Drug Utilization Review Board (DUR Board Sample Clauses

Drug Utilization Review Board (DUR Board. The Department maintains a DUR Board that reflects the structure of the healthcare delivery model that includes both a managed care and a Fee-for- Service delivery system. Each CHC-MCO that does not already include a PH- MCO representative and each BH-MCO is required to include a representative to serve as a member of the DUR Board. The DUR Board is a standing advisory committee that recommends the application of predetermined standards related to Pro-DUR, Retro-DUR, and related administrative and educational interventions designed to protect the health and safety of the Medical Assistance program Participants. The Board reviews and evaluates pharmacy claims data and prescribing practices for efficacy, safety, and quality against predetermined standards using nationally recognized drug compendia and peer-reviewed medical literature as a source. The Board recommends appropriate utilization controls and protocols, including Prior Authorization, automated Prior Authorization, system edits, guidelines to determine medical necessity, generic substitution, and quantity limits for individual medications or for therapeuticcategories.
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