Improving Drug Utilization Review Controls in Part D (Starts on page 131.)
CMS has implemented Level I and Level II requirements for Drug Utilization Review (DUR), and is now requiring Level III action for 2013. CMS expects to see from your organization:
- Improved Use of Concurrent Claim Edits
- Improved Use of Formulary Utilization Management Designs
- Improved Retrospective DUR Programming and Case Management
Source: CMS; April 2, 2012. Starts on page 131.
Supplemental Guidance Related to Improving Drug Utilization Review (DUR) Controls in Part D
This document contains more detail around the DUR actions for 2013, and includes additional suggestions, sample letters and FAQs to implement the DUR and case management requirements outlined by CMS.
Source: Tudor, Cynthia G., Ph.D.; CMS; August 31, 2012.
Unintentional Drug Poisoning in the United States
Drug overdose death rates in the United States have never been higher. The increase in drug overdose death rates is largely because of prescription opioid painkillers. Among emergency department visits for the misuse or abuse of drugs, legal drugs have caught up with illegal drugs. Insurance companies should identify these patients and notify the patient’s providers.
Source: Centers for Disease Control & Prevention; July 2010.