Drug Utilization Review Under Medicare

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

Additional Materials:

Contact:

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

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.

Oct 26, 2020

Oct 19, 2020

Oct 8, 2020

Oct 1, 2020

Sep 30, 2020

Sep 23, 2020

Sep 21, 2020

Sep 17, 2020

Sep 16, 2020

Sep 14, 2020

Looking for more? Browse all our products here