Prescription Drugs: Automated Prospective Review Systems Offer Significant Potential Benefits for Medicaid
AIMD-94-130
Published: Aug 05, 1994. Publicly Released: Aug 22, 1994.
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Highlights
Pursuant to a congressional request, GAO reviewed states' use of information technology in implementing their drug utilization review (DUR) programs, focusing on the: (1) effectiveness of using automated systems to perform prospective reviews; and (2) extent to which the Health Care Financing Administration (HCFA) has encouraged the use of automated prospective DUR systems.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To increase patient safety and the potential for significant program savings, the Secretary of Health and Human Services should direct the Administrator, HCFA, to: (1) gather information on the costs and benefits of automated prospective DUR systems; (2) develop guidance on desirable features and capabilities for these systems; and (3) provide this information and guidance to all states. |
HCFA agrees with the recommendation and continues to study automated prospective DUR systems through its Iowa demonstration project and annual reports submitted by the states. HCFA has shared some information with the states and provided some guidance on assessing the benefits of these systems. In addition, its August 1996 DUR newsletter included some best practices of effective automated DUR system design, as reported by the states. However, HCFA does not plan to provide the states with guidance on desirable system features or capabilities other than to share information on distinctive features as contained in the states' annual reports. Further, GAO/AIMD-96-72 contains a new recommendation to HCFA that supersedes this recommendation.
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Topics
DrugsFraudHealth care cost controlHealth hazardsMedicaidMedical information systemsProgram abusesRisk managementState-administered programsPrescription drugs