Computer-Based Drug-Utilization Review — Risk, Benefit, or Boondoggle?

Abstract

On October 28, 1990, with little debate, Congress passed the Omnibus Budget Reconciliation Act, requiring the states to provide claims-based drug-utilization review to approximately 34 million Medicaid enrollees.^1,2 The provisions of the program were borrowed from the ill-fated Medicare Catastrophic Coverage Act of 1988, repealed in 1990; the stated goals were to reduce potentially inappropriate prescribing and dispensing of medications, enhance the counseling of patients, and reduce growth in expenditures for drugs.¹ Drug-utilization review is a structured, ongoing program that interprets patterns of drug use in relation to predetermined criteria and attempts to prevent or minimize inappropriate prescribing.³, . . .