DUR Alerts

Alerts concerning clinically significant drug-drug interactions, therapeutic duplications, ingredient duplications, or maximum dosage are part of the claim adjudication process.

Alerts do not cause claims to reject and are intended to provide information to assist the pharmacist in working with the prescribing provider to provide appropriate pharmaceutical therapy.

Alerts are contained in the “Drug Use Review/Professional Pharmacy Service (DUR/PPS)” segment, shown below. Refer to the Claims Billing (B1) Transaction for specific transaction, segment, and field requirements.

The system's ProDUR processes assist the pharmacist by addressing situations in which potential drug problems may exist. ProDUR performed prior to dispensing helps pharmacy providers ensure that the person receives clinically appropriate medications. This is accomplished by providing information to the dispensing pharmacist that may not have been previously available particularly if the person is using more than one pharmacy. The system assists pharmacy providers in the prospective review for people enrolled in Medicaid by providing online information on prescriptions paid by HHSC within the defined time period. Examples of DUR messages include the clinically significant drug-drug interactions and therapeutic duplications.

Prospective (concurrent) drug use review edits apply to all claims unless otherwise identified.