Indiana Code 12-15-35-32.1. Annual report contents
(1) A description of the nature and scope of the prospective drug review program.
Terms Used In Indiana Code 12-15-35-32.1
- criteria: means the predetermined and explicitly accepted elements that are used to measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary, and not likely to result in adverse medical outcomes. See Indiana Code 12-15-35-5
- DUR: means the program designed to measure and assess on a retrospective and a prospective basis the proper use of outpatient drugs in the Medicaid program. See Indiana Code 12-15-35-8
- retrospective DUR: means the part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards that are developed on an ongoing basis with professional input. See Indiana Code 12-15-35-14
- standards: means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the Medicaid recipient database. See Indiana Code 12-15-35-15
(3) Detailed information on the specific criteria and standards in use and any changes in criteria.
(4) A description of the nature and scope of the retrospective DUR program.
(5) A summary of the educational interventions used and an assessment of the effect of these educational interventions on the quality of care.
(6) An estimate of the cost savings generated as a result of the DUR program including savings to the Medicaid drug program attributable to the prospective and retrospective DUR.
(7) An overview of the fiscal impact of the DUR program on other areas of the Medicaid program.
(8) A quantifiable assessment of how DUR has improved quality of care.
(9) A summary of the total number of prescriptions reviewed by drug therapeutic class.
As added by P.L.76-1994, SEC.4.