DUR: Alert Criteria
Active alerts on for all drugs:
- Overutilization (Early Refill): Refill request interval for drug is less than 75 percent of previous prescription’s days supply.
- Drug-Drug Interaction: Drug-drug interaction is flagged as Severity Level 1, which includes drug combinations that are contraindicated and generally should not be dispensed or administered to the same patient.
- Drug-Pregnancy Conflict: Drug is contraindicated or not recommended during pregnancy.
Active alerts on for selected prospective DUR target drugs only. Providers may refer to the Medi-Cal Fee-for-Service Prospective Drug Use Review (DUR) Target Drugs spreadsheet for more information.
- Drug-Allergy Conflict: Patient has demonstrated hypersensitivity to target drug or drug class as indicated by patient-specific allergy information accessed from medical and hospital paid claims.
- Drug-Age Conflict: Target drug is contraindicated in pediatric or geriatric patients.
- Incorrect Drug Dosage: Prescribed dose for target drug falls outside the usual adult or pediatric daily dose for common indications of the drug.
- Drug-Disease Conflict: Patient has known medical condition that contraindicates use of target drug.
- Ingredient Duplication: Target drug is a chemical duplicate of an ingredient in the patient's paid claims active medication history.
- Therapeutic Duplication: Target drug duplicates one or more drugs in the same therapeutic or pharmacologic class in the patient's paid claims active medication history.
- Underutilization (Late Refill): Refill request interval for maintenance-use target drug exceeds 125 percent of previous prescription's days supply.
- Additive Toxicity: Target drug exceeds the threshold of four or more active prescriptions within the following therapeutic categories: opioid pain or cough medications, benzodiazepines, skeletal muscle relaxants, other sleep drugs and tranquilizers (non-benzodiazepine), antipsychotic medications, and other selected psychotropic medications with CNS depressant properties.
- Up to three online Medi-Cal DUR alerts for a prescription are visible to the pharmacist. Additional alerts pertaining to the prescription are available to the pharmacist by calling the POS/Internet Help Desk at 1-800-427-1295.
- Multiple alerts on a prescription are prioritized by therapeutic problem type according to the following hierarchy:
- drug-allergy conflict
- drug-pregnancy conflict
- drug-disease conflict
- drug-drug interaction (other pharmacy)
- therapeutic duplication
- clinical misuse/additive toxicity
- ingredient duplication
- drug-age conflict
- drug-drug interaction (same pharmacy)
- incorrect dose