergies, and each drug's name, strength, quantity, fill date, and charge (R156-17b-609(2)).
A patient profile must be kept at least one year from the most recent fill or refill (R156-17b-609(1)).
Utah law lets profile information be released only to listed persons, such as the patient, a lawfully authorized drug enforcement officer, the patient's authorized payer, and treating providers (Utah Code § 58-17b-604(4)).
5.2 Prospective Drug Utilization Review & Patient Medication Profiles
Blueprint item 3.3 covers prospective drug utilization review (DUR), including PMP access. Utah's DUR rule is R156-17b-611, and the profile rules are § 58-17b-604 and R156-17b-609. PMP reporting is covered in Section 9.4.
The DUR duty (R156-17b-611(2)–(3))
"For the purpose of promoting therapeutic appropriateness, a pharmacist shall at the time of dispensing a prescription ... review the patient's medication record." The review must at least identify clinically significant:
- inappropriate drug utilization (over- or under-use);
- therapeutic duplication;
- drug-disease contraindications;
- drug-drug interactions;
- incorrect drug dosage or duration of treatment;
- drug-allergy interactions; and
- clinical abuse or misuse.
When the review finds a problem, the pharmacist "shall take appropriate steps to avoid or resolve the problem including consultation with the prescribing practitioner." Failing to do so is unprofessional conduct (R156-17b-502(18)).
Key points:
- DUR applies at every dispensing, including refills, because the rule applies whenever a prescription is dispensed.
- DUR is a pharmacist (or supervised intern) function. A technician may not perform DUR (R156-17b-601(2)(c)).
- Software alerts support DUR but do not replace it. Overriding a serious alert without evaluating it, and without documenting the reason, is inconsistent with the duty to resolve the problem.
| DUR category | Example |
|---|---|
| Inappropriate utilization | A 30-day zolpidem supply requested after 14 days |
| Therapeutic duplication | Lisinopril and losartan from two different prescribers |
| Drug-disease | An NSAID for a patient with active peptic ulcer disease |
| Drug-drug | Clarithromycin for a patient taking high-dose simvastatin |
| Dose or duration | Ketorolac ordered beyond its 5-day maximum |
| Drug-allergy | Amoxicillin for a patient with a documented penicillin allergy |
| Abuse or misuse | Concurrent opioid and benzodiazepine from prescribers who don't coordinate, confirmed in the CSD |
Patient medication profiles
The statute (§ 58-17b-604)
- Each pharmacy must establish a medication profile system under DOPL rules.
- The pharmacy must maintain a profile for any patient who expresses a desire for that service, and may charge an appropriate professional fee for maintaining it and for copying or providing information to another authorized person.
- Release is restricted. A pharmacist, intern, or technician may not release or discuss information in a prescription or profile with anyone except:
- the patient in person, or the patient's legal guardian or designee;
- a lawfully authorized federal, state, or local drug enforcement officer;
- a third-party payment program the patient has authorized;
- a pharmacist, intern, or technician providing pharmacy services to the patient, or a prescribing practitioner treating the patient;
- another pharmacist, intern, technician, or prescriber to whom the patient has requested a prescription transfer; or
- the patient's attorney, with written authorization signed before a notary by the patient (or by a parent, guardian, or personal representative, as applicable).
The rule (R156-17b-609)
| Requirement | Detail |
|---|---|
| Retention | Keep each profile at least one year from the most recent fill or refill. A hospital pharmacy may delete an inpatient profile at discharge if the hospital record keeps the prescriptions. |
| Minimum contents | Patient's full name, address, telephone number, date of birth or age, and gender; significant patient history, including known allergies and drug reactions; and a list of prescription drugs obtained at the pharmacy showing name, strength, quantity, fill or refill date, and the charge to the patient; plus any comments relevant to the patient's drug use |
| Who may enter data | A pharmacist, pharmacy intern, pharmacy technician, technician trainee, or DMP designee |
The PIC must ensure that "a reasonable effort is made to obtain, record and maintain patient medication records" (R156-17b-603(3)(d)).
DUR and the Controlled Substance Database
The CSD supports DUR for controlled substances and gabapentin. Utah does not require the pharmacist to query it on every fill, but § 58-37f-304(4) requires a dispenser whose review suggests excessive opioid acquisition to reasonably attempt to contact the prescriber. Accessing and reviewing the database in accordance with the chapter carries civil immunity (§ 58-37f-701). See Section 9.4.
Retrospective DUR
Medicaid programs and payers perform retrospective DUR on claims data after dispensing, looking for patterns such as overuse or fraud. On the MPJE, "prospective" means before dispensing, by the pharmacist, and "retrospective" means after dispensing, by a program.
Scenarios
- Ciprofloxacin and tizanidine. The combination is contraindicated (CYP1A2 inhibition). The pharmacist should hold the prescription, consult the prescriber about an alternative, and document the intervention.
- Patient declines to give allergy history. Utah's rule requires significant history "including known allergies" in the profile, and the PIC must make a reasonable effort to get it. Document the attempt and the patient's refusal, and use professional judgment.
- A spouse calls for a list of the patient's medications. Unless the spouse is the patient's legal guardian or designee, § 58-17b-604(4) does not permit release.
Which statement correctly describes prospective DUR under Utah Admin. Code R156-17b-611?
It may be delegated entirely to a licensed pharmacy technician who clears software alerts
It is required only for new prescriptions, not refills
The pharmacist reviews the patient's medication record at the time of dispensing each prescription and must take appropriate steps, including consulting the prescriber, to resolve significant problems
It is a monthly retrospective review of claims performed by the Board of Pharmacy
Which item is among the minimum contents of a Utah patient medication profile under R156-17b-609?
The patient's employer and household income
The patient's Social Security number
The charge for each prescription drug dispensed to the patient
The prescriber's tax identification number
How long must a Utah pharmacy maintain an established patient medication profile for a patient served on a recurring basis?
At least six years, to match HIPAA documentation rules
Until the patient requests deletion
At least five years from the date the profile was created
At least one year from the date of the most recent prescription filled or refilled
A caller identifies herself as a patient's adult daughter and asks the pharmacist to read her the list of her mother's medications. She is not the patient's legal guardian or designee. What does Utah Code § 58-17b-604(4) permit?
The pharmacist may not release the profile information to her, because she is not among the persons the statute authorizes
The pharmacist may release the list to any caller who is a relative in an emergency
The pharmacist may release the list because she is an adult family member
The pharmacist may release the list if the daughter confirms her mother's date of birth
Sections you finish are checked off in the contents.