Health Care Services

Drug Utilization Overview

Why does Alaska Medicaid have
a Drug Utilization Review program?

Alaska Medicaid’s Drug Utilization Review, (DUR), program was developed in order to comply with the federal requirements set forth in the Omnibus Budget Reconciliation Act of 1990. Prospective and retrospective DUR are required by both federal and state law. The state of Alaska contracts with Affiliated Computer Services, (ACS), to conduct the DUR program. FHSC provides these services to the following states: AK, AR, FL, HI, KY, MD, MI, NV, NY, PA, SC, TN.


Prospective DUR:

Prospective DUR is performed by all Alaska pharmacists before filling any prescription. Proprietary software developed by FHSC, is used to check for potential problems with a Medicaid patient’s medication therapy. This software will bring the pharmacists attention to such matters as drug-drug interactions, high or low doses, early or late refills, pregnancy cautions, as well as other potential problems.


Retrospective DUR:

Retrospective DUR is performed by the state’s DUR Committee some time after a prescription is filled. The committee consists of three physicians and three pharmacists who are actively practicing in the community, as well as 1 pharmacist who is a state employee and coordinates the committee’s activities. The committee meets periodically to review the use of medications by Medicaid recipients, and identify regimens that do not meet predetermined criteria. When an aberrant pattern of prescribing and/or utilization is identified, an educational letter is sent to the prescriber and/or dispensing pharmacist informing them of a potential problem and requesting a reply which explains how the issue will be addressed.

Results:

The state of Alaska has a successful DUR program. Thanks to our providers, the rate of return for compliance letters is quite good. During Federal Fiscal Year 2006, the committee reviewed an average of 152 profiles each month, and sent 1288 letters to providers addressing criteria associated with the following eight therapeutic classes:


1. Ataractics - Tranquilizers


2. Psychostimulants - Antidepressants


3. Bronchial Dilators


4. Analgesics, Narcotic


5. Analgesic, Non-Narcotic, General


6. Sedatives, Non-Barbiturate


7. Anticonvulsants


8. Fungicides

During Federal Fiscal Year 2006, cooperation between Medicaid providers and the DUR Committee resulted in improved patient safety, and allowed the state of Alaska to reduce drug expenditures by over $200,000.00.