Ala. Admin. Code r. 560-X-16-.24

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-16-.24 - Prospective DUR

(1) Prospective DUR (PRODUR) is required at the point of sale or distribution before each prescription is filled or delivered to a Medicaid recipient. It must include screening, patient counseling, and patient profiles.

(2) Screening - The review must include screening for potential drug therapy problems as specified by the Alabama State Board of Pharmacy. This includes screens for:

(a) Therapeutic duplication means the prescribing and dispensing, where overlapping periods of drug administration are involved and where such prescribing or dispensing is not medically indicated, of:

(1) two or more doses of the same drug,

(2) at least two drugs from the same therapeutic class, or

(3) at least two drugs from different therapeutic classes with similar pharmacological effects being used for the same indication.

(b) Drug/Disease contraindications

(c) Drug interactions

(d) Incorrect dosage or duration of drug treatment

(e) Drug allergy interactions, and

(f) Clinical abuse/misuse

(3) PRODUR screening must use predetermined standards which are based upon the peer-reviewed medical literature and the three compendia referenced in Rule No. 560-X-16-.23(7). Criteria and standards developed by the DUR Board will be distributed to the providers by Medicaid in Medicaid Provider Notices and/or Bulletins.

(4) PRODUR screening is the sole responsibility of each Medicaid participating pharmacy and is a requirement for participation in the program.

(5) Prospective DUR screening will be conducted through the Medicaid electronic claims processing system. Pharmacists must respond to prospective DUR alerts to continue claims processing through the Medicaid fiscal agent.

(6) Pharmacies without computers must screen based on guidelines provided by the Alabama State Board of Pharmacy Practice Act and criteria and standards endorsed by the DUR Board.

(7) In the absence of patient-specific diagnosis or allergy information, the pharmacist should consult the patient or the patient's health care provider, if in the pharmacist's judgment, obtaining such information is essential.

(8) Patient counseling shall be offered to all Medicaid recipients receiving new prescriptions and, where appropriate, refill prescriptions and such counseling will be in conformance with guidelines as established by the Alabama State Board of Pharmacy. This regulation includes prescriptions dispensed by mail-order pharmacies. The act specifies that it is permissible for the offer to counsel to be made in a written communication, by telephone, or in a manner determined by the pharmacist to be appropriate.

(9) Patient profiles shall be maintained on all Medicaid recipients receiving medications. The pharmacist must make a reasonable effort to obtain, record, and maintain information as outlined in the Alabama State Board of Pharmacy Practice Act. At a minimum, profile should contain:

(a) Patient name, age, gender, address and phone number;

(b) Individual patient history, including a list of prescription medications and devices, where appropriate; and

(c) Pharmacist comments.

(10) Each pharmacy provider shall maintain a recipient log that indicates whether or not counseling was offered, and provided.

Author:

Ala. Admin. Code r. 560-X-16-.24

Emergency rule: Effective July 1, 1993. Permanent rule effective October 14, 1993. Amended: Filed January 7, 1997; effective February 11, 1997.

Statutory Authority: State Plan, Page 74a; Title XIX, Social Security Act; 42 CFR Section 440.120; Public Law 101-508.