Sec. 3. Each health maintenance organization that has a prescription drug benefit shall establish and operate, or cause to be established and operated, a drug utilization review program that includes the following: (1) Retrospective review of prescription drugs furnished to enrollees. (2) Education of physicians, enrollees, and pharmacists regarding the appropriate use of prescription drugs. (3) Ongoing periodic examination of data on outpatient prescription drugs to ensure quality therapeutic outcomes for enrollees. (4) Clinically relevant criteria and standards for drug therapy. (5) Nonproprietary criteria and standards, developed and revised through an open, professional consensus process. (6) Interventions that focus on improving therapeutic outcomes, including prospective drug utilization review programs that monitor for possible prescription drug problems or complications, including drug to disease interactions, drug to drug interactions, or therapeutic duplication.
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