§ 27-13-38-3 — Drug utilization review programs; contents

Each health maintenance organization that
has a prescription drug benefit shall establish and operate, or cause to
be established and operated, a drug utilization review program that
includes the following:
(1) Retrospective review of prescription drugs furnished to
enrollees.
(2) Education of physicians, enrollees, and pharmacists regarding
the appropriate use of prescription drugs.
(3) Ongoing periodic examination of data on outpatient
prescription drugs to ensure quality therapeutic outcomes for
enrollees.
(4) Clinically relevant criteria and standards for drug therapy.
(5) Nonproprietary criteria and standards, developed and revised
through an open, professional consensus process.
(6) Interventions that focus on improving therapeutic outcomes,
including prospective drug utilization review programs that
monitor for possible prescription drug problems or complications,
including drug to disease interactions, drug to drug interactions,
or therapeutic duplication.

Legislative History

As added by P.L.69-1998, SEC.16.