1. The Medicaid Drug Utilization Review Board shall develop and recommend to the Oklahoma Health Care Authority Board a retrospective and prospective drug utilization review program for medical outpatient drugs to ensure that prescriptions are appropriate, medically necessary, and not likely to result in adverse medical outcomes. 2. The retrospective and prospective drug utilization review program shall be operated under guidelines established by the Medicaid Drug Utilization Review Board as follows: a. The retrospective drug utilization review program shall be based on guidelines established by the Medicaid Drug Utilization Review Board using the mechanized drug claims processing and information retrieval system to analyze claims data in order to: (1) identify patterns of fraud, abuse, gross overuse or underuse, and inappropriate or medically unnecessary care, (2) assess data on drug use against explicit predetermined standards that are based on the compendia and other sources for the purpose of monitoring: (a) therapeutic appropriateness, (b) overutilization or underutilization, (c) appropriate use of generic drugs, (d) therapeutic duplication, (e) drug-disease contraindications (f) drug-drug interactions, (g) incorrect drug dosage, (h) duration of drug treatment, and (i) clinical abuse or misuse, and (3) introduce remedial strategies in order to improve the quality of care and to conserve program funds or personal expenditures. b. (1) The prospective drug utilization review program shall be based on guidelines established by the Medicaid Drug Utilization Review Board and shall provide that, before a prescription is filled or delivered, a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from: (a) therapeutic duplication, (b) drug-drug interactions, (c) incorrect drug dosage or duration of drug treatment, (d) drug-allergy interactions, and (e) clinical abuse or misuse. (2) In conducting the prospective drug utilization review, a pharmacist may not alter the prescribed outpatient drug therapy without the consent of the prescribing physician or purchaser.
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