As used in Sections 1 through 5 of this act: 1. “Compendia” means the “American Hospital Formulary Services Drug Information”, “U.S. Pharmacopoeia Drug Information”, peer- reviewed medical literature, other information provided by individuals involved in health care, and information as needed by the Medicaid Drug Utilization Review Board; 2. “Criteria” means those explicit and predetermined elements that are used to assess or measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary, and not likely to result in adverse medical outcomes; 3. “Authority” means the Oklahoma Health Care Authority; 4. “Drug-disease contraindication” means the possibility that the therapeutic effect of a drug would be adversely altered by the presence of another disease or condition; 5. “Drug interactions” means the possibility that two or more drugs taken by a patient may lead to clinically significant toxicity that is uncharacteristic of any one of the drugs present or that the taking of which leads to interference with the effectiveness of one or any of the drugs; 6. “Drug to drug interaction” means a clinically significant adverse medical effect that results from the use of two or more drugs together; 7. “Drug Utilization Review” or “DUR” means both retrospective and prospective drug utilization review designed to educate physicians and pharmacists and thereby ensure that prescriptions are appropriate, medically necessary and not likely to have adverse medical results; 8. “Overutilization” or “underutilization” means the use of a drug in such quantities that the desired therapeutic goal is not achieved; 9. “Prospective drug utilization review” means the part of a drug utilization review program that occurs before a drug is dispensed, and that is designed to screen, based on explicit and predetermined criteria and standards, for potential drug therapy problems, including, but not limited to: a. therapeutic duplication, b. drug-disease contraindications, c. incorrect drug dosage or duration of drug treatment, d. drug allergy interactions, and e. clinical abuse or misuse; and 10. “Retrospective drug utilization review” means the part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards on an ongoing basis with professional input. Retrospective drug utilization review includes the periodic examination of Medicaid drug pharmacy claims data and other information sources to identify the frequency of patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care: a. among physicians, pharmacists, and patients, or b. associated with specific drugs.
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