Prescription drug utilization review in the private sector.
With increased coverage of prescription drugs by health insurance plans, utilization data are now becoming available and there is renewed interest in drug utilization review (DUR) programs. This article describes the DUR programs now being conducted by private sector firms for health insurance plans. The programs were found to be highly automated and very efficient. Most firms estimate at least two to three dollar direct savings for each dollar invested in DUR. Much of this results from controlling overutilization and gaining compliance with drug formulary guidelines. In addition, the firms report finding drug therapy problems in about two to three percent of the enrollees receiving prescriptions.
Kralewski
J
J
Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis.
Wertheimer
A
A
Ratner
E
E
D002626:Chemistry, Pharmaceutical; D003625:Data Collection; D011307:Drug Prescriptions / Q000191:economics; D017723:Drug Utilization Review / Q000191:economics / Q000458:organization & administration*; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services / Q000592:standards / Q000706:statistics & numerical data*; D008509:Medication Systems; D010595:Pharmacists; D010820:Physicians; D014481:United States