Drug Utilization Review Program Sample Clauses

The Drug Utilization Review Program clause establishes a process for systematically reviewing the prescription and use of medications within a healthcare setting. Typically, this involves evaluating prescribing patterns, monitoring for inappropriate drug use, and ensuring compliance with established guidelines or formularies. By implementing such a program, the clause helps to promote patient safety, optimize therapeutic outcomes, and control healthcare costs by identifying and addressing potential issues related to medication use.
Drug Utilization Review Program. (A) The Contractor shall operate a drug utilization review program that includes prospective drug review, retrospective drug use review, and an educational program as required at 42 CFR 456, subpart K. (B) The Contractor shall provide a detailed description of its drug utilization review program activities to the State on an annual basis, as directed by the Department.
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Drug Utilization Review Program. The MCO must have a process in place to conduct prospective and retrospective utilization review of prescriptions that is consistent with Medicare Part D drug utilization review standards (see 42 C.F.R. 423.153). Prospective review should take place at the dispensing pharmacy’s point-of-sale (POS). The prospective review at the POS should compare the prescribed medication against previous drug history for drug-to-drug, ingredient duplication, therapeutic duplication, and high dose situations. The MCO’s retrospective review should monitor prescriber and contracted pharmacies for outlier activities. Retrospective reviews should also determine whether services were delivered as prescribed and consistent with the MCO’s payment policies and procedures. Prior to the Operational Start Date, HHSC will transmit a file with up to one year of medication history for Members with recent Medicaid eligibility, moving from the fee-for-service program. Outgoing MCOs will transfer this data for members moving to a new MCO.
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Drug Utilization Review Program. The MCO must have a process in place to conduct prospective and retrospective utilization review of prescriptions that is consistent with Medicare Part D drug utilization review standards (see 42 C.F.R. § 423.153). Prospective review should take place at the dispensing pharmacy’s point-of-sale (POS). The prospective review at the POS should compare the prescribed medication against previous drug history for drug-to-drug, interactions, ingredient duplication, therapeutic duplication, age or gender contraindications, drug-allergy contraindications, overutilization or underutilization, incorrect dosage, and high dose situations. The MCO’s retrospective review should monitor prescriber and contracted pharmacies for outlier activities. Retrospective reviews should also determine whether services were delivered as prescribed and consistent with the MCO’s payment policies and procedures. The MCO must provide a summary of the quarterly retrospective reviews, including outcomes, as described in UMCM Chapter 5.13.1, MCO Drug Utilization Review (DUR) Quarterly Report Template. The MCO’s Drug Utilization Review should specifically assess prescribing patterns for psychotropic medications as defined by Texas Family Code § 266.001(7). If the MCO identifies patterns outside of the MCO’s parameters for psychotropic medications, or if HHSC notifies the MCO of outlier prescribing patterns, then the MCO must conduct a peer-to-peer discussion on the appropriateness of the drug regimen with the prescriber. For children, the MCO must model its parameters on DFPS’s Psychotropic Medication Utilization Parameters for ▇▇▇▇▇▇ Children. (See DFPS’s website for more information: ▇▇▇▇://▇▇▇.▇▇▇▇.▇▇▇▇▇.▇▇.▇▇/Child_Protection/Medical_Services/guide-psychotropic.asp).For adults, the MCO must base its parameters for psychotropic medications on approved compendia, such as peer-reviewed academic literature or nationally accepted guidelines.
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Drug Utilization Review Program. The MCO must have a process in place to conduct prospective and retrospective utilization review of prescriptions that is consistent with Medicare Part D drug utilization review standards (see 42 C.F.R. § 423.153). Prospective review should take place at the dispensing pharmacy's point-of-sale (POS). The prospective review at the POS should compare the prescribed medication against previous drug history for drug-to-drug, interactions, ingredient duplication, therapeutic duplication, age or gender contraindications, drug-allergy contraindications, overutilization or underutilization, incorrect dosage, and high dose situations. The MCO's retrospective review should monitor prescriber and contracted pharmacies for outlier activities. Retrospective reviews should also determine whether services were delivered as prescribed and consistent with the MCO's payment policies and procedures. The MCO must provide a summary of the quarterly retrospective reviews, including outcomes, as described in UMCM Chapter 5.13.1, "MCO Drug Utilization Review (DUR) Quarterly Report Template." Prior to the Operational Start Date, HHSC will transmit a file with up to one year of medication history for Members with recent Medicaid eligibility, moving from the fee-for-service program. Outgoing MCOs will transfer this data for members moving to a new MCO.
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Drug Utilization Review Program. The CONTRACTOR shall maintain written policies and procedures governing its drug utilization review (DUR) program, in compliance with any applicable Federal Medicaid law.
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Related to Drug Utilization Review Program

  • Utilization Review NOTE: The Utilization Review process does not apply to Services that are not covered by Blue Shield because of a coverage determination made by Medicare. State law requires that health plans disclose to Sub- scribers and health plan providers the process used to authorize or deny health care services under the plan. Blue Shield has completed documentation of this process ("Utilization Review"), as required un- der Section 1363.5 of the California Health and Safety Code. To request a copy of the document describing this Utilization Review process, call the Customer Service Department at the telephone number indicated on your Identification Card.

  • Program Review The State ECEAP Office will conduct a review of each contractor’s compliance with the ECEAP Contract and ECEAP Performance Standards every four years. The review will involve ECEAP staff and parents. After the Program Review, the State ECEAP Office will provide the contractor with a Program Review report. The contractor must submit an ECEAP Corrective Action Plan for non-compliance with ECEAP Performance Standards. The Plan must be approved by the State ECEAP Office.

  • Position Review 18.3.1 Either an employee or the University may request an audit of the duties and responsibilities of a position he/she/it believes is not allocated to the proper class. Employees requesting such an audit are expected to notify the Union at the time of their request. 18.3.2 Job audits will be performed and reclassification decisions will be made by the University’s Human Resources Services staff according to the University’s Classification Process. The affected employee(s) and the Union will be notified of the outcome of a job audit in writing. In the event of a reallocation that results in removal of a position from the bargaining unit, the written notice will describe the manner in which the bargaining unit work is being distributed, including the classification and position(s) of any employee(s) absorbing work from the reallocated position. 18.3.3 If an employee disagrees with a classification decision made by the Human Resources staff, the employee may request review of that decision through the Director of OFM/State Human Resources within 30 (thirty) calendar days of receiving the final allocation decision from the University. Should the employee disagree with the Director’s decision, the employee may further appeal the matter to the Washington Personnel Resources Board within 30 (thirty) calendar days of being provided the written decision of the Director. The Board will render a decision, which will be final and binding. Decisions regarding appropriate classification will be reviewed in accordance with this Section and will not be subject to the grievance procedure specified in Article 40 of this Agreement.

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

  • Quality Assurance Program An employee shall be entitled to leave of absence without loss of earnings from her or his regularly scheduled working hours for the purpose of writing examinations required by the College of Nurses of Ontario arising out of the Quality Assurance Program.