Drug utilization review. Medical search

Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.

An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.

Review of the medical necessity of hospital or other health facility admissions, upon or within a short time following an admission, and periodic review of services provided during the course of treatment.

The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.

Health insurance providing benefits to cover or partly cover hospital expenses.

Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.

Excessive, under or unnecessary utilization of health services by patients or physicians.

Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.

I'm sorry for any confusion, but "Utah" is a proper noun and refers to a state in the United States, it does not have a medical definition. If you have any medical questions or need information on specific medical conditions or terms, I would be happy to help!

Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.

Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.

The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.

Drugs that cannot be sold legally without a prescription.

Directions written for the obtaining and use of DRUGS.

The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).

Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.

Planning for health resources at a regional or multi-state level.

The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.

Facilities for the preparation and dispensing of drugs.

Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)

Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.

Institutions with an organized medical staff which provide medical care to patients.

Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.

The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)

The functions and activities carried out by the U.S. Postal Service, foreign postal services, and private postal services such as Federal Express.

Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members. (1/550)

Published and widely disseminated guidelines for the care and management of asthma characterize asthma as a chronic, inflammatory disease and propose specific recommendations for therapy with inhaled anti-inflammatory medications. In a retrospective analysis of medical and pharmacy claims data of approximately 28,000 asthmatic members from five managed care settings, the dominant pattern of pharmacologic therapy that emerged was the use of bronchodilators without inhaled anti-inflammatory drug therapy. In addition, a significant proportion of asthmatic patients received no prescription drug therapy for asthma. Less than one third of asthmatic patients received any anti-inflammatory therapy and the majority of these received one or two prescriptions per year. Specialist physicians were two to three times more likely than non-specialists during a study period of 1 year to prescribe an anti-inflammatory medication, and were half as likely to have their asthmatic patients experience an emergency department or hospital event. This database analysis suggests that greater conformity with guidelines and/or access to specialist physician care for asthmatic members will lead to improved patient outcomes. (+info)

The three dimensions of managed care pharmacy practice. (2/550)

Our goal is to provide a framework for pharmacy in an evolving healthcare marketplace by identifying and discussing the three dimensions of pharmacy practice: (1) pharmacy practice across the continuum of care; (2) the major elements of pharmacy practice; and (3) the evolution of pharmacy during the five stages of the development of managed care. The framework was devised under the proposition that there is a substantial consistency in what patients need or should expect from pharmacists. As integrated health systems develop, pharmacists must apply their skills and knowledge across the continuum of care to ensure that they play an integral part in the systems. In a managed care environment characterized by change and the development of integrated health systems, pharmacists have opportunities to become involved directly in patient care in such areas as disease prevention, home healthcare, primary care, and subacute care. Information systems, hospital drug distribution, clinical pharmacy, and the fiscal environment comprise the major elements of pharmacy practice within an integrated health system, and the way in which each of these elements evolves as the healthcare market adapts to managed care is critical to pharmacy practice. If the pharmacy profession can demonstrate its ability to manage disease and health, improve outcomes, and reduce costs within the evolving healthcare system, pharmacists will play a vital role in the managed healthcare market in the approaching new millennium. (+info)

Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: a comparison in managed care and fee-for-service environments. (3/550)

We compared course of treatment with tricyclic antidepressant drugs (TCADs) and selective serotonin reuptake inhibitors (SSRIs) to assess interactive effects of antidepressant type with payer type and patient characteristics. A nationwide sampling of adults (n = 4,252) from approximately equal numbers of health maintenance organization (HMO) and indemnity enrollees were prescribed no antidepressants for 9 months, and thereafter prescribed a TCAD or SSRI. Using a retrospective analysis of prescription claims, these cohorts of TCAD and SSRI utilizers were followed for 13 to 16 months after their initial antidepressant prescription. Outcome measures included (1) termination of antidepressant treatment before 1 month; and (2) failure to receive at least one therapeutic dose during treatment lasting 3 months or more. Rates of premature termination and subtherapeutic dosing were significantly higher for TCAD-treated than SSRI-treated patients, and for HMO than indemnity enrollees. The interaction of HMO enrollment and TCAD use was associated with particularly high rates. Excluding patients terminating in the first month, the proportions of TCAD and SSRI utilizers remaining in treatment over time were not significantly different. We conclude that SSRIs may provide advantages in treatment adherence and therapeutic dosing, particularly in environments with limited prescriber time. The first month of treatment may be especially critical in determining compliance. (+info)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (4/550)

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed. (+info)

Considerations in pharmaceutical conversion: focus on antihistamines. (5/550)

The practice of pharmaceutical conversion, which encompasses three types of drug interchange (generic, brand, and therapeutic substitution), is increasing in managed care settings. Pharmaceutical conversion has numerous implications for managed care organizations, their healthcare providers, and their customers. Although drug cost may be a driving consideration in pharmaceutical conversion, a number of other considerations are of equal or greater importance in the decision-making process may affect the overall cost of patient care. Among these considerations are clinical, psychosocial, and safety issues; patient adherence; patient satisfaction; and legal implications of pharmaceutical conversion. Patient-centered care must always remain central to decisions about pharmaceutical conversion. This article discusses the issues related to, and implications of, pharmaceutical conversion utilizing the antihistamines class of drugs as the case situation. (+info)

The diagnostic and treatment approach to two common conditions by the physician members of a community health maintenance organization. (6/550)

We retrospectively collected data from one community managed care organization on all ambulatory care patients initially diagnosed with pneumonia or acute bronchitis from October, 1, 1992, to March 31, 1993, and from November 1, 1993, to January 31, 1994. We considered treatment to be successful when patients did not return for any related service within 15 days of initial diagnosis. We identified 2,490 episodes of illness, 85.7% which were acute bronchitis and 14.3% which were pneumonia. Overwhelmingly, physicians approached these conditions empirically (no diagnostic test); just 8.6% of patients had a diagnostic test during the 15-day episode of illness. Two-hundred twenty-nine of the episodes (9.2%) were apparently related to initial diagnoses, as they occurred during the 15-day period. More branded prescriptions (vs. generic) were dispensed during these related episodes. One patient was hospitalized and 19 patients used the emergency room either for first or subsequent visits. Empiric treatment is associated with effective diagnosis and therapy in ambulatory care patients with acute bronchitis and pneumonia. It remains unclear, however, if this strategy is the most cost-effective or if it leads to the most effective utilization of services. (+info)

Effect of a drug supply and cost sharing system on prescribing and utilization: a controlled trial from Nepal. (7/550)

The effect on prescribing habits of a drug supply and cost sharing system was studied in a hill district in Nepal. In this district the inadequate yearly supply of drugs from the government was supplemented by an extra supply from the project. Drugs were sold at a fixed prescription charge which covered all drugs for one episode of illness. The prescribing pattern in this district was compared to a control district with only the yearly government drug supply and no drug scheme. Drugs prescribed were also compared to theoretical needs based on the recorded diagnoses of the same patients and recommended treatment guidelines. Attendance figures were studied before and after the introduction of the drug scheme in the test district. A 25% sample of prescriptions was taken from all health posts in both districts, over a one year period. This was in total 11,772 prescriptions from 22 health posts. The results show that in the drug scheme district health workers prescribed essential drugs excessively. However, the doses that were prescribed were somewhat better than in the control district. Utilization of health facilities dropped by 18% in the drug scheme district and then increased in the second year. A supply of essential drugs does not necessarily improve the quality of care, or increase attendance levels. The WHO indicators designed to assess the quality of drug use at health facilities can give a misleading picture, as they do not include information on dosages. The effect on quality of care of supply and financing mechanisms needs further study. (+info)

Postmarketing analysis of lovastatin use in the VA Northern California System of Clinics: a retrospective, computer-based study. (8/550)

Prevention of coronary heart disease is a major public health goal. The efficacy of lovastatin in lowering serum cholesterol has been proven in research studies, but its efficacy in practice is unclear. To evaluate our practice patterns and outcome in the Veterans Administration Northern California System of Clinics, we reviewed computer-based records of 203 unselected patients issued lovastatin; 193 (95%) were men, and the average patient age was 66 +/- 9 years. The average daily dose of lovastatin was 24 +/- 10 mg, and average duration of therapy was 22 +/- 11 months. Only 72 patients (35%) were instructed on the prescription to take their medication with the evening meal, and only 59 patients (29%) had seen a dietitian during the observed (1 to 3 years) treatment period. Nevertheless, among the 124 patients with pretreatment lipid data, total serum cholesterol decreased by 18% from 271 +/- 45 to 221 +/- 41 mg/dL (P < 0.001), and low density lipoprotein (LDL)-cholesterol decreased by 23% from 185 +/- 43 to 143 +/- 37 (P < 0.001) mg/dL. High density lipoprotein-cholesterol and triglycerides were unchanged. Of the 168 patients with LDL-cholesterol data during the treatment period, only 74 (44%) achieved an LDL-cholesterol level of less than 130 mg/dL, the minimum goal for a population of older males with a high incidence of other cardiac risk factors. Safety surveillance with liver function testing was performed at least once in 192 patients (95%), but with creatine phosphokinase (CPK) testing in only 123 patients (61%) during the survey period. Enzyme elevations were minor, but occurred at least intermittently in approximately one quarter of patients. Only 5.7% of patients on lovastatin manifested an increase in transaminases on therapy. Due to incomplete baseline data, it is unclear how many patients had elevated CPK as a result of lovastatin. We conclude that: (1) lovastatin is effective in lowering total and LDL-cholesterol in practice, but is often used in dosage insufficient to lower LDL-cholesterol to goal levels; (2) patients are not being adequately educated on dosing schedules; (3) toxicity may be underestimated by infrequent and inconsistent surveillance; and (4) nonpharmacologic therapy is underutilized. (+info)

A Drug Utilization Review (DUR) is a systematic retrospective examination of a patient's current and past use of medications to identify medication-related problems, such as adverse drug reactions, interactions, inappropriate dosages, duplicate therapy, and noncompliance with the treatment plan. The goal of DUR is to optimize medication therapy, improve patient outcomes, reduce healthcare costs, and promote safe and effective use of medications.

DUR is typically conducted by pharmacists, physicians, or other healthcare professionals who review medication records, laboratory results, and clinical data to identify potential issues and make recommendations for changes in medication therapy. DUR may be performed manually or using automated software tools that can analyze large datasets of medication claims and electronic health records.

DUR is an important component of medication management programs in various settings, including hospitals, long-term care facilities, managed care organizations, and ambulatory care clinics. It helps ensure that patients receive the right medications at the right doses for the right indications, and reduces the risk of medication errors and adverse drug events.

Utilization review (UR) is a comprehensive process used by healthcare insurance companies to evaluate the medical necessity, appropriateness, and efficiency of the healthcare services and treatments that have been rendered, are currently being provided, or are being recommended for members. The primary goal of utilization review is to ensure that patients receive clinically necessary and cost-effective care while avoiding unnecessary or excessive treatments.

The utilization review process may involve various steps, including:

1. Preauthorization (also known as precertification): A prospective review to approve or deny coverage for specific services, procedures, or treatments before they are provided. This step helps ensure that the planned care aligns with evidence-based guidelines and medical necessity criteria.
2. Concurrent review: An ongoing evaluation of a patient's treatment during their hospital stay or course of therapy to determine if the services remain medically necessary and consistent with established clinical pathways.
3. Retrospective review: A retrospective analysis of healthcare services already provided to assess their medical necessity, appropriateness, and quality. This step may lead to adjustments in reimbursement or require the provider to justify the rendered services.

Utilization review is typically conducted by a team of healthcare professionals, including physicians, nurses, and case managers, who apply their clinical expertise and adhere to established criteria and guidelines. The process aims to promote high-quality care, reduce wasteful spending, and safeguard patients from potential harm caused by inappropriate or unnecessary treatments.

Concurrent review in a medical context refers to the process of evaluating a patient's treatment plan or care while it is still ongoing, as opposed to a retrospective review that takes place after the fact. The goal of concurrent review is to ensure that the care being provided is appropriate, necessary, and evidence-based, and to identify any potential issues or concerns that may arise during the course of treatment.

Concurrent review is often used in the context of utilization management, where it can help to prevent unnecessary or excessive use of healthcare resources. It may involve reviewing a patient's medical records, laboratory results, and other relevant data to assess the appropriateness of diagnostic tests, medications, and other treatments. The findings of the concurrent review can then be used to inform clinical decision-making and ensure that the patient receives the most effective and efficient care possible.

Concurrent review is typically carried out by a team of healthcare professionals, including physicians, nurses, and other specialists, who work together to evaluate the patient's care and make recommendations for improvement. The process is designed to be collaborative and transparent, with the goal of promoting high-quality care and improving patient outcomes.

Drug utilization refers to the use of medications by patients or healthcare professionals in a real-world setting. It involves analyzing and evaluating patterns of medication use, including prescribing practices, adherence to treatment guidelines, potential duplications or interactions, and outcomes associated with drug therapy. The goal of drug utilization is to optimize medication use, improve patient safety, and minimize costs while achieving the best possible health outcomes. It can be studied through various methods such as prescription claims data analysis, surveys, and clinical audits.

Hospitalization Insurance is a type of health insurance that provides coverage for the expenses incurred during a hospital stay, including surgery, diagnostic tests, doctor's visits, and other related services. This type of insurance may also cover the cost of hospital room and board, intensive care unit (ICU) stays, and nursing services. Some policies may also provide coverage for ambulance transportation, home health care, and rehabilitation services following a hospital stay. The specific benefits and coverage limits will vary depending on the policy and insurance provider.

An insurance claim review is the process conducted by an insurance company to evaluate a claim made by a policyholder for coverage of a loss or expense. This evaluation typically involves examining the details of the claim, assessing the damages or injuries incurred, verifying the coverage provided by the policy, and determining the appropriate amount of benefits to be paid. The insurance claim review may also include investigating the circumstances surrounding the claim to ensure its validity and confirming that it complies with the terms and conditions of the insurance policy.

Health services misuse is not a term that has a specific medical definition. However, it generally refers to the inappropriate or unnecessary use of health services, resources, or treatments. This can include overutilization, underutilization, or incorrect utilization of healthcare services. Examples may include ordering unnecessary tests or procedures, using emergency department services for non-urgent conditions, or failing to seek timely and appropriate medical care when needed. Health services misuse can result in harm to patients, increased healthcare costs, and decreased efficiency in the delivery of healthcare services.

Managed care programs are a type of health insurance plan that aims to control healthcare costs and improve the quality of care by managing the utilization of healthcare services. They do this by using a network of healthcare providers who have agreed to provide services at reduced rates, and by implementing various strategies such as utilization review, case management, and preventive care.

In managed care programs, there is usually a primary care physician (PCP) who acts as the patient's main doctor and coordinates their care within the network of providers. Patients may need a referral from their PCP to see specialists or access certain services. Managed care programs can take various forms, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point-of-Service (POS) plans, and Exclusive Provider Organizations (EPOs).

The goal of managed care programs is to provide cost-effective healthcare services while maintaining or improving the quality of care. They can help patients save money on healthcare costs by providing coverage for a range of services at lower rates than traditional fee-for-service plans, but they may also limit patient choice and require prior authorization for certain procedures or treatments.

I'm sorry for any confusion, but "Utah" is not a medical term or concept. It is a geographical location, being the 45th state admitted to the United States of America. If you have any questions related to medical topics, I would be happy to try and help answer those for you!

A formulary is a list of prescription drugs, both generic and brand-name, that are approved for use in a specific health plan or healthcare system. The formulary includes information on the preferred drugs within each therapeutic class, along with any restrictions or limitations on their use. Formularies are developed and maintained by a committee of healthcare professionals, including pharmacists and physicians, who evaluate the safety, efficacy, and cost-effectiveness of different medications.

The purpose of a formulary is to promote the appropriate use of medications, improve patient outcomes, and manage healthcare costs. By establishing a preferred list of drugs, health plans and healthcare systems can negotiate better prices with pharmaceutical manufacturers and ensure that patients receive high-quality, evidence-based care.

Formularies may include various types of medications, such as oral solid dosage forms, injectables, inhalants, topicals, and others. They are typically organized by therapeutic class, and each drug is assigned a tier based on its cost and clinical value. Tier 1 drugs are usually preferred generics or lower-cost brand-name medications, while Tier 2 drugs may be higher-cost brand-name medications that have no generic equivalent. Tier 3 drugs are typically specialty medications that are used to treat complex or rare conditions and are often associated with high costs.

Healthcare providers are encouraged to prescribe drugs that are listed on the formulary, as these medications have been thoroughly reviewed and deemed safe and effective for use in their patient population. However, there may be situations where a non-formulary medication is necessary to treat a particular patient's condition. In such cases, healthcare providers can request an exception or prior authorization to prescribe the non-formulary drug.

Formularies are regularly updated to reflect new drugs that come on the market, changes in clinical guidelines, and shifts in the therapeutic landscape. Health plans and healthcare systems may also modify their formularies in response to feedback from patients and providers or to address concerns about safety, efficacy, or cost.

In summary, a formulary is a comprehensive list of prescription drugs that are approved for use in a specific health plan or healthcare system. Formularies promote the appropriate use of medications, improve patient outcomes, and manage costs by encouraging the prescribing of safe and effective drugs that have been thoroughly reviewed and deemed appropriate for their patient population.

A generic drug is a medication that contains the same active ingredients as an originally marketed brand-name drug, known as its "innovator" or "reference listed" drug. The active ingredient is the component of the drug that is responsible for its therapeutic effect. Generic drugs are required to have the same quality, strength, purity, and stability as their brand-name counterparts. They must also meet the same rigorous Food and Drug Administration (FDA) standards regarding safety, effectiveness, and manufacturing.

Generic drugs are typically less expensive than their brand-name equivalents because generic manufacturers do not have to repeat the costly clinical trials that were required for the innovator drug. Instead, they demonstrate through bioequivalence studies that their product is therapeutically equivalent to the reference listed drug. This means that the generic drug delivers the same amount of active ingredient into a patient's bloodstream in the same timeframe as the brand-name drug.

In summary, generic drugs are copies of brand-name drugs with the same active ingredients, dosage forms, strengths, routes of administration, and intended uses. They must meet FDA regulations for safety, efficacy, and manufacturing standards, ensuring that they provide patients with the same therapeutic benefits as their brand-name counterparts at a more affordable price.

A prescription fee is not a medical definition per se, but rather a term used in the context of pharmacy and healthcare services. It refers to the charge for dispensing a medication that has been prescribed by a healthcare professional. The prescription fee may cover the cost of the medication itself, as well as any additional services provided by the pharmacist, such as counseling on how to take the medication, potential side effects, and monitoring requirements.

Prescription fees may vary depending on the location, the type of medication, and the healthcare system in place. In some cases, prescription fees may be covered or subsidized by health insurance plans, while in other cases, patients may be responsible for paying the fee out of pocket. It is important for patients to understand their prescription coverage and any associated costs before filling a prescription.

Prescription drugs are medications that are only available to patients with a valid prescription from a licensed healthcare professional, such as a doctor or nurse practitioner. These drugs cannot be legally obtained over-the-counter and require a prescription due to their potential for misuse, abuse, or serious side effects. They are typically used to treat complex medical conditions, manage symptoms of chronic illnesses, or provide necessary pain relief in certain situations.

Prescription drugs are classified based on their active ingredients and therapeutic uses. In the United States, the Drug Enforcement Administration (DEA) categorizes them into five schedules (I-V) depending on their potential for abuse and dependence. Schedule I substances have the highest potential for abuse and no accepted medical use, while schedule V substances have a lower potential for abuse and are often used for legitimate medical purposes.

Examples of prescription drugs include opioid painkillers like oxycodone and hydrocodone, stimulants such as Adderall and Ritalin, benzodiazepines like Xanax and Ativan, and various other medications used to treat conditions such as epilepsy, depression, anxiety, and high blood pressure.

It is essential to use prescription drugs only as directed by a healthcare professional, as misuse or abuse can lead to severe health consequences, including addiction, overdose, and even death.

A drug prescription is a written or electronic order provided by a licensed healthcare professional, such as a physician, dentist, or advanced practice nurse, to a pharmacist that authorizes the preparation and dispensing of a specific medication for a patient. The prescription typically includes important information such as the patient's name and date of birth, the name and strength of the medication, the dosage regimen, the duration of treatment, and any special instructions or precautions.

Prescriptions serve several purposes, including ensuring that patients receive the appropriate medication for their medical condition, preventing medication errors, and promoting safe and effective use of medications. They also provide a legal record of the medical provider's authorization for the pharmacist to dispense the medication to the patient.

There are two main types of prescriptions: written prescriptions and electronic prescriptions. Written prescriptions are handwritten or printed on paper, while electronic prescriptions are transmitted electronically from the medical provider to the pharmacy. Electronic prescriptions are becoming increasingly common due to their convenience, accuracy, and security.

It is important for patients to follow the instructions provided on their prescription carefully and to ask their healthcare provider or pharmacist any questions they may have about their medication. Failure to follow a drug prescription can result in improper use of the medication, which can lead to adverse effects, treatment failure, or even life-threatening situations.

"Drug costs" refer to the amount of money that must be paid to acquire and use a particular medication. These costs can include the following:

1. The actual purchase price of the drug, which may vary depending on factors such as the dosage form, strength, and quantity of the medication, as well as whether it is obtained through a retail pharmacy, mail-order service, or other distribution channel.
2. Any additional fees or charges associated with obtaining the drug, such as shipping and handling costs, insurance copayments or coinsurance amounts, and deductibles.
3. The cost of any necessary medical services or supplies that are required to administer the drug, such as syringes, needles, or alcohol swabs for injectable medications, or nebulizers for inhaled drugs.
4. The cost of monitoring and managing any potential side effects or complications associated with the use of the drug, which may include additional medical appointments, laboratory tests, or other diagnostic procedures.

It is important to note that drug costs can vary widely depending on a variety of factors, including the patient's insurance coverage, the pharmacy where the drug is obtained, and any discounts or rebates that may be available. Patients are encouraged to shop around for the best prices and to explore all available options for reducing their out-of-pocket costs, such as using generic medications or participating in manufacturer savings programs.

Pharmaceutical services insurance refers to a type of coverage that helps individuals and families pay for their prescription medications. This type of insurance is often offered as part of a larger health insurance plan, but can also be purchased as a standalone policy.

The specifics of pharmaceutical services insurance coverage can vary widely depending on the policy. Some plans may cover only generic medications, while others may cover both brand-name and generic drugs. Additionally, some policies may require individuals to pay a portion of the cost of their prescriptions in the form of copays or coinsurance, while others may cover the full cost of medications.

Pharmaceutical services insurance can be especially important for individuals who have chronic medical conditions that require ongoing treatment with expensive prescription medications. By helping to offset the cost of these medications, pharmaceutical services insurance can make it easier for people to afford the care they need to manage their health and improve their quality of life.

Regional health planning is a process that involves the systematic assessment, analysis, and prioritization of healthcare needs for a defined geographic population in a specific region. It aims to develop and implement strategies, programs, and services to address those needs in a coordinated and efficient manner. This collaborative approach often involves various stakeholders, such as healthcare providers, public health officials, community leaders, and advocates, working together to improve the overall health and well-being of the population in that region.

The medical definition of 'Regional Health Planning' can be outlined as follows:

1. Systematic assessment: A comprehensive evaluation of the healthcare needs, resources, and infrastructure within a specific region, taking into account demographic, epidemiological, and socioeconomic factors that influence health outcomes.
2. Analysis: The examination of data and information gathered during the assessment to identify gaps, priorities, and opportunities for improvement in healthcare services and delivery.
3. Prioritization: The process of ranking healthcare needs and issues based on their urgency, impact, and feasibility of intervention, to ensure that resources are allocated effectively and efficiently.
4. Strategy development: The creation of evidence-based, data-driven plans and interventions aimed at addressing the prioritized health needs and improving the overall health of the regional population.
5. Collaboration: The active engagement and partnership of various stakeholders, including healthcare providers, public health officials, community leaders, and advocates, in the planning, implementation, and evaluation of regional health initiatives.
6. Coordination: The alignment and integration of healthcare services, programs, and policies across different levels and sectors to ensure seamless care and avoid duplication of efforts.
7. Continuous improvement: The ongoing monitoring and evaluation of regional health programs and interventions to assess their effectiveness, make adjustments as needed, and incorporate new evidence and best practices into future planning efforts.

I'm sorry for any confusion, but "United States" is a geopolitical entity, specifically the name of the country consisting of 50 states, and it is not a medical term or concept. Therefore, I can't provide a medical definition for it. If you have any questions related to health, medicine, or biology, I would be happy to try to help answer those!

A pharmacy is a retail store or a healthcare facility where medications, both prescription and over-the-counter, are sold or dispensed. Pharmacies are staffed by professional pharmacists who provide medication therapy management services, including reviewing the patient's medication history, checking for potential drug interactions, dosage adjustments, and providing education to patients on the safe and effective use of their medications.

Pharmacies may also offer other health-related products such as medical supplies, vitamins, and personal care items. Some pharmacies are part of a larger healthcare system, such as hospitals or clinics, while others are standalone retail stores. In addition to traditional brick-and-mortar locations, there are also online pharmacies that operate over the internet.

It's important for patients to only obtain medications from licensed and reputable pharmacies to ensure their safety and the effectiveness of their treatment.

Cost sharing in a medical or healthcare context refers to the portion of health care costs that are paid by the patient or health plan member, rather than by their insurance company. Cost sharing can take various forms, including deductibles, coinsurance, and copayments.

A deductible is the amount that a patient must pay out of pocket for medical services before their insurance coverage kicks in. For example, if a health plan has a $1,000 deductible, the patient must pay the first $1,000 of their medical expenses before their insurance starts covering costs.

Coinsurance is the percentage of medical costs that a patient is responsible for paying after they have met their deductible. For example, if a health plan has 20% coinsurance, the patient would pay 20% of the cost of medical services, and their insurance would cover the remaining 80%.

Copayments are fixed amounts that patients must pay for specific medical services, such as doctor visits or prescription medications. Copayments are typically paid at the time of service and do not count towards a patient's deductible.

Cost sharing is intended to encourage patients to be more cost-conscious in their use of healthcare services, as they have a financial incentive to seek out lower-cost options. However, high levels of cost sharing can also create barriers to accessing necessary medical care, particularly for low-income individuals and families.

Pharmaceutical fees are charges that healthcare professionals or institutions may impose on patients for various services related to the prescribing and dispensing of medications. These fees can include costs associated with medication therapy management, drug monitoring, medication reconciliation, and other clinical services provided by pharmacists or other healthcare providers.

It's important to note that these fees are separate from the cost of the medication itself and may not be covered by insurance. Patients should always ask about any potential fees before receiving pharmaceutical services and clarify whether they will be responsible for paying them out-of-pocket.

A hospital is a healthcare facility where patients receive medical treatment, diagnosis, and care for various health conditions, injuries, or diseases. It is typically staffed with medical professionals such as doctors, nurses, and other healthcare workers who provide round-the-clock medical services. Hospitals may offer inpatient (overnight) stays or outpatient (same-day) services, depending on the nature of the treatment required. They are equipped with various medical facilities like operating rooms, diagnostic equipment, intensive care units (ICUs), and emergency departments to handle a wide range of medical situations. Hospitals may specialize in specific areas of medicine, such as pediatrics, geriatrics, oncology, or trauma care.

Physician's practice patterns refer to the individual habits and preferences of healthcare providers when it comes to making clinical decisions and managing patient care. These patterns can encompass various aspects, such as:

1. Diagnostic testing: The types and frequency of diagnostic tests ordered for patients with similar conditions.
2. Treatment modalities: The choice of treatment options, including medications, procedures, or referrals to specialists.
3. Patient communication: The way physicians communicate with their patients, including the amount and type of information shared, as well as the level of patient involvement in decision-making.
4. Follow-up care: The frequency and duration of follow-up appointments, as well as the monitoring of treatment effectiveness and potential side effects.
5. Resource utilization: The use of healthcare resources, such as hospitalizations, imaging studies, or specialist consultations, and the associated costs.

Physician practice patterns can be influenced by various factors, including medical training, clinical experience, personal beliefs, guidelines, and local availability of resources. Understanding these patterns is essential for evaluating the quality of care, identifying potential variations in care, and implementing strategies to improve patient outcomes and reduce healthcare costs.

Cost control in a medical context refers to the strategies and practices employed by healthcare organizations to manage and reduce the costs associated with providing patient care while maintaining quality and safety. The goal is to optimize resource allocation, increase efficiency, and contain expenses without compromising the standard of care. This may involve measures such as:

1. Utilization management: Reviewing and monitoring the use of medical services, tests, and treatments to ensure they are necessary, appropriate, and evidence-based.
2. Case management: Coordinating patient care across various healthcare providers and settings to improve outcomes, reduce unnecessary duplication of services, and control costs.
3. Negotiating contracts with suppliers and vendors to secure favorable pricing for medical equipment, supplies, and pharmaceuticals.
4. Implementing evidence-based clinical guidelines and pathways to standardize care processes and reduce unwarranted variations in practice that can drive up costs.
5. Using technology such as electronic health records (EHRs) and telemedicine to streamline operations, improve communication, and reduce errors.
6. Investing in preventive care and wellness programs to keep patients healthy and reduce the need for costly interventions and hospitalizations.
7. Continuously monitoring and analyzing cost data to identify trends, opportunities for improvement, and areas of potential waste or inefficiency.

I'm sorry for any confusion, but "Postal Service" is not a term used in medical definitions. It generally refers to the system for delivering mail and packages, such as the United States Postal Service (USPS). If you have any questions about medical terminology or concepts, I'd be happy to help answer those!

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... suicidality rates and tolerability of drugs. Despite these controversies, usage of antidepressants remains high. This research ... by the SSRIs favourable adverse effect profile and increased safety in overdose compared to the older generation of drugs. This ... suicidality rates and tolerability of drugs. Despite these controversies, usage of antidepressants remains high. This research ... by the SSRIs favourable adverse effect profile and increased safety in overdose compared to the older generation of drugs. This ...

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... dispensers will be required to report dispensations to the Controlled Substance Utilization Review and Evaluation System (CURES ... Californias Prescription Drug Monitoring Program. CURES (Controlled Substance Utilization Review and Evaluation System) is a ... Beginning August 1, 2024, dispensers will be required to report dispensations to the Controlled Substance Utilization Review ... CURES is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or ...

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Comparison of drug utilization patterns in Observational Data: antiepileptic drugs in Pediatric Patients. Paediatr Drugs 2015; ... Drug utilisation studies provide an insight into the current standards and trends of drug prescriptions. Information from these ... Drug utilization pattern of antiepileptic drugs: a pharmacoepidemiologic and pharmacovigilance study in a tertiary teaching ... Objectives This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends ...

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... in the Medicaid Drug Utilization Review Program as collected through the Newly Revised Medicaid Drug Utilization Review Annual ... The DUR Annual Report Survey included since 2014 new sections on fraud, waste and abuse, Prescription Drug Monitoring Program ... Medicare Utilization Review, Medicaid Drug Utilization Review, CMS Annual Report Survey, Utilization Management, CMS Drug ... CMS Drug Utilization Review. This dataset contains information on labelers and products in the Medicaid Drug Utilization Review ...

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Results of search for su:{Drug utilization review.} Refine your search. *. Availability. * Limit to currently available items ... Local production and access to medicines in low- and middle-income countries : a literature review and critical analysis. by ...

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2) The "Drug Utilization Review board," defined in paragraph (C) of this rule, shall, in compliance with 42 U.S.C. 1396r-8 ( ... d) The DUR board shall develop an informational package on the nature of the drug utilization review program. ... Rule 5160-9-04 , Pharmacy services: drug utilization review.. Ohio Administrative Code ... A) Patient profiles, prospective drug utilization review (DUR), and patient counseling. (1) Patient profiles, prospective DUR ...

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New York State Drug Utilization Review Board Hepatitis C Virus Clinical Criteria Review ... New York State Drug Utilization Review Board Hepatitis C Virus Clinical Criteria Review. Oct 6, 2014 ... New York State Drug Utilization Review Board Hepatitis C Virus Clinical Criteria Review ... Home / Blog / New York State Drug Utilization Review Board Hepatitis C Virus Clinical Criteria Review ...

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Drug utilization review board meeting notes, and. *State prescription drug lists.. The study team developed a coding scheme to ... Last Reviewed: September 27, 2023 Source: National Center on Birth Defects and Developmental Disabilities ... NCBDDD funded a comprehensive literature review of studies that investigate a large range of factors that might increase the ... Prescription prior-authorization policy means that the health plan or state program is required to review a physicians ...

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Find out how they are reviewed on the Blue Cross MedicareRx plan. ... Drugs you take may require prior authorization, step therapy or ... Drug Utilization Review. Blue Cross MedicareRx conducts drug utilization reviews that help make sure youre getting safe and ... a generic name drug) instead of starting with a drug that costs more. If the first drug doesnt work for you, then the plan ... A drug that may not be needed because you are taking another drug to treat the same medical condition ...

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Drug Utilization Review Board. Governors Council on Mental Health Stigma. Governors Council on the Prevention of ...

https://www.nj.gov/humanservices/involved/boards/

Drug Utilization Review Board, assistance, Minn. Statutes 2006 256B.0625. Drugs and medicine, preferred drug list, Minn. ... Drugs and medicine, utilization, Minn. Statutes 2006 256B.0625. Nursing facilities, Minn. Statutes 2006 256B.434, 2006 256B.435 ... Drug utilization, Minn. Statutes 2006 256B.0625. Intermediate care facilities for persons with developmental disability, Minn. ... Drugs and medicine, preferred drug list, Minn. Statutes 2006 256B.0625. Federal health care reform waiver, pregnant women and ...

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Drug Utilization Review (DUR) *. Fraud, Waste and Abuse *. Generic Drugs *. Government/Legal Affairs ... Substance Use Disorder Advisory Group: A Focus on Prescription Drug Use * Addressing Barriers to Value-Based Payment Models in ...

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DI-094 Botulinum toxin type a for the treatment of neurological diseases: drug utilisation review ... DI-094 Botulinum toxin type a for the treatment of neurological diseases: drug utilisation review ... Prescription suitability was determined based on the approved indications in the drug data sheet of the three BT type A ...

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i) performing a drug utilization review, prescription drug order clarification from a. prescriber, final review of the ... drug-drug;. (ii) drug-food;. (iii) drug-disease; and. (iv) adverse drug reactions; and. (d) evaluation of the prescription drug ... d) participating in drug utilization review;. (e) ensuring proper and safe storage of drugs and devices;. (f) maintaining ... Drug Administration.. (27) Drug regimen review includes the following activities:. (a) evaluation of the prescription drug ...

https://le.utah.gov/~2005/bills/sbillenr/SB0142.htm

Title: Drug Utilization Review Board Subject: Quarterly Meeting Date and Time: 7/27/2017 2:00:00 PM ...

https://www.ms.gov/dfa/pmn/Home/NoticeDetails/9be39878-28ac-4691-b04e-d093364422ac

Chapter 9. Rational Use of Drugs and Essential Drugs: AnAtlas Approach. Chapter 10. Drug Utilization Evaluation/Review: An ... Chapter 7. Drug Induced Diseases and Utilization of Clinical Drug Literature. Chapter 8. Online Pharmaceutical Care Services ... Chapter 2. Patient Profile and Some Essential Drugs in a Nutshell. Chapter 3. Clinical Trials Monitoring of a Drug and ... Clinical Pharmacokinetics (Therapeutic Drug Monitoring). Chapter 12. Pharmaceutical Care: Its Scope, Management and ...

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Wertheimer A. The defined daily dose system (DDD) for drug utilization review. Hosp Pharm. 1986;21(3):233-4. ... Other types of drugs were tested with the same algorithm (Model 3), including drugs affecting the nervous system (N02-N06), ... Correlations between drug use and test results. We investigated whether previous use of montelukast, or other drugs that affect ... The reference group for each drug was those who had received one or none prescriptions of the drug in question. ...

https://link.springer.com/article/10.1007/s11096-020-01160-8

Maintained proper drug storage procedures, registries, and records for controlled drugs.. *Collected co-payments or full ... Improved operational planning and business frameworks to enhance resource utilization and reduce waste. ... Reviewed and verified customer information and insurance provider information.. Manager, 02/2016 - 01/2017. Jbs Usa - Oklahoma ... Provided consultations and answered inquiries from patients, healthcare professionals and physicians regarding drugs, potential ...

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IROs and UM providers offer specialized medical review solutions such as drug utilization review and peer review for group ... In drug utilization review, clinicians review patients prescription and medication data (and/or OTC drugs) before, during or ... Drug Utilization Review Leading providers of drug utilization review (DUR) programs deliver prospective, concurrent and ... Utilization Review The process of utilization review aims to assist payers in improving coordination of care, verifying members ...

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Drug Utilization Review Board Subnavigation toggle for Drug Utilization Review Board * 2022 DURB Meeting Information ... Health Planning - CON Batching Review. * Nursing Home Batching Notice March 28 2022. - Posted 03/28/22 ...

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Global prevalence of antidepressant drug utilization in the community: protocol for a systematic review. Lunghi C, Dugas M, ... Strategies to engage family physicians in primary care research: A systematic review. Girard A, Dugas M, Lépine J, Carnovale V ... Secondary Analysis of a Systematic Review. Diouf NT, Musabyimana A, Blanchette V, Lépine J, Guay-Bélanger S, Tremblay MC, Dogba ...

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Everybody says, "We are doing drug utilization review -- can we get our meaningful use points to collect our money?" You have ... Ethics, Electronic Health Record Integrity and the Patient-Physician Relationship 0.25 CME / ABIM MOC Credits Clinical Review ... Pleasedo not use this form to submit personal or patient medical information or to report adverse drug events. You are ...

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Perform drug utilization reviews to determine the presence of the following: *Therapeutic duplication, drug-disease ... drug-drug interactions, incorrect dosage, incorrect duration of therapy, drug-allergy interactions, suboptimal utilization ... Interpret drug literature and other resources to formulate an appropriate response to drug information requests ...

https://www.swosu.edu/pharmacy/current-students/experiential-program/appe/institutional-rotation.php

Impact of FDA drug risk communications on health care utilization and health behaviors: a systematic review.﻽. Dusetzina SB, ... Local institutional review board (IRB) review of a multicenter trial: local costs without local context.﻽. Ravina B, Deuel L, ... A review of disease progression models of Parkinsons disease and applications in clinical trials.﻽. Venuto CS, Potter NB, Ray ... Financing of U.S. biomedical research and new drug approvals across therapeutic areas.﻽. Dorsey ER, Thompson JP, Carrasco M, de ...

https://www.urmc.rochester.edu/people/112359350-earl-ray-dorsey

Healthcare providers treating, evaluating, or performing utilization review in the California workers compensation system may ... Medical Treatment Utilization Schedule - drug formulary. The Division of Workers Compensation has adopted a drug formulary to ... MTUS Drug Formulary Webinar - December 13 and 14, 2017. The webinar provides an overview of the MTUS Drug Formulary regulations ... U.S. Food & Drug Administration Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations - Orange Book ...

https://www.dir.ca.gov/dwc/MTUS/MTUS-Formulary.html

DUR - Drug Utilization Review. Federally mandated, Medicaid-specific prospective and retrospective drug utilization review ... ProDUR - Prospective Drug Utilization Review. The federally-mandated, Medicaid-specific prospective drug utilization review ... RetroDUR - Retrospective Drug Utilization Review. A series of post-payment analytical reports which evaluate the use of drugs ... Responsible for the current Retrospective Drug Utilization Review conducted for NYSDOH HIPAA - Health Insurance Portability and ...

https://www.emedny.org/glossary.aspx

The Division of Workers' Compensation has adopted a drug formulary to implement Assembly Bill 1124 (Statutes 2015, Chapter 525). (ca.gov)
The regulations establish an evidence-based drug formulary, consistent with California's Medical Treatment Utilization Schedule (MTUS), to augment the provision of high-quality medical care, maximize health, and promote return to work in a timely fashion, while reducing administrative burden and cost. (ca.gov)
The DWC welcomes public comment on the MTUS Formulary and Drug List. (ca.gov)
The webinar provides an overview of the MTUS Drug Formulary regulations, including the adoption of the drug list, implementation of updated MTUS guidelines, a demo of the online formulary tools for pharmaceutical searches. (ca.gov)
What should I do before I can talk to my doctor about changing my prescription drugs or requesting an exception to the UPMC for Life formulary? (upmchealthplan.com)
Headquartered in St. Louis , Express Scripts provides integrated PBM services including network-pharmacy claims processing, home delivery services, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. (prnewswire.com)

In community pharmacy Settings, Federal Law (OBRA-90) requires drug utilization review for patients receiving medication through Medicaid. (wikipedia.org)
Recognizing that Medicaid recipients faced similar risks in the 1980s, Congress provided for the ambulatory drug utilization review under the Omnibus Budget Reconciliation Act of 1990. (wikipedia.org)
Drug utilization review is mandated for Medicaid programs beginning in 1993. (harvard.edu)
This dataset contains information on labelers and products in the Medicaid Drug Utilization Review Program as collected through the Newly Revised Medicaid Drug Utilization Review Annual Report Survey, regarding prescriptions and reimbursements. (johnsnowlabs.com)
As part of a multifaceted response to address the growing problem of overuse and abuse of opioid analgesics ("opioids") in the Part D program, the Centers for Medicare & Medicaid Services (CMS) adopted a policy in 2013 for Medicare Part D plan sponsors to implement enhanced drug utilization review. (cms.gov)

The increasing utilisation of the new AEDs presents a fresh challenge of identifying new toxicities and drug interactions. (bmj.com)
UPMC for Life has identified major drug interactions and sends a warning when a community pharmacist tries to fill a prescription for a medication that interacts with another medication the member is currently taking. (upmchealthplan.com)

1 - 3 A recent review showed that lack of adherence to a priori defined validity criteria may help explain why primary studies on the same topic provide different results. (bmj.com)
and the Database of Abstracts of Reviews of Effectiveness (DARE), which selects systematic reviews published in peer reviewed journals on the basis of their adherence to a few methodological requirements. (bmj.com)
High adherence to the 'Wise List' treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines. (janusinfo.se)

This authorized, structured and ongoing review is related to pharmacy benefit managers. (wikipedia.org)
Beginning August 1, 2024, dispensers will be required to report dispensations to the Controlled Substance Utilization Review and Evaluation System (CURES) using version 4.2B of the American Society for Automation in Pharmacy (ASAP) format. (ca.gov)
Pharmacy services: drug utilization review. (ohio.gov)
An Integrated Care Management Plan which includes ED/Inpatient/pharmacy utilization history data and care alerts, is shared with the member's care team. (healthchoiceaz.com)
We have built safeguards into our pharmacy system that are designed to minimize the chance of a harmful drug interaction from occurring. (upmchealthplan.com)
Our internal clinical pharmacy team reviews, reports, and identifies members who are potentially at risk for adverse drug events. (upmchealthplan.com)
From the pharmacy perspective, we always care about the drug usage," Ling said. (pcom.edu)
In his role as an associate professor of pharmacy practice at PCOM School of Pharmacy , Ling is teaching his students to think about ways to improve patient outcomes by reviewing emerging drug therapies. (pcom.edu)

In this systematic review, AED prescriptions in different countries were identified from the published literature. (bmj.com)
On the other hand, a systematic review concluded that there was no evidence for clinical benefits from the use of NSAIDs or steroidal drugs in the treatment of patients with dementia [ 11 ]. (springer.com)
Strategies to engage family physicians in primary care research: A systematic review. (nih.gov)
Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review. (nih.gov)
Global prevalence of antidepressant drug utilization in the community: protocol for a systematic review. (nih.gov)
4 Some key issues still remain unresolved: which checklists and scales are the ideal approaches 5 and how the results of quality assessment in a systematic review should be handled in the analysis and interpretation of results. (bmj.com)
Methods: The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information). (bvsalud.org)

Short-acting and Long-acting Opioids Utilization among Women Diagnosed with Endometriosis in the United States: A Population-based Claims Study. (harvard.edu)
CMS immediately began working with Part D sponsors to improve drug utilization controls and better manage overutilization of opioids at the beneficiary level. (cms.gov)
reviews the utilisation of strong opioids on the Community Drug Schemes over a ten-year period. (hse.ie)
Prior to initiation of opioids for CNCP, prescribers should ensure that individuals understand the expected benefit and risk of harms, and agree treatment goals, a review strategy and a plan for discontinuation. (hse.ie)
In addition to the harms associated with misuse and abuse of the drugs, there are other possible harms from opioids. (cadth.ca)

The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? (harvard.edu)
Cars T, Lindhagen L, Malmström R, Neovius M, Schwieler J, Wettermark B, Sundström J. Effectiveness of Drugs in Routine Care: A Model for Sequential Monitoring of New Medicines using Dronedarone as Example. (janusinfo.se)

Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. (wikipedia.org)
Then, how to use drug utilization evaluation and drug economy evaluation to improve and optimize the allocation of medical and health resources is a major problem faced by many countries. (wikipedia.org)
CURES (Controlled Substance Utilization Review and Evaluation System) is a database of Schedule II, Schedule III, Schedule IV and Schedule V controlled substance prescriptions dispensed in California serving the public health, regulatory oversight agencies, and law enforcement. (ca.gov)
Prospective DUR (PDUR) is an evaluation of planned drug therapy prior to dispensing, while concurrent DUR (CDUR) is a real-time review of the course of treatment, monitoring drug therapies and patient outcomes. (admere.com)

In 1970, Drug utilization review program was carried out by a private pharmaceutical management company. (wikipedia.org)
Substantiated benefits of independent review include patient protection, positive impact on health plan review processes and other health care management activities, and a reduction of costly litigation. (admere.com)
Similarly, utilization management services have become more prominent. (admere.com)
As noted by the National Association of Independent Review Organizations (NAIRO), IROs render increased transparency for both payers and providers, decreased risk through proactive risk management and improved member satisfaction through unbiased, evidenced-based external determination. (admere.com)
As a URAC-accredited national provider of independent medical and utilization reviews, AMR offers a wide array of services to group health organizations including acting as a delegated entity within utilization management programs. (admere.com)
Director of Quality Improvement, Case Management, Risk Manager - Responsible for the quality, utilization, and risk programs for a 100+ bed medical/surgical/psychiatric hospital with two campuses. (exponent.com)
Director of Quality Assurance/Utilization Review - Responsible for utilization, quality, and risk management programs for a 130-bed medical/surgical and psychiatric hospital. (exponent.com)
Reorganized and streamlined the utilization management program. (exponent.com)
A variety of solutions address the rising cost of drugs under the medical benefits including medical policies, infusion site of care, channel management, and more. (bcbsmt.com)
Utilization Management - Offering over a hundred programs at no additional charge like prior authorization, step therapy and drug dispensing limits. (bcbsmt.com)

By conducting drug utilization analysis, we can improve the quality of patient care, enhance therapeutic outcomes, prevent adverse drug reactions, and reduce inappropriate pharmaceutical expenditures, reducing overall healthcare costs. (pcom.edu)
pH Sensitive Drug Delivery Systems (PSDDS) are gaining importance as these systems deliver the drug at specific time as per the pathophysiological need of the disease, resulting in improved patient therapeutic efficacy and compliance. (scialert.net)

Impact of a nationwide prospective drug utilization review program to improve prescribing safety of potentially inappropriate medications in older adults: An interrupted time series with segmented regression analysis. (harvard.edu)
A range of other medications were tested with the same algorithm, including drugs acting on the immune system, but none of them correlated with (overall) significantly improved test results. (springer.com)
One of UPMC for Life 's goals in designing drug formularies and utilization programs is to promote the safe and effective use of medications. (upmchealthplan.com)
Drug utilization is also reviewed after prescriptions for medications have been filled. (upmchealthplan.com)
As the price and utilization of these medications continue to escalate, it becomes increasingly necessary to ensure safe and effective medication use while managing costs. (bcbsmt.com)

Prescription prior-authorization policy means that the health plan or state program is required to review a physician's prescription request before coverage for the medication is granted. (cdc.gov)
Review status of authorization and referral requests. (healthchoiceaz.com)

Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). (harvard.edu)
Drug utilisation studies provide an insight into the current standards and trends of drug prescriptions. (bmj.com)
Drug Utilization Review (DUR) is designed to improve the quality of pharmaceutical care by ensuring that prescriptions are appropriate, medically necessary and unlikely to result in adverse medical outcomes. (alabama.gov)

Prospective drug utilization review refers to assessing appropriate drug and decision making therapeutically before patients' medication are dispensed. (wikipedia.org)
This prospective review is based on the history recording of the drug and medication. (wikipedia.org)
Leading providers of drug utilization review (DUR) programs deliver prospective, concurrent and retrospective reviews that allow payers to assess the necessity and safety of drugs and/or medication regimens. (admere.com)
Medicaid's DUR program includes prospective, online and retrospective review as well as use of standards developed by the National Council for Prescription Drug Programs (NCPDP). (alabama.gov)

In a clinical trial, researchers attempt to determine if new medical treatments, drugs or devices are safe and effective. (pcom.edu)
As part of a recent research project, Ling analyzed results from a clinical trial involving a drug therapy for patients with HFrEF (heart failure with reduced ejection fraction). (pcom.edu)
So we conducted a drug utilization analysis to retrospectively review the medical records of patients with HFrEF at our clinic and assess their eligibility for the clinical trials. (pcom.edu)
This exercise is very similar to what Ling does when he retrospectively reviews charts from clinical studies and prepares case reports. (pcom.edu)
Provide drug information and clinical support to healthcare teams. (soliant.com)
Optimal clinical outcome cannot be achieved if drug plasma concentrations are constant. (scialert.net)
Although, significant progress has been made in the controlled drug delivery area, more advances are yet to be made for treating many clinical disorders, such as diabetes and rhythmic heart disorders. (scialert.net)
Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). (aetna.com)

Methods Databases Embase (1980-May 2017), Medline (1946-May 2017) and PubMed were searched for original research on AED utilisation. (bmj.com)

By the mid-1970, many medical programs cooperate with private companies that providing drug utilization review. (wikipedia.org)
Drug Utilization Review" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus, MeSH (Medical Subject Headings) . (harvard.edu)
CURES is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or patient care. (ca.gov)
e) Peer-reviewed medical literature (that is, scientific, medical, and pharmaceutical publications in which original manuscripts are rejected or published after having been critically reviewed by unbiased independent experts). (ohio.gov)
The primary objectives of independent review organizations (IROs) are to help ensure that any proposed medical treatment is consistent with State or federal guidelines, plan language and or evidenced based medicine. (admere.com)
Utilization review often includes medical director services, panel reviews for complex cases , as well as fully- or partially-delegated pre-service, concurrent and post-service physician level reviews. (admere.com)
Another is physician-level review of medical records utilized by health plan professionals to determine whether or not to uphold a denial of coverage for a specific claim. (admere.com)
Current offerings include the use of the Medical Treatment Utilization Schedule (MTUS) and tips for Qualified Medical Evaluators (QME). (ca.gov)
Utilization review is a health insurance company's opportunity to review a request for medical treatment. (howstuffworks.com)
The purpose of the review is to confirm that the plan provides coverage for your medical services. (howstuffworks.com)
In his medical writing class, Ling instructs his students to find a topic of interest and search for information about new drug therapies, changes in treatment guidelines or findings about the disease itself. (pcom.edu)
Prior to joining Exponent, Ms. Maltby was an independent Healthcare Consultant, where she reviewed and evaluated medical records, depositions, and other records for the identification of issues in litigated cases, workers' compensation claims, and insurance matters. (exponent.com)
Ongoing monitoring of medical staff, assisted nursing department in development of peer review. (exponent.com)
2014). He has published numerous articles in international peer-reviewed journals as well as several books and monographs, including a book on paediatrics that is the standard text book for medical students in India and south Asia. (who.int)

Concurrent administration of potentially nephrotoxic drugs should be carefully approached or avoided. (petsupplies.com)
Ask about our concurrent drug-utilization review and risk identification outreach for opioid misuse, and many other options. (bcbsmt.com)

A retrospective review of all severe theophylline toxicity admissions to the ICU from 1 January 2013 to 31 December 2018 was conducted. (bvsalud.org)

BACKGROUND: It is widely acknowledged that many prescription drug errors occur in the ambulatory care setting and that they have serious quality of care implications. (cdc.gov)

In drug utilization review, clinicians review patients' prescription and medication data (and/or OTC drugs) before, during or after dispensing to ensure appropriate decision-making and positive patient outcomes. (admere.com)

Pharmacoepidemiol Drug Saf. (harvard.edu)

Methods for assessment of methodological quality by systematic reviews are still in their infancy and there is substantial room for improvement. (bmj.com)

Provided consultations and answered inquiries from patients, healthcare professionals and physicians regarding drugs, potential side effects and specified use. (livecareer.com)
Healthcare providers treating, evaluating, or performing utilization review in the California workers' compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering at https://www.mdguidelines.com/MTUS . (ca.gov)
Schmidt-Mende K, Andersen M, Wettermark B, Hasselström J. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines -A pragmatic open-label cluster randomized controlled trial in primary care. (janusinfo.se)

b) The DUR board shall recommend multiple levels of interventions for physicians and pharmacists targeted toward therapy problems or individuals identified in the course of retrospective drug use reviews. (ohio.gov)

Formal programs for assessing drug prescription against some standard. (harvard.edu)
The DUR Annual Report Survey included since 2014 new sections on fraud, waste and abuse, Prescription Drug Monitoring Program and state Managed Care Organizations. (johnsnowlabs.com)
State prescription drug lists. (cdc.gov)
The review is done each time you fill a prescription, as well as on a regular basis. (bcbsnm.com)
Prescription suitability was determined based on the approved indications in the drug data sheet of the three BT type A available in the hospital: Botox, Dysport and Xeomin. (bmj.com)
the use of prescription drugs. (utah.gov)
Clients should be advised to observe for signs of potential drug toxicity and be given a Client Information Sheet with each prescription. (petsupplies.com)
With 50% of Americans having at least one prescription 1 , drug coverage is a vital benefit to employees. (bcbsmt.com)
Give employees more choices while retaining the benefits and availability for nearly all branded prescription drugs with prescription drug coverage and programs designed to help simplify experiences and lower costs. (bcbsmt.com)
This seamless digital experience encourages members to select lower cost drug identified through its search engine, resulting in lower costs for the life of the prescription and a cash reward for switching. (bcbsmt.com)
The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. (who.int)
Mode de prescription de médicament en soins de santé primaires à Riyadh (Arabie saoudite). (who.int)
Les médecins de soins de santé primaires en Arabie saoudite ont besoin d'une formation continue pour améliorer leurs pratiques de prescription. (who.int)
2pharmacists)reachedaconsensus reviewedinmoredetailintheliterature Riyadhcityisservedbyalmost120PHC about whether the prescription was reviews accompanying this series of centresdistributedacross5healthsec- clearlywrittenornot.Inadditionthe papers[1-3]. (who.int)

The Cox1/2 inhibitors are included in the umbrella term non-steroidal anti-inflammatory drugs (NSAIDs) In addition to these drugs, cortisone-based steroids could be candidates to address inflammaging, although they have, in addition to their anti-inflammatory effects also immune-suppressive activities. (springer.com)
Since many NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforation, concomitant use of EQUIOXX with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. (petsupplies.com)

Objectives This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends in different countries. (bmj.com)
There is an increasing prevalence of new-generation anti-epileptic drugs (AEDs). (bmj.com)

Then, especially in the community medicine setting, Drug utilization review plays a key role for pharmacist. (wikipedia.org)

Objectives To describe how the methodological quality of primary studies is assessed in systematic reviews and whether the quality assessment is taken into account in the interpretation of results. (bmj.com)
Severe theophylline toxicity requiring haemodialysis accounts for approximately one-third of drug toxicity cases admitted to the Livingstone Tertiary Hospital (LTH) intensive care unit (ICU) in Gqeberha, South Africa, imposing a significant resource burden.Objectives. (bvsalud.org)

Prevention of drug-related problems such as adverse drug reactions, treatment failure, overuse, under-use, incorrect dosage and use of over-the-counter drugs g. (wikipedia.org)
There are some issues addressed by this review: drug abuse clinically, alteration of drug dosage, drug-drug interaction, and drug-disease interaction. (wikipedia.org)

There can be limits on how much of a drug you're allowed. (bcbsnm.com)
The presence of calcium limits their compatibility with certain drugs that form precipitates of calcium salts, and also prohibits their simultaneous infusion through the same administration set as blood because of the likelihood of coagulation. (dog.com)

The HDHP-HSA and ACA Preventive Drug Programs are benefits that groups can choose if they have High Deductible Health Plans (HDHP). (bcbsmt.com)

They are as follows: (1) reducing hospitalizations due to adverse drug events, (2) preventing and detecting fraud and abuse, and (3) supporting evidence-based prescribing through communication with others through academic details (i.e., face-to-face educational outreach by authoritative professionals in the non-profit sector). (wikipedia.org)

a) The DUR board shall review and recommend criteria used in DUR. (ohio.gov)

This increase poses important problems, including a) the lack of available antimicrobial therapy for VRE infections, because most VRE are also resistant to drugs previously used to treat such infections (e.g., aminoglycosides and ampicillin), and b) the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms (e.g. (cdc.gov)
This increase poses several problems, including a) the lack of available antimicrobials for therapy of infections caused by VRE, because most VRE are also resistant to multiple other drugs (e.g., aminoglycosides and ampicillin) previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus. (cdc.gov)

From 1985, hospitals in America are requested to use drug utilization review when using antibiotics. (wikipedia.org)
Antibiotics were the most commonly prescribed drugs in both sectors. (who.int)

Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. (bvsalud.org)

It set up three relevant goals for a drug utilization review program. (wikipedia.org)

Questions have been raised on the efficacy of treatment of depression and anxiety, suicidality rates and tolerability of drugs. (wits.ac.za)
In the last two decades, several new anti-epileptic drugs (AEDs) have been approved for the treatment of epilepsy. (bmj.com)
The plan can ask you to start treatment with a drug that costs less but works just as well (for example, a generic name drug) instead of starting with a drug that costs more. (bcbsnm.com)
Sydney (T. Gottlieb) drugs for treatment of most infections. (cdc.gov)
therefore, variations both in a disease state and in drug plasma concentration need to be taken into consideration in developing drug delivery systems intended for the treatment of disease with adequate dose. (scialert.net)

California law (Health and Safety Code Section 11165.1) requires all California licensed health care practitioners authorized to prescribe Schedule II, Schedule III, Schedule IV and Schedule V controlled substances to register for access to CURES upon issuance of a Drug Enforcement Administration Controlled Substance Registration Certificate. (ca.gov)

The process of utilization review aims to assist payers in improving coordination of care, verifying members receive high-quality, medically necessary care , and improving organizational oversight. (admere.com)

Drug utilization review refers to a review of prescribing, dispensing, administering and ingesting of medication. (wikipedia.org)
A health insurance exclusion refers to anything an insurance plan doesn't cover, from drugs to surgeries. (howstuffworks.com)

Novox is a non-steroidal anti-inflammatory drug (NSAID). (kvsupply.com)
EQUIOXX (firocoxib) belongs to the coxib class of non-narcotic, non-steroidal anti-inflammatory drugs (NSAID). (petsupplies.com)

Local production and access to medicines in low- and middle-income countries : a literature review and critical analysis. (who.int)

It is reviewed as new drugs come to market and when potentially harmful drug combinations are discovered. (upmchealthplan.com)

Drug utilization reviews will help ensure that drugs are used appropriately (for individual patients). (wikipedia.org)
In addition, in a study conducted in Scotland, the Predicting Emergency Admissions Over the Next Year (PEONY) score was used to predict the emergency admissions of patients aged ≥ 40 years using chronically used drugs. (nature.com)
Drug compatibility should be monitored in patients requiring adjunctive therapy. (petsupplies.com)
These plans allow clients to customize their benefits on some chronic disease states and navigate patients to preferred drugs to reduce costs. (bcbsmt.com)

One type of peer review consists of managing a doctor's performance and ensuring his or her skills are held to the highest standards. (admere.com)
Overall, peer review was developed to improve the quality and safety of patient care, reduce an organization's malpractice liability and meet regulatory requirements. (admere.com)
Peer review companies have been found to have a positive influence on health plans' internal review processes, such as accelerating time frames for review and bringing in more external specialists for reviews of complex cases. (admere.com)

Because the ACA was designed to improve care and reduce costs, the independent review industry experienced marked growth soon after the legislation was passed. (admere.com)

4 Studies based on health insurance records may however underestimate actual drug use because drugs not reimbursed by national health services may not be recorded. (bmj.com)

Employers see reduced health care spend with increased use of lower-cost drugs. (bcbsmt.com)
ABSTRACT This paper reviews the essential components of health care delivery systems in Arab countries and their development over the past 3 decades. (who.int)

Overall, only 496 (51.4%) used the quality assessment in the analysis and interpretation of the results or in their discussion, with no significant differences between Cochrane reviews and paper based reviews (52% v 49%, P = 0.58). (bmj.com)
Conclusions Cochrane reviews fared better than systematic reviews published in paper based journals in terms of assessment of methodological quality of primary studies, although they both largely failed to take it into account in the interpretation of results. (bmj.com)
Critical appraisal of the methodological quality of primary studies is an essential feature of systematic reviews. (bmj.com)
We compared the approaches used for quality assessment of primary studies by Cochrane systematic reviews with systematic reviews published in paper based journals. (bmj.com)
We determined how quality assessment is used and whether systematic reviews consider quality assessment in their results. (bmj.com)
We developed this form by taking into account published reports on the quality assessment of trials included in systematic reviews. (bmj.com)

For example, the increasing use of lamotrigine in Sweden resulted in an increase in the reports of adverse reactions to the drug. (bmj.com)
Through the OMS, Part D sponsors are provided quarterly reports on high risk beneficiaries and are required to provide CMS with the outcome of their review of each case. (cms.gov)
As Risk Manager, performed reviews, follow up, trending of incident reports, identification of potential problems, and interfacing with legal department and malpractice carrier. (exponent.com)

Chemicals and Drugs2

Analytical, Diagnostic and Therapeutic Techniques and Equipment1

Anthropology, Education, Sociology and Social Phenomena1

Information Science1

Health Care19

Geographicals2

Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members. (1/550)

The three dimensions of managed care pharmacy practice. (2/550)

Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: a comparison in managed care and fee-for-service environments. (3/550)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (4/550)

Considerations in pharmaceutical conversion: focus on antihistamines. (5/550)

The diagnostic and treatment approach to two common conditions by the physician members of a community health maintenance organization. (6/550)

Effect of a drug supply and cost sharing system on prescribing and utilization: a controlled trial from Nepal. (7/550)

Postmarketing analysis of lovastatin use in the VA Northern California System of Clinics: a retrospective, computer-based study. (8/550)

Drug Utilization Review

Utilization Review

Concurrent Review

Drug Utilization

Insurance, Hospitalization

Insurance Claim Review

Health Services Misuse

Managed Care Programs

Utah

Formularies as Topic

Drugs, Generic

Prescription Fees

Prescription Drugs

Drug Prescriptions

Drug Costs

Insurance, Pharmaceutical Services

Regional Health Planning

United States

Pharmacies

Cost Sharing

Fees, Pharmaceutical

Hospitals

Physician's Practice Patterns

Cost Control

Postal Service

Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members. (1/550)

The three dimensions of managed care pharmacy practice. (2/550)

Course of antidepressant treatment with tricyclic versus selective serotonin reuptake inhibitor agents: a comparison in managed care and fee-for-service environments. (3/550)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (4/550)

Considerations in pharmaceutical conversion: focus on antihistamines. (5/550)

The diagnostic and treatment approach to two common conditions by the physician members of a community health maintenance organization. (6/550)

Effect of a drug supply and cost sharing system on prescribing and utilization: a controlled trial from Nepal. (7/550)

Postmarketing analysis of lovastatin use in the VA Northern California System of Clinics: a retrospective, computer-based study. (8/550)

Drug utilization review - Wikipedia

Drug Utilization Review | Harvard Catalyst Profiles | Harvard Catalyst

A drug utilization review on antidepressants

Controlled Substance Utilization Review and Evaluation System | State of California - Department of Justice - Office of the...

Anti-epileptic drug utilisation in paediatrics: a systematic review | BMJ Paediatrics Open

CMS Drug Utilization Review - John Snow Labs

Results of search for 'su:{Drug utilization review.}' › WHO HQ Library catalog

Rule 5160-9-04 - Ohio Administrative Code | Ohio Laws

New York State Drug Utilization Review Board Hepatitis C Virus Clinical Criteria Review - Dr. Gish

Research on ADHD | CDC

Prior Authorization/Utilization Management | Blue Cross and Blue Shield of New Mexico

Department of Human Services | Public Advisory Boards, Commissions & Councils

MN Revisor's Office

Format for Formulary Submissions | AMCP.org

DI-094 Botulinum toxin type a for the treatment of neurological diseases: drug utilisation review | European Journal of...

Treating rheumatoid arthritis to target: an Italian rheumatologists' survey on the acceptance of the treat-to-target...

Utah Legislature SB0142

Notice Details

Essence of Clinical Pharmacy - Nova Science Publishers

A possible effect of montelukast on neurological aging examined by the use of register data | International Journal of Clinical...

Senior Pharmacy Technician Resume Sample

Medical Review Solutions for Group Health Plans

2022 Public Notices | Georgia Department of Community Health

johanie lépine - Search Results - PubMed

Hate Your EHR? Was It a Big Mistake? Here's What to Do

VII. APPE Rotations - F. Institutional APPE Rotation | SWOSU

Earl Ray Dorsey, M.D. | UR Medicine

DWC medical treatment utilization schedule - Drug Formulary

eMedNY : Glossary of Terms

Formulary6

Medicaid5

Interactions2

Adherence3

Pharmacy8

Systematic review7

Opioids5

Effectiveness2

Evaluation4

Management10

Therapeutic2

Medications5

Authorization2

Prescriptions3

Prospective4

Clinical8

20171

Medical14