Medicaid Drug Utilization Review and Managed Care: The Perspectives and Experiences of State Program Directors

Abstract

OBJECTIVE: To obtain from Medicaid drug utilization review (DUR) program directors their perspectives on the current status of their retrospective and prospective DUR programs, and to ascertain their assessment of the current and future influence of managed care on the integrity of these programs. PARTICIPANTS: All directors of state Medicaid drug utilization review programs. DESIGN: Telephone contact and faxed survey. RESULTS: Eighty-two percent (n=42) of the program directors responded. The majority of states did not carve out their pharmacy benefit plans when contracting services from managed care organizations (MCOs). The DUR program directors commented that Medicaid agencies should put strict data-reporting requirements into their contracts with MCOs. Several of the program directors did not know whether MCOs reported to Medicaid certain data that could be potentially useful for DUR purposes, indicating that communication between the DUR program and other departments within Medicaid agencies should b...