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1

DUR

or DUE

Drug Utilization Review or Drug use Evaluation
program for assessing appropriateness of drug therapy by evaluating date on drug use against some std / predetermined criteria

clinical appropriateness / Cost effectiveness / desired outcomes

 

3 Types:
Retrospective / Concurrent / Prospective

2

RETROspective DUR

Review of drug therapy performed
AFTER drug dispensed 

COMMON ISSUES
Appropriateness / over-under-utilization / generic use

clinical abuse-misuse / therapeutic duplication / Contraindications

drug-drug interactions / drug dosage / asthma / duration

3

Concurrent DUR

ONGOING MONITORING of drug therapy DURING course of treatment

Common issues:

Drug - drug interactions / excessive doses / too high or too low doses

duplicate therapy / pregnancy / age / gender

 

WARFARIN + INR monitoring

4

PROSPECTIVE DUR

Evaluation of a patient's drug therapy BEFORE a drug is dispensed

Common:
therapeutic interchange / generic substitution

incorrect dosage / DRUG ALLERGY / clinical abuse

 

Penicillin Allergy

5

Formulary SYSTEM

Systematically maintained COMPILATIONS

of therapeutically effective pharmaceuticals NECESSARY

for rational patient treatment

6

Formularies

Continuously updated lists of DRUGS OF CHOICE approved for use in a healthcare facility / benefit plan and 

WILL BE REIMBURSED BY THE PAYER

Classified by DEGREE OF RESTRICTIVENESS
Closed / Open / Everythign in between

Tier system

7

P&T Process  / Committees

Pharmacy & Therapeutics

Responsible for establishing & maintaining 
DRUG FORMULARIES

 

Provides guidance on info providede in dossiers to MCOs
Product Info + Disease Discription / Clinical Evidence / Economic Value

8

Step-Care Protocols / Algorithims

Care Maps / Treatment Algorithims, 

CAN BE IN COMBO WITH PRIOR AUTH

PLAN for a prescribed course of treatment in the management of a disease

REQUIRES use of recognized FIRST-LINE DRUG before approval of a more complex second -line drug

 

9

Disease State Management

or just Disease Management

Set of ACTIVITIES aimed at 
Improving health + Clinical outcomes
of a population of patients defined by all having a CHRONIC MEDICAL ILLNESS

organized through the use of technologies such as 
electronic health records / disease registry programs

COPD + Diabetes + Heart Failure + GI Disorders

HYPERcholesterolemia / HT / ESRD / CAD / ASTHMA

10

DPS

Drug Product Selection

Include

Therapeutic Interchange
drug products with a different chemical structure but are of the same pharmacological/therapeutic class

Generic Substitution

11

Therapeutic Interchange

Type of DPS

Drug Product Selection

AUTHORIZED EXCHANGE of a drug with a different chemical composition

but the same inteneded THERAPEUTIC OUTCOME as one prescripted

 

ILLEGAL TO DO WITHOUT PRIOR AUTHORIZATION

12

Generic Substitution

 

Use of a version of a generic multisource drug product other than the brand or version subscribed

SAME ACTIVE INGREDIENTS

Chemically IDENTICAL in:

Strength / Concentration / Dosage Form / Route of Admin

BIOEQUIVALENT

13

ORANGE BOOK

Generic Equivalents = PHARMACEUTICAL EQUIVALENTS

defined in this book

A = NO KNOWN Bioequivalence Problems

AB = Sufficient BioEQ evidence

14

MAC = Maximum Allowable Cost

Not good news with GENERICS

Health plans + PBMS are increasingly setting MAC pricing

when multiple generic versions are available

MAXIMUM INGREDIENT COST
that will be paid for the drug, regardless of acquisition cost of drug

reimburseed below the acquisition costs for some pharmacies