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Drug Ultization Review Alerts Cheat Sheet by

Common Drug Utilization Review Alerts
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DUR Alerts

Alert
Code
Expl­ana­tion
HIGH/LOW DOSE
Hold
The Incorrect Dosage screening system alerts pharma­cists when doses for certain prescribed target drugs fall outside the normal adult or pediatric dosage range. Adult recipients are defined as people 18 years and over. Pediatric recipients are under the age of 18 years. Recipi­ent­-sp­ecific inform­ation is not required since dose ranges are based on standa­rdized weights for various age groups with normal hepatic and renal function. No geriatric dosing standards (for ages 65 years and older) are included in the incorrect dosage warning screen at the present time. This Alert can be pre-ov­err­idden.
INCORRECT DURATION
MX
Incorrect duration of drug therapy occurs when the number of days of prescribed therapy exceeds or falls short of the recomm­end­ations contained in the predet­ermined criteria and standards. This involves primarily antibi­otics prescribed for irregular periods of time. Antibi­otics used chroni­cally in prophy­laxis or dermat­olo­gical treatments are excluded. This Alert can be pre-ov­erridd
DRUG AGE CONFLICT
PA
The Drug-P­edi­atric and Drug-G­eri­atric screening systems check for inappr­opriate use of select target drugs for specific age ranges. Pediatric conflicts pertain to patients age 18 years and under; geriatric conflicts pertain to patients age 65 years and over. Can be pre-ov­err­idden in the same pharmacy that filled the drug claim in conflict
DRUG INTERA­CTION
DD
The Drug Intera­ction Alert screens only for signif­icant (Severity Level 1) intera­ctions between the drug in a new prescr­iption and drugs currently active on the patient's profile. This screen accounts for serum half-life when editing for active medica­tions in the patient’s paid claims medication history. Unlike other alerts, this alert is not confined to a target drug list but includes all drugs on the Formulary File.
THERAP­EUTIC DUPLIC­ATION
TD
Therap­eutic duplic­ation occurs when a patient receives two or more drugs from the same therap­eutic or pharma­cologic class such that the combined daily dose increases the risk of an adverse medical result or incurs additional program costs without additional therap­eutic benefit. Can be pre-ov­err­idden by the same pharmacy that processed the drug claim in conflict.
NGREDIENT DUPLIC­ATION
ID
Ingredient Duplic­ation occurs when a patient receives two or more prescr­iptions containing the same active chemical compound. Can be pre-ov­err­idden in the same pharmacy that the drug claim in conflict was filled.
EARLY REFILL
ER
The Early Refill (or Overut­ili­zation) Alert screen warns the pharmacist of early refills and/or potential abuse situat­ions. This screen identifies a subsequent prescr­iption submitted for the same target drug when the patient’s medication paid claims history shows greater than 25 percent of the previously dispensed prescr­iption days supply remains. Can be pre-ov­err­idden in the same pharmacy as the drug claim in conflict.
LATE REFILL
LR
The Late Refill (or Underu­til­iza­tion) Alert screen creates warnings when subthe­rap­eutic patterns of prescr­iption use are detected. Alerts are generated when patients fail to renew prescr­iptions for select mainte­nan­ce-use target drugs on a timely basis. Pharma­cists are notified when the renewal request interval is greater than 125 percent of the previous prescr­ipt­ion’s days supply. This Alert can be pre-ov­err­idden.
ADDITIVE TOXICITY
AT
The Clinical Misuse­/Ad­ditive Toxicity screening system warns pharma­cists when the number of active prescr­iptions for select drugs in previously defined therap­eutic classes for a single patient exceed a specified threshold. Currently this occurs when a new prescr­iption drug has overlaping Central Nervous System effects with at least 3 other drugs active on the patient's profile
DRUG DISEASE
MC
The Drug-D­isease screening system alerts pharma­cists when certain target drugs are prescribed for patients with existing medical condit­ions. ICD-9 diagnosis codes from medical and hospital claims data are used to detect diseases that may be aggravated or altered by the prescribed target drug. Diseases are classified as either short term (remain active in patient history for 110 days) or long term (remain active indefi­nit­ely). Disease durations are determined by consensus of the DUR Board
DRUG ALLERGY
DA
The Drug-A­llergy screening system utilizes patien­t-s­pecific allergy inform­ation (ICD 9 "­E" codes from medical and hospital claims) to alert pharma­cists when newly submitted drug claims contain ingred­ients which have a signif­icant potential to cause an allergic reaction. This Alert can be pre-ov­err­idden
DRUG PREGNANCY
PG
Alerts for target drugs in pregnancy categories D or X are transm­itted to the pharma­cist. The presence of pregnancy is determined by ICD-9 codes from the patient medical claim history as well as prescr­iption claim history for prenatal vitamins. This Alert can be pre-ov­err­idden

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