Drug Utilization Review (DUR) Program

The purpose of the Utah Medicaid DUR program is to promote evidence-based best clinical practice, as well as to identify patterns of fraud, abuse, gross overuse, and inappropriate or suboptimal treatment. We aim to partner with prescribers, pharmacists, and Medicaid patients to enhance prescribing and dispensing practices, as well as medication use by individual patients.  Pharmacy staff utilize communication tools, such as motivational interviewing, and to promote and reinforce best practices in the delivery and administration of pharmacy benefits.

Prospective DUR

Prospective drug utilization review involves a review of drug therapy before each prescription is filled or delivered to a member and includes counseling of the member or their caregiver. This counseling involves motivational interviewing and is based on evidence-based predetermined clinical standards.

Retrospective DUR

Retrospective drug utilization interventions are often determined through a review of claims data or other records. Outcome measures are often derived from the Centers for Medicare and Medicaid Services (CMS) guidance, as well as measures outlined by the National Committee for Quality Assurance (NCQA) to best utilize claims data to create interventions and improve patient outcomes.

Current Drug Utilization Review Interventions