Drug Utilization Review

Drug Utilization Review is a program designed to measure and to assess on a retrospective and prospective basis the proper use of outpatient drugs in the medical program.

     Drugs or drug classes which are reviewed and found to be either over-utilized, abused, or have significant safety concerns, are determined to be candidates for prior authorization. These reviews are considered by the Drug Utilization Review Board, made up of actively practicing healthcare professionals, and recommendations are made in regard to these drugs or drug classes. If it is determined by the Board that the prior authorization process should be implemented, appropriate criteria for approval are determined by the Board with input from providers, drug manufacturers, and other experts. The Board then makes these recommendations to the Bureau for Medical Services.

     The DUR Board is responsible for the establishment of implementation of medical standards and criteria for the prospective and retrospective DUR programs.  It is the goal of the DUR Board to improve the quality of care for West Virginia Medicaid recipients through the use of drugs , assuring that the drugs are appropriate, medically necessary, and not likely to result in adverse medical effects.  The DUR Board is charged with making recommendations for educational interventions to prescribers and pharmacists to identify and reduce for both providers and patients, the frequency of patterns of fraud, abuse, gross overuse and inappropriate or medically unnecessary care.

Meeting Agendas & Minutes:

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Time:         4:00 - 6:00 p.m. * unless otherwise noted

for more information contact:

Vicki Cunningham, R. Ph.
Drug Utilization Review Coordinator
304-558-1700
vickicunningham@wvdhhr.org

printer friendly schedule

Place:

Rooms B10 and B11
Department of Health and Human Resources Building
350 Capitol Street
Charleston, WV

Date

DUR Board Presentation

Vytorin
Skeletal Muscle Relaxants
Antidepressants (AD)
HID 2008 Report - Quarter 1
DUR Board Presentation

2007 Meetings

2006 Meetings

Apidra
Exubera

DUR Board Members:

Retrospective Drug Utilization Review:

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A Retrospective Drug Utilization Review Committee (RDUR), comprised of actively practicing healthcare professionals, meets monthly to review members’ prescription profiles which have been identified for drug utilization issues. West Virginia Medicaid contracts with Health Information Designs (HID) to conduct the initial reviews and referrals for the Committee. The purpose of these reviews is to reduce inappropriate care and avoid potential adverse drug-drug or drug-disease interactions. Physicians and pharmacists are notified by letter when potential problems are identified. Health Information Designs also assists the pharmacy program in conducting population-based educational interventions for both medical prescribers and pharmacy providers. A lockin program, aimed at reducing the inappropriate use of controlled substances, is overseen by the RDUR Committee and maintained by the Bureau for Medical Services and Health Information Designs. A quarterly newsletter for Medicaid providers and prescribers is published by Health Information Designs This letter provides the latest prescribing and dispensing regulations from the Centers for Medicare and Medicaid (CMS), current clinical information and Bureau policy updates.