We are independent & ad-supported. We may earn a commission for purchases made through our links.
Advertiser Disclosure
Our website is an independent, advertising-supported platform. We provide our content free of charge to our readers, and to keep it that way, we rely on revenue generated through advertisements and affiliate partnerships. This means that when you click on certain links on our site and make a purchase, we may earn a commission. Learn more.
How We Make Money
We sustain our operations through affiliate commissions and advertising. If you click on an affiliate link and make a purchase, we may receive a commission from the merchant at no additional cost to you. We also display advertisements on our website, which help generate revenue to support our work and keep our content free for readers. Our editorial team operates independently of our advertising and affiliate partnerships to ensure that our content remains unbiased and focused on providing you with the best information and recommendations based on thorough research and honest evaluations. To remain transparent, we’ve provided a list of our current affiliate partners here.
Health

Our Promise to you

Founded in 2002, our company has been a trusted resource for readers seeking informative and engaging content. Our dedication to quality remains unwavering—and will never change. We follow a strict editorial policy, ensuring that our content is authored by highly qualified professionals and edited by subject matter experts. This guarantees that everything we publish is objective, accurate, and trustworthy.

Over the years, we've refined our approach to cover a wide range of topics, providing readers with reliable and practical advice to enhance their knowledge and skills. That's why millions of readers turn to us each year. Join us in celebrating the joy of learning, guided by standards you can trust.

What is Drug Utilization Review?

Tricia Christensen
By
Updated: May 17, 2024
Views: 24,306
Share

Drug utilization review can be defined as review of drugs used in a population (a state, a country, an age group, or subscribers of a health insurance plan) to determine effectiveness, potential dangers, problems with drug interaction, and other issues. There are drug utilization review boards that are private and might work for health insurance or pharmacy companies. As of 1993, with the passage of the Omnibus Budget Reconciliation Act of 1990, every US state also must have a drug utilization review board that oversees outpatient prescriptions for Medicaid patients, and these make recommendations about best prescription drugs, drug problems and drug interactions, which are available to pharmacists and physicians.

There are reasons why oversight of what is prescribed can be so vital. With thousands of potential drugs available, combinations of medications can quickly become lethal, or they make people so sick that it dramatically increases medical costs. It is fair to state that people have died from prescribed medications that should not have been prescribed together or that were taken incorrectly. Having boards or private organizations that oversee potential interactions and make certain physicians and pharmacists are aware of them is valuable.

In some cases a drug utilization review board mandates that pharmacists speak to people when they are prescribed new medications. This won’t stop all potentially deadly interactions unless patients are forthcoming about what they’re taking. The practice of doctor shopping to gain prescriptions from several physicians, especially for those people who pay privately instead of through an insurance company, may be hard to track. Still the majority of people receive prescriptions from one physician or maybe a couple, and if they fill them at the same pharmacy, this can be tracked.

One intervention that may occur with drug utilization review is that a pharmacist may not fill a prescribed drug if he sees a patient is on something else with which it will conflict. Ideally this intervention should occur at the doctor’s office, but it doesn’t always. Pharmacists or doctors can also perform what is called retrospective drug utilization review to evaluate what medicines a patient is currently taking, and perhaps make changes if needed to more effective or more appropriate drugs.

An aspect of drug utilization review that is not so savory to some critics is this issue of review for cost saving measures. In systems like Medicaid and in many health plans, certain medications are “preferred,” even if they are not the best treatment for everyone. Statistically, preferred medications are usually fairly effective, but they also may be the cheapest, and not always best. While many people support review that can save lives, they feel uncomfortable or are soundly against the idea of using an oversight committee to make recommendations about drugs based on a cost factor. In some instances, cutting costs may not be weighed equally with the health priorities of the individual.

Share
WiseGeek is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Tricia Christensen
By Tricia Christensen
With a Literature degree from Sonoma State University and years of experience as a WiseGeek contributor, Tricia Christensen is based in Northern California and brings a wealth of knowledge and passion to her writing. Her wide-ranging interests include reading, writing, medicine, art, film, history, politics, ethics, and religion, all of which she incorporates into her informative articles. Tricia is currently working on her first novel.

Editors' Picks

Discussion Comments
By babylove — On May 15, 2011

@wizup – The Medicare drug plan she chooses depends mostly on the medications she’s taking. As you know, not all drugs are covered. My plan costs around $30.00 month and offers free generic and I get partial coverage for my name brand prescriptions.

It really is a personal call on how much she can afford to spend and what type of meds she’s taking. One thing you need to be aware of though is that there are penalties she’ll have to pay if she waits at getting the Part D coverage later on.

By wizup — On May 12, 2011

I think the real problem here is the drug utilization committee and the Medicare preferred drug programs. My mom just turned 65 and is now eligible for it, but how do you determine which plan is the right one? Are the Medicare part d plans worth it?

She takes numerous prescriptions for breast cancer, lupus, thyroid, high blood pressure and depression. She can’t do without any of her meds even for a day. I don’t have the names of them all in front of me right now, but what I’m wondering is, will Medicare alone be enough to cover her prescriptions or is it worth spending the extra money for additional coverage?

By whitesand — On May 12, 2011

@ISay - I agree with you that drug utilization management should be performed at the highest level, but no matter who conducts the reviews, doesn’t it all come down to the responsibility of our physicians and pharmacists to utilize them? They are the ones administering the drugs and dispensing them to the patients.

Don’t get me wrong I’m not blaming anyone here. What I’m saying is that the reviews are available to both physicians and pharmacists alike and for the most part they’re doing a good job. But in my opinion not enough is being done to thoroughly investigate prescription drug usage on a patient level.

It’s ultimately the patients responsibility to know what their taking and to ask questions. But if they’ve developed and addiction or are doing something illegal, or even if their just following doctors orders, then the responsibility falls back on the medical profession.

By ISay — On May 09, 2011

Drug utilization reviews have only become the responsibility of the states because big pharmaceutical companies aren't taking the time to fully research and determine the effects of the drugs they're producing and distributing.

I say it shouldn't be up to states and taxpayers to cover the expense of drug utilization reviews, but the companies that manufacture the drugs in the first place should cover the expense of reviews.

Tricia Christensen
Tricia Christensen
With a Literature degree from Sonoma State University and years of experience as a WiseGeek contributor, Tricia...
Learn more
Share
https://www.wisegeek.net/what-is-drug-utilization-review.htm
Copy this link
WiseGeek, in your inbox

Our latest articles, guides, and more, delivered daily.

WiseGeek, in your inbox

Our latest articles, guides, and more, delivered daily.