DUR/Reports

Retrospective Drug Utilization Review (DUR)
Retrospective drug utilization review involves evaluating medicinal therapies after the medications have been provided to the patient. The purpose of this review is to determine patterns of dispensing that may be inappropriate and are in opposition with your policy. HCIdea will be able to match DEA and NPI numbers with the physician in which the claim was processed. This allows the health plan to identify the physician so they may communicate their treatment protocol. This is beneficial for improving member satisfaction while reducing costs by identifying inappropriate patterns that may be identified such as:

Clinical abuse/misuse
Drug-disease interactions
Drug-drug interactions
Erroneous dosage, duration of therapy or choice of therapy
Over and under utilization
Therapeutic duplication
Under utilization of generic substitutes