What Is Drug Utilization Study?

How do you do a drug utilization review?

Steps in Conducting a Drug Use EvaluationIdentify or Determine Optimal Use.

An organization’s established criteria are defined to compare optimal use with actual use.

Measure Actual Use.



Evaluate the DUR Program.

Report the DUR Findings..

What does MTM stand for in pharmacy?

Medication therapy management (MTM) is a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best therapeutic outcomes for patients.

What are Tier 4 drugs?

Tier 4 includes non-preferred brand drugs and non-preferred generic drugs. Tier 5 is the highest tier. It contains very high cost brand and generic drugs, which may require special handling and/or close monitoring.

How much is the penalty for not having Medicare Part D?

The late enrollment penalty amount typically is 1% of the national base beneficiary premium (also called “base beneficiary premium”) for each full, uncovered month that the person didn’t have Part D or other creditable coverage. The national base beneficiary premium for 2020 is $32.74.

How is Medicare Part D penalty calculated?

Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020, $33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $. 10 and added to your monthly Part D premium.

What does drug utilization review mean?

Drug Utilization Review (DUR) is a coordinated effort by physicians and pharmacists to ensure the desired outcome for a patient. DUR can be done prospectively by the pharmacist while a prescription is being processed or retrospectively by HMSA by reviewing claims data and other records for utilization patterns.

How do I know what tier my drugs are?

The easiest way to find out what tier your drugs are in is by using your plan’s drug list. When you look up a drug, the second column of the drug list will show you what tier it’s in. You can find out more about how to read a drug list in our Help Center. Find your plan’s drug list.

What are the drug utilization management rules?

Utilization management restrictions (or “usage management” or “drug restrictions”) are controls that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) can place on your prescription drugs and may include: Quantity Limits – limiting the amount of a particular medication that you can receive in a given time.

What does a utilization manager do?

“Utilization management is the integration of utilization review, risk management, and quality assurance into management in order to ensure the judicious use of the facility’s resources and high-quality care.”

Who is responsible for completing a drug utilization review?

Value of DUR Programs: Managed health care systems and pharmacy benefit management companies (PBMs) have the responsibility of managing the medication use in the client’s membership. DUR programs are integral in helping to understand, interpret, and improve the prescribing, administration, and use of medications.

Why drug utilization research is important?

The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price.

What is drug utilization management?

Utilization management is a collection of treatment review and cost reduction techniques used by health insurers and health plans. … Common utilization management techniques for prescription drugs include prior authorization, step therapy, quantity limits, and mandatory generic substitution.