Drug Utilization Review Under Medicare

T-PEMD-89-5: Published: Aug 1, 1989. Publicly Released: Aug 1, 1989.

Additional Materials:


Office of Public Affairs
(202) 512-4800

GAO discussed the proposed Health Care Financing Administration (HCFA) drug utilization review system, focusing on: (1) drug safety; (2) the proposed system's development and implementation; and (3) pharmacy participation. GAO found that: (1) research on prescription practices for the elderly indicated that inappropriate drug prescription could cause adverse drug reactions which could lead to drug-induced illnesses, hospitalization and possible death and add to health care expenditures; (2) recent legislation required an electronic system that pharmacies would use to verify Medicare eligibility, keep Medicare drug purchase records, process and pay bills, and review drug utilization; (3) the proposed system would not include individual medication profiles or information on drug allergies or over-the-counter drugs, which could help pharmacists make appropriate prescription judgments; (4) the proposed system would have limited ability to detect drug interactions, excessive dosages, and duplicative drug therapies, and would be focused more on the general public than the elderly; (5) HCFA procedures for reviewing drug utilization did not focus on quality-of-care issues or on merging patient diagnosis information from Medicare claims with prescription information; (6) HCFA may not have sufficiently planned for testing whether information from the three independently developed regional systems would be efficient; and (7) HCFA may not have sufficient pharmacy participation.

Nov 15, 2017

Nov 14, 2017

Nov 13, 2017

Nov 6, 2017

Oct 31, 2017

Oct 18, 2017

Oct 4, 2017

Looking for more? Browse all our products here