Zdrowie i gospodarka · 23/09/1994

Medicaid Program; Drug Use Review Program and Electronic Claims Management System for Outpatient Drug Claims

This final rule revises some of the regulatory requirements for the drug use review (DUR) program for covered outpatient drugs furnished to recipients under the Medicaid program. The regulatory requirements became effective on January 2, 1993, as a result of an interim final rule with comment period that we published on November 2, 1992. Specifically, these revisions-- Clarify the definitions of overutilization, underutilization, consensus process, peer-reviewed literature, adverse medical result, adverse drug-drug interaction, appropriate and medically necessary, and individual medical history; Change the requirements for licensure of DUR board members, and telephone counseling arrangements for mail order pharmacies; Include non-prescription drugs in the consideration of alteration of therapeutic effect; Require hospitals to give assurances that they have met the requirements of the statute before claiming the hospital exemption from DUR; Specify the issues that State agencies must address when formulating counseling standards; Clarify the bases for DUR board recommendations; Clarify the distinction between DUR and surveillance and utilization review (SUR); and Make certain techni