Drug Utilization Review (DUR)

Drug utilization review programs help to ensure that prescriptions for outpatient drugs are appropriate, medically necessary, and not likely to result in adverse medical consequences. DUR programs use professional medical protocols and computer technology and data processing to assist in the management of data regarding the prescribing of medicines and the dispensing of prescriptions over periods of time.

Federal legislation that requires states to implement DUR programs also requires states to establish DUR boards whose function is to play a major role in each state's DUR program. Pursuant to state law, the DURB was created to establish and implement medical standards and criteria for Medicaid's DUR programs. The New York State Medicaid DURB is comprised of health care professionals appointed by the Commissioner and includes physicians and pharmacists that actively practice in New York.

Responsibilities of the DURB include:

  • The establishment and implementation of medical standards and criteria for the retrospective and prospective DUR program.
  • The development, selection, application, and assessment of educational interventions for physicians, pharmacists and recipients that improve care.
  • The collaboration with managed care organizations to address drug utilization concerns and to implement consistent management strategies across the fee-for-service and managed care pharmacy benefits.
  • The review of therapeutic classes subject to the Preferred Drug Program.

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