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States’ Actions Based on Medicaid Drug Utilization Reviews

States are required to establish drug utilization review (DUR) programs to receive the Federal share of Medicaid payments (42 CFR §456.703). DUR programs must involve ongoing and periodic retrospective examination of claims data to identify patterns of fraud, abuse, gross overuse, or medically unnecessary care. (42 CFR §456.709). We will review the actions that States have taken on the basis of information generated by their DUR programs related to inappropriate dispensing and potential abuse of prescription drugs, including opiates.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services States’ Actions Based on Medicaid Drug Utilization Reviews Office of Evaluation and Inspections OEI-05-13-00550 2017

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