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DRUG UTILIZATION REVIEW BILL REQUIRING "COMPREHENSIVE" DUR SYSTEM BY JAN. 1, 1991 START-UP INTRODUCED BY SEN. WILSON; SEN. HEINZ IS CO-SPONSOR

Executive Summary

A drug utilization review bill that would expand the scope of the DUR system mandated by the Medicare Catastrophic Care Act's outpatient drug reimbursement provisions and require a Jan. 1, 1991 start-up was introduced by Sen. Wilson (R-Calif.) on April 19. A press statement from Wilson's office notes that the California senator's plan "would be far more comprehensive" that the "rudimentary drug review system" required by the catastrophic care legislation as part of the claims processing system. Sen. Heinz (R-Penn.), the sponsor of the Catastrophic Care Act in the Senate, is the primary co-sponsor. Under Wilson's bill S 859, the DUR system attached to the Medicare outpatient claims processing system will provide participating pharmacies "prompt 24-hour electronic access to a medication profile for each beneficiary" receiving a prescription drug. The bill would require a medication profile for each Medicare beneficiary to include "drug name, dosages, quantities, methods of administration, last date dispensed, the identity and location of the prescribing physician or dentist, and the identity and location of the dispensing pharmacy." The profile would be expected to carry all such information for the 180-day period preceding each new prescription. The design of the system, Wilson said, "is to be piloted in Seattle, King County, Washington," by a non-profit organization formed "for the purpose of conducting a demonstration of the system." Wilson said he would seek private funding in order to provide Congress and HHS data from the pilot program as a test of the system. The "guiding force" of the Seattle group, Wilson said, is Dr. Chisato Kawabori, HHS regional director of the administration on aging, whose son, Justini Kawabori, did research on the DUR project as a member of Wilson's senate staff. Wilson is a member of the Senate's Special Committee on Aging. According to the bill's language, the DUR system proposed by Wilson would identify potential adverse reactions stemming from "the interaction of the prescribed drug with one or several other drugs being used by the beneficiary; the interaction of the prescribed drug with a known allergy . . . or known physical condition or illness presented by the beneficiary; drug abuses, incorrect dosages; and under, over, and misutilization of the prescribed drug." The bill also includes several provisions aimed at protecting the privacy of beneficiaries. Wilson characterized the development of a comprehensive DUR system as a cost-saving measure with "the potential to save billions of health care dollars now reimbursed by the federal government, state governments and third party payors." Wilson explained that "the range of expert estimates indicates that, even if we assume the very lowest estimate, then arbitrarily cut it in half, and then halve it again, and if the federal government then pays for the entire medication management program I propose (hardware, software and operating costs, the cost benefit to the government will be four to one." At a House subcommittee hearing on April 19, HHS Inspector General Richard Kusserow called the 1991 mandated start-up date for the claims processing and DUR system "extremely optimistic". In order to ensure the start-up of the claims processing system by the Jan. 1, 1991 starting date, he suggested that the DUR program could be implemented in two phases -- the first phase would focus on payments; the second phase would involve detailed prescribing information on the patient designed to prevent "mismedication" problems. A draft report from the HHS Inspector General's Office was released to Congress in January The final report is expected imminently.
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