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Executive Summary

The American Medical Association can support drug utilization review programs providing that physicians are "actively involved in the development, implementation and maintenance of the DUR programs," according to a draft report to be considered by the association's House of Delegates. "Often it is difficult to define a precise range of accepted medical practice for any given prescribing issue, such as the appropriateness of a specific drug for an illness," the committee report says. "Thus, it is essential that prescribing standards for DUR be developed by physicians and that they be based on the peer-reviewed medical literature and the experiences of physicians with expertise in drug therapy." Developed by the association's Board of Trustees, the report will be considered at AMA's Interim Meeting Dec. 2-5 in Orlando, Fla. The AMA report also states that in an acceptable DUR program, "primary emphasis is placed on high quality patient care through improved prescribing by physicians, dispensing by pharmacists, and medication compliance by patients." In addition, "focused professional education is emphasized as the primary intervention strategy." AMA's concern with DUR was heightened when Congress passed the Medicare Catastrophic Care Act in 1988, which was repealed in 1989. During discussions about the program with the Health Care Financing Administration, AMA urged that Medicare DUR not be run by "drug bill processors" who "lacked the knowledge of what constitutes appropriate prescribing practices." DUR is again in the spotlight with the enactment of the Medicaid drug prudent purchasing law (see preceding story). Drug utilization review programs are defined in the report as formal mechanisms for assessing data on drug use against set standards. The object of the programs is to correct patterns of drug use that are inconsistent with the standards. The report recommends that AMA ** oppose DUR programs that "focus only on cost containment and prevent physicians form prescribing the most appropriate drugs for individual patients"; ** "interact with appropriate pharmacy organizations to develop guidelines for prospective point-of-sale DUR that will decrease the incidence of adverse events from drug therapy"; and ** "recognize the right of government and private third-party payers to include in DUR programs a component that addresses fraud and abuse, but reaffirms the right of physicians, who are so accused, to due process."

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