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Vermont News: Are You Performing Prospective DUR As Required?
Published in the September 2007 Vermont Board of Pharmacy Newsletter
Prospective Drug Utilization Review (DUR) is required to be done by each pharmacist before they dispense a prescription (see Pharmacy Rule 19.9). The purpose of DUR is to improve the quality of pharmaceutical care by ensuring prescriptions are appropriate, medically necessary, and are not likely to result in adverse medical results. Under the prospective DUR, pharmacists are required to screen prescriptions for potential problems. The pharmacist may not defer this review to prescription insurers.
Several recent diversion disciplinary cases have made it evident to the Board that not all pharmacists are performing prospective DUR, especially when it concerns clinical misuse and/or abuse of prescription drugs. In some of these cases, the diversion would have been apparent earlier if the pharmacist was adhering to his or her professional responsibility of DUR. The excuse that “I filled the prescription because the insurance allowed the claim to go through” is unacceptable. If a patient wants an early refill on a medication, a review is warranted. There should be some explanation, especially if the medication is a controlled substance, as to the need for an early refill. The best standard of practice is to document the reason for the early refill. Is this patient taking the medication according to the doctor’s directions? Is this patient misusing and/or abusing the medication? Is consultation with the doctor warranted? How early can the patient have a refill – does it depend on the type of medication? Each pharmacist, acting in accordance with the standards of pharmacy practice, must use their judgment in answering these questions regarding the appropriate action to take. Finally, the requirement of prospective DUR is not waived just because the patient is willing to pay cash.
