Drug Utilization Review
The objective of Drug Utilization Review is to improve the quality of pharmaceutical care by ensuring that Prescriptions are appropriate, medically necessary, and unlikely to result in adverse medical outcomes.
Windsor Rx seeks to ensure the safety of dispensed medications by notifying dispensing providers of potential adverse events at the point-of-dispensing when potential adverse events may occur for medications being dispensed to members. The online messaging process classifies events at different levels of severity and includes drug-to-drug interactions and therapeutic duplications. The following is a description of the DUR Program
Windsor Rx has adopted DueCare, a software program developed by First Data Bank and leased by our pharmacy claims processor, for identifying therapeutic duplications and at point-of-dispensing.
For Therapeutic Duplications, DueCare searches for therapy that is not medically indicated and may potentially result in adverse events and sends a message back to the pharmacy regarding the alert. The system searches for overlapping periods of time that include:
- Two or more doses of the same drug
- At least two drugs from the same therapeutic class
- At least two drugs from different therapeutic classes with similar pharmacological effects being used for the same indication
DueCare searches for drug interactions at the point-of-dispensing that may potentially result in adverse events and notifies the dispensing provider of such interactions, including their type and severity level.
Drug interactions are classified into the following severity levels:
Level 1: A potentially severe or life-threatening interaction. The occurrence has been suspected, established or probable in well controlled studies. Contraindicated drug combinations may also have this severity level.
Level 2: The interaction may cause deterioration in a patient’s clinical status. The occurrence is suspected, established or probable in well controlled studies.
Level 3: The interaction causes minor effects. The occurrence suspected, established or is probable based on well-controlled studies.
Level 4: The interaction may cause moderate-to-major effects, but data are very limited.
Level 5: Interaction may cause minor-to-moderate effects. The occurrence is unlikely or there is not good evidence of an altered clinical effect.
Messages for severity level 1 and 2 are transmitted to a dispensing provider at point of dispensing to inform the prescribing provider of the potential adverse interaction.
The Pharmacy Director analyzes drug interactions and therapeutic duplication reports every quarter for trends and may select certain alerts to send to the prescribing physician as informational.
The Pharmacy Director presents findings to the Windsor P&T Committee for further review and recommendations.
DueCare additional notifies the pharmacist when one of the following alerts occur:
- Over-utilization
- Under-utilization
- Appropriate use of generic products
- Drug/disease contraindications
- Incorrect drug dosage or duration
- Drug allergy interactions
- Clinical abuse/misuse
