Drug Utilization Review
CenCal Health Drug Utilization Review (DUR) Program
CenCal Health’s Drug Utilization Review program is an authorized, structured, ongoing review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication. The program includes a comprehensive review of patients’ prescription and medication data to ensure appropriate medication decision making and positive patient outcomes. The CenCal Health DUR program is classified into two categories:
- Retrospective–Review of therapy after the patient has received medication
- Educational – Outreach program to educate practitioners on common therapy problems
These reviews play a key role in helping managed health care systems understand, interpret, and improve the prescribing, administration, and use of medications.
Retrospective DUR Program Overview:
A retrospective DUR is reviewed after the patient has received the medication. The review may detect patterns in prescribing, dispensing, or administering drugs to prevent recurrence of inappropriate use or abuse, and serves as a means for target interventions. In retrospective DUR, examination of claims and other records determine whether the drug therapy met approved criteria, and aids prescribers in improving care for their patients, individually and within groups of patients, such as those with diabetes, asthma, or high blood pressure.
Issues Commonly Addressed by Retrospective DUR:
- Therapeutic appropriateness
- Over and underutilization
- Therapeutic duplication
- Drug-disease contraindications
- Drug-drug interactions
- Incorrect drug dosage
- Clinical abuse/misuse
Example of a Retrospective DUR:
- An analysis of member prescription utilization may identify a group of patients whose therapy does not meet approved guidelines. Upon retrospective review CenCal Health may identify a group of patients with asthma who, according to their medical and pharmacy history, should be using orally inhaled steroids. Using this information, CenCal Health can then encourage physicians to prescribe the indicated drug.
DUR Educational Program Overview:
An educational outreach program to educate practitioners on common drug therapy problems with the aim of improving prescribing and dispensing practices. These educational efforts are in collaboration with the State DUR board’s educational program as shared with CenCal Health.
Current DUR Educational Articles
2023 DUR Educational Articles
2023 Immunization Update: COVID-19, Influenza, RSV, HepB, Pneumococcal, HPV, Polio, Mpox, and MMR
No Added Benefit from Concomitant Use of GLP-1 Agonists and DPP-4 Inhibitors
New Resources Available for Perinatal Mental Health Conditions
FDA Approves First Over-the-Counter Naloxone Nasal Spray
Updated Guidance by the CDC and FDA for Prescribing Opioids
Clinical Review: Management of Acute Postpartum Pain
Removal of DATA-Waiver (X-Waiver) Requirement
Risks to Patients Exposed to Xylazine in Illicit Drugs
Improving the Quality of Care: Treatment of Latent Tuberculosis Infection
2022 Immunization Update: Mpox, HepB, Influenza, COVID-19, Pneumococcal, Zoster
2022 DUR Educational Articles
2021 DUR Educational Articles
Improving the Quality of Care Legislative Impact on the Use of Naloxone
Updated: Drug Safety Communication: Voluntary Recall of Varenicline (Chantix) Due to Nitrosamine
2021 Immunization Updates: COVID-19, Influenza, and Meningococcal Disease
Drug Safety Communication: FDA Requests Removal of Pregnancy Contraindications for Statins
Drug Safety Communication: Voluntary Recall of Varenicline (Chantix) Lots of Containing Nitrosamine
Drug Safety Communication: Potential Increased Arrhythmia Risk from Lamotrigine
Clinical Review: Recommendations for the Management of Acute Dental Plan
Clinical Review: Recommendations for the Tapering of Benzodiazepines
2020 DUR Educational Articles
Drug Safety Communication: Stronger Warning Labels for Benzodiazepines
2020 Immunization Updates: Vaccination during COVID 19, Flu, HepA, and Tdap
Clinical Review: 2020 Standards of Care Treatment of Type 2 Diabetes
Clinical Guideline: Reproductive Health in Rheumatic and Musculoskeletal Disease
Drug Safety Communication: Mental Health Side Effects from Montelukast
2019 DUR Educational Articles
Alert: Improving the Quality of Care: Risks Associated with the Use of Gabapentin
Alert: New Global Guidelines for the Treatment of Asthma
2019 Immunization Updates: Flu, HepA, HPV, Measles, CA School Requirements
Drug Safety Communication: Sleep Behavior Risks with Select Sleep Aids
Drug Safety Communication: Risks with Sudden Discontinuation of Opioids
Drug Safety Communication: Updated Adverse Effects from Fluoroquinolones
Clinical Review Update: Morphine Equivalent Daily Dose
Alert: New Naloxone Regulations Effective on January 1, 2019
2018 DUR Educational Articles
2018 Immunization Updates: Flu, Tdap, HepB, Zoster, MMR, Adult Vaccines
Alert: Mandatory Use of CURES 2.0 Begins October 2, 2018
Drug Safety Communication: Adverse Effects from Fluoroquinolone Antibiotics
ProDUR Update: Additive Toxicity Alert Now Focused Only On CNS Depressants
In the Pharmacy: Pharmacists Furnishing Nicotine Replacement Products
Drug Safety Communication: New Age Limit for Opioid Cough and Cold Medicines