Utilization Review
Comprehensive utilization review of public health services is essential to both maintain quality of care and safeguard against unnecessary expenditures. Commonwealth Medicine capabilities include comprehensive utilization reviews to achieve both these goals.
As a federal mandate—as well as an important public health service—drug utilization reviews (DURs) must be conducted thoroughly and with a close attention to detail. Commonwealth Medicine, as part of its Clinical Pharmacy Services program, ensures state Medicaid members are receiving appropriate, medically necessary, prescription drug therapy.
These reviews are conducted prospectively—to screen for drug therapy problems, incorrect dosing, drug-disease interaction, possible abuse and other issues—and retrospectively, which targets patterns in the system to monitor proper use of medications. Through educational programs for pharmacists, providers and Medicaid members, we are also able to improve the system by promoting the proper use of medications.