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Drug Utilization Review

Utilization Review Services - Workers Compensation

Drug Utilization Review

URAC Accredited Independent Review Organization

Drug Utilization Review is a process to assist the adjuster in addressing claim pharmaceutical usage. These reviews are conducted by a licensed pharmacist who addresses the appropriateness of an injured workers drug regime. This review offers medical evidence to support the use of medications or the lack of evidence to support the continued use of mediation. The review can also provide a recommended drug detoxification program when appropriate.


Drug utilization review refers to a review of prescribing, dispensing, administering and ingesting of medication.  This authorized, structured and ongoing review is related to pharmacy benefit managers (PBM).    Also, drug use/ utilization evaluation and Medication utilization evaluations  are the same as drug utilization review.

Drug utilization reviews will help ensure that drugs are used appropriately (for individual patients).   In the drug utilization review, medicine and health history including all phases of dispensing for a patient is exactly listed.   Also, this review is designed to attempt to attain proper decision making therapeutically and gain a positive outcome for the patient.   If treatment is considered inappropriate, it will be necessary to intervene with providers control the cost or misuse of  medication.


Prospective drug utilization review involves evaluating a patient’s planned drug therapy before a medication is dispensed, this is most often its a part of an online claims adjudication process.

Concurrent drug utilization review is performed during the course of treatment and involves the ongoing monitoring of drug therapy to foster positive patient outcomes.

A retrospective drug utilization review is after the patient has received the medication. A retrospective review aims to detect patterns in prescribing, dispensing or administering drugs. Based on current patterns of medication use, prospective standards and target interventions can be developed to prevent recurrence of inappropriate medication use or abuse.

Often a claimant is drug tested every month at a cost of $1,200 per month.   If the claimant is drug test randomly throughout the yet which is just as effective, the savings could be in excess of $10,000 per year.

There are five specific benefits from Drug Utilization Reviews

  1. Identifying and saving costs for the employer if the review results in savings
  2. Preventing the use of unnecessary or inappropriate drug therapy
  3. Identifying and addressing co-morbidities
  4. Improving overall drug effectiveness
  5. Ensuring physician and patient compliance