DUR: DUR and the Pharmacist
About DUR
Medi-Cal Fee-for-Service Drug Use Review (DUR) is a dynamic program that
optimizes medical and pharmaceutical care for recipients while reducing the cost
of care. The DUR program began in 1995 after Congress passed the Omnibus Budget
Reconciliation Act (OBRA) of 1990, which required each state to establish a Drug
Utilization Review program for covered outpatient drugs (Section 4401). In
addition to the Medi-Cal Fee-for-Service DUR, pharmacists have created in-store
patient profile databases using stand-alone software to build an extensive
electronic “net” intended to help pharmacists identify critical
medication-dispensing concerns.
Professional Responsibility
Medi-Cal’s Fee-for-Service DUR system can alert pharmacists about potential
problems with a recipient’s new prescription, which may create a perception that
all possible problems are detected electronically. This is not true.
The Medi-Cal DUR program is an advisory-only program created to aid
pharmacists’ decision-making. Pharmacists have the final legal and professional
responsibility for screening a recipient’s prescriptions against today’s
knowledge about drug interactions and other potential dosing hazards.
Technological Limitations
While the Medi-Cal Fee-for-Service DUR program maintains a tremendously broad
database, it does not contain a complete pharmaceutical or medical history for
every recipient. Information that is part of a recipient’s medical or pharmacy
record may be stored outside the DUR program database. The DUR program database
only contains information about drugs purchased through the Medi-Cal program.
Information about products purchased out-of-pocket (such as
non-Medi-Cal-reimbursed or Share-of-Cost products) and those products covered by
managed care programs are not reported to the DUR program. Because of the
technological limitations, pharmacists play a crucial role in providing safe
medication dispensing to Medi-Cal recipients.