26-18-101 - Definitions.
26-18-101. Definitions.
As used in this part:
(1) "Appropriate and medically necessary" means, regarding drug prescribing,dispensing, and patient usage, that it is in conformity with the criteria and standards developed inaccordance with this part.
(2) "Board" means the Drug Utilization Review Board created in Section 26-18-102.
(3) "Compendia" means resources widely accepted by the medical profession in theefficacious use of drugs, including "American Hospital Formulary Services Drug Information,""U.S. Pharmacopeia - Drug Information," "A.M.A. Drug Evaluations," peer-reviewed medicalliterature, and information provided by manufacturers of drug products.
(4) "Counseling" means the activities conducted by a pharmacist to inform Medicaidrecipients about the proper use of drugs, as required by the board under this part.
(5) "Criteria" means those predetermined and explicitly accepted elements used tomeasure drug use on an ongoing basis in order to determine if the use is appropriate, medicallynecessary, and not likely to result in adverse medical outcomes.
(6) "Drug-disease contraindications" means that the therapeutic effect of a drug isadversely altered by the presence of another disease condition.
(7) "Drug-interactions" means that two or more drugs taken by a recipient lead toclinically significant toxicity that is characteristic of one or any of the drugs present, or that leadsto interference with the effectiveness of one or any of the drugs.
(8) "Drug Utilization Review" or "DUR" means the program designed to measure andassess, on a retrospective and prospective basis, the proper use of outpatient drugs in theMedicaid program.
(9) "Intervention" means a form of communication utilized by the board with a prescriberor pharmacist to inform about or influence prescribing or dispensing practices.
(10) "Overutilization" or "underutilization" means the use of a drug in such quantitiesthat the desired therapeutic goal is not achieved.
(11) "Pharmacist" means a person licensed in this state to engage in the practice ofpharmacy under Title 58, Chapter 17b, Pharmacy Practice Act.
(12) "Physician" means a person licensed in this state to practice medicine and surgeryunder Section 58-67-301 or osteopathic medicine under Section 58-68-301.
(13) "Prospective DUR" means that part of the drug utilization review program thatoccurs before a drug is dispensed, and that is designed to screen for potential drug therapyproblems based on explicit and predetermined criteria and standards.
(14) "Retrospective DUR" means that part of the drug utilization review program thatassesses or measures drug use based on an historical review of drug use data againstpredetermined and explicit criteria and standards, on an ongoing basis with professional input.
(15) "Standards" means the acceptable range of deviation from the criteria that reflectslocal medical practice and that is tested on the Medicaid recipient database.
(16) "SURS" means the Surveillance Utilization Review System of the Medicaidprogram.
(17) "Therapeutic appropriateness" means drug prescribing and dispensing based onrational drug therapy that is consistent with criteria and standards.
(18) "Therapeutic duplication" means prescribing and dispensing the same drug or two ormore drugs from the same therapeutic class where periods of drug administration overlap and
where that practice is not medically indicated.
Amended by Chapter 280, 2004 General Session