In response to the nationwide opioid epidemic, state Medicaid programs are increasing efforts to address prescription opioid misuse. Drug utilization review (DUR) is one of the tools they can use for this purpose. DUR is a two-phase process consisting of prospective and retrospective screening and monitoring of prescription drug claims to identify potential fraud, misuse, or medically unnecessary care, and to implement corrective action.
This fact sheet describes federal statute and regulations related to drug utilization control, summarizes DUR requirements for state Medicaid programs under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act, P.L. 115-271), and examines compliance with these requirements as of fiscal year 2018.
A companion compendium of state DUR policies, with policies specific to each of the 50 states and the District of Columbia, can be found here.