Three Phases of DUR
Ohio pharmacy law requires that all pharmacists are to perform Prospective DUR (ProDUR) counseling service to all patients prior to dispensation of any drug. Ohio Medicaid utilizes a Point Of Sale (POS) system which enhances the ProDUR functions by connecting all Ohio Medicaid pharmacies together. This pharmacy link enables a pharmacist to determine, prior to dispensation, whether the drugs requested are over-utilized, under-utilized, contraindicated drug combinations, or contraindicated drug use by diagnosis. The automated POS system augments the manual intervention currently performed by the pharmacist.Retrospective DUR
Retrospective DUR (RetroDUR) involves evaluating patterns of drug therapy either concurrent with therapy or after a patient has completed therapy. Interventions may be necessary in specific cases and may be in the form of letters, newsletters, bulletins or medical literature to providers and/or consumers. The RetroDUR intervention program is aimed at patients who are at risk of drug-induced illness, potential drug overutilization and the monitoring of physicians' prescribing activities. The DUR program utilizes paid Medicaid claims data to screen for potential adverse drug reactions, therapeutic appropriateness, incorrect drug dose or duration, drug allergy interaction and clinical abuse.
The RetroDUR program focuses on the interaction between the physician's prescribing and the consumer. By utilizing patient profiles generated from Medicaid paid claims data, monthly reviews are performed according to criteria approved by the DUR Board. After a review, intervention letters and response forms are mailed to selected providers. In addition to the intervention letters, guidelines and publications may be included along with the consumer's profile for the provider to review. Follow-up letters are sent to all responding physicians while a second letter is sent to those physicians who do not respond. A re-review is conducted 12 months after the original review to calculate cost savings.
Each review compares drug utilization and diagnostic data to identify overutilization, underutilization, contraindicated drug combinations, contraindicated drug use by diagnosis, iatrogenic (drug induced) and adverse drug reactions. Each individual patient profile is reviewed by members of the DUR Committee to determine if the drug therapy appears to be medically and therapeutically appropriate or if it indicates inappropriate usage.
When problems are identified, DUR notifies the physicians and/or the pharmacies in an effort to remedy the situation. These intervention letters vary according to the issue or problem, but always invite provider response. This exchange of information is designed to make the provider aware of the risk to the patient and give him or her the opportunity to supply clinical information relevant to this treatment that is not apparent to the reviewers.
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