Drug Utilization Review
Dynamic Four-Step Analysis
Progressive Medical's Drug Utilization Review (DUR) is a dynamic, four-step process of prospective review, concurrent review, proactive audits and retrospective utilization review. Providing clients with a DUR report enables them to view a detailed report of their company's activity for a specified time frame. This report allows for cost savings by reviewing brand and generic utilizations.
Reports utilized:
- Prospective Utilization Review - Working with a client's data, we provide up front information that allows all involved parties to plan for future outcomes using historical data.
- Concurrent Utilization Review - We conduct a pharmacy level review of prescription data through industry standard rejections.
- Proactive Audit - These audits are reviewed internally and monitored by clinical pharmacists. Any interventions needed are communicated to claims representatives and include claimants with excessive medications on file, use of multiple physicians, duplicate therapy, excessive duration of use and potentially inappropriate use based upon injury information.
- Retrospective Utilization Review - Prior to each invoicing cycle, a retrospective utilization review "red flags" items that hit or exceed set triggers within our system.
Clinical Pharmacists Ensure Accuracy.
Our DUR process is performed by clinical pharmacists, dedicated to ensuring high quality data. These reports offer clients a quick insight into the interworkings of their managed care claims.
