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Related Experiment Videos

Drug utilization review in the managed care environment.

B Briesacher1, J DuChane

  • 1Institute for Pharmaceutical Economics, Philadelphia College of Pharmacy and Science, PA 19104-4495, USA.

Medical Interface
|February 7, 1995
PubMed
Summary

Managed care organizations can improve drug utilization review (DUR) and drug use evaluation (DUE) by leveraging advanced data systems and integrated healthcare, rather than creating new quality measures.

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Area of Science:

  • Health Services Research
  • Pharmaceutical Policy

Background:

  • Traditional drug use evaluation (DUE) and Medicaid drug utilization review (DUR) models are inadequate for managed care organizations.
  • Developing new quality measurement systems like HEDIS may discard valuable existing clinical frameworks.

Purpose of the Study:

  • To propose an improved approach for drug utilization review (DUR) and drug use evaluation (DUE) within managed care settings.
  • To enhance the effectiveness of DUR/DUE by integrating managed care strengths with clinical criteria.

Main Methods:

  • Utilizing managed care's strengths: advanced electronic data management, integrated healthcare system interchange, and robust customer communication.
  • Combining clinical criteria with sophisticated healthcare management strategies.

Main Results:

  • Managed care organizations can enhance DUR/DUE processes by adopting their core competencies.
  • A synergistic approach integrating clinical data with management systems can significantly improve drug use oversight.

Conclusions:

  • Managed care organizations should adapt existing DUR/DUE frameworks using their technological and systemic advantages.
  • Integrating clinical evidence with advanced healthcare management offers a revolutionary path for optimizing drug utilization and evaluation.

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