Prescription Drugs:

HCFA's Proposed Drug Utilization Review System Ignores Quality of Care Issues

PEMD-89-26BR: Published: Jul 13, 1989. Publicly Released: Jul 20, 1989.

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Pursuant to a congressional request, GAO provided information on the Health Care Financing Administration's (HCFA) plans to implement a drug utilization review system to check the safety of drugs for elderly Medicare beneficiaries taking over-the-counter medications.

GAO found that HCFA: (1) is preparing to issue a solicitation for the development and implementation by January 1991 of a national Medicare outpatient prescription drug program, designed to verify Medicare eligibility and deductible levels, screen for potential adverse drug effects, and bill payments; (2) proposed a drug review function that would compare interactions among 225 drugs, although existing systems could check for many more drugs, maximum and minimum dosages, allergic reactions, interactions between over-the-counter and prescription drugs, and drug-to-food interactions; and (3) emphasized financial considerations, rather than health and safety aspects of the drug review process. GAO also found that the HCFA proposal for the drug review function failed to address: (1) how its minimum review capabilities could provide adequate information on safe drug use by the elderly population; (2) why HCFA is developing a severely limited system when more comprehensive and well-tested systems already exist; (3) why HCFA is proposing an unrealistically short testing period; (4) whether HCFA sufficiently considered incentives or other methods to encourage pharmacy participation; and (5) whether the proposed system will be operational and meet its stated objectives by the congressionally mandated deadline. GAO believes that the proposed system's meeting legislative requirements depends on whether the drug review function meets HCFA and congressional objectives and is operational by January 1991.

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