Drug utilization review (DUR) is a process required by federal law in the Omnibus Budget Reconciliation Act of 1990 (OBRA 90) to assure that prescriptions for covered outpatient drugs are appropriate, medically necessary, and not likely to result in adverse medical results.

DUR is designed to educate both prescribing providers and pharmacy providers on how to identify and reduce the frequency of patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care among prescribing providers, pharmacists, and people enrolled in Medicaid. Education and alerts are made available to prescribing providers and pharmacists both prospectively and retrospectively about:

  • Medication appropriateness
  • Overutilization and underutilization
  • Appropriate use of generic products
  • Therapeutic duplication
  • Drug-disease contraindications
  • Drug-drug interactions
  • Incorrect drug dosage or duration of drug treatment
  • Drug-allergy interactions
  • Clinical abuse/misuse

The DUR process assesses data on drug use against predetermined standards, consistent with the following:

1. Compendia consisting of the following:

  • American Hospital Formulary Service Drug Information
  • United States Pharmacopeia-Drug Information (or its successor publications)
  • DRUGDEX Information System

2. Peer–reviewed medical literature