Sec. 39. Retrospective DUR must:
(1) be based on the guidelines established by the board; and
(2) use the mechanized drug claims processing and information retrieval system to analyze claims data to do the following:
(A) Identify patterns of fraud, abuse, gross overuse, and inappropriate or medically unnecessary care.
(B) Assess data on drug use against explicit predetermined standards that are based on the compendia and other sources to monitor the following:
(i) Therapeutic appropriateness.
(ii) Overutilization or underutilization.
(iii) Therapeutic duplication.
(iv) Drug-disease contraindications.
(v) Drug-drug interactions.
(vi) Incorrect drug dosage or duration of drug treatment.
(vii) Clinical abuse and misuse.
As added by P.L.75-1992, SEC.19.
Structure Indiana Code
Chapter 35. Drug Utilization Review
12-15-35-1. "Appropriate and Medically Necessary" Defined
12-15-35-3. "Compendia" Defined
12-15-35-4. "Counseling" Defined
12-15-35-4.5. "Covered Outpatient Drug" Defined
12-15-35-5. "Criteria" Defined
12-15-35-6. "Drug-Disease Contraindication" Defined
12-15-35-7. "Drug-Drug Interaction" Defined
12-15-35-8. "Drug Utilization Review" or "Dur" Defined
12-15-35-9. "Intervention" Defined
12-15-35-10. "Overutilization or Underutilization" Defined
12-15-35-11. "Pharmacist" Defined
12-15-35-12. "Physician" Defined
12-15-35-13. "Prospective Dur" Defined
12-15-35-14. "Retrospective Dur" Defined
12-15-35-15. "Standards" Defined
12-15-35-17. "Therapeutic Appropriateness" Defined
12-15-35-17.5. "Therapeutic Classification" or "Therapeutic Category" Defined
12-15-35-18. "Therapeutic Duplication" Defined
12-15-35-18.5. Application of Chapter
12-15-35-18.7. Formulary Requirements
12-15-35-19. Drug Utilization Review Board; Establishment
12-15-35-20. Membership of Board
12-15-35-20.1. Conflicts of Interest
12-15-35-20.5. Therapeutics Committee Established; Members; Limitations; Terms; Votes; Meetings
12-15-35-21. Board; Appointment; Term
12-15-35-22. Qualifications of Board Members
12-15-35-23. Physician Appointments; Geographic Balance
12-15-35-24. Reappointment of Members
12-15-35-25. Chairman; Compensation; Expenses
12-15-35-27. Retrospective and Prospective Dur Program Responsibility
12-15-35-28. Duties of the Board; Preferred Drug List; Report
12-15-35-28.5. Therapeutics Committee Duties
12-15-35-29. Quorum; Majority Vote on Dur Criteria and Standards for Prescribing
12-15-35-30. Local Practices; Monitoring
12-15-35-31. Intervention; Approval; Requisites
12-15-35-32.1. Annual Report Contents
12-15-35-34. Confidential Identifying Information; Release of Cumulative Nonidentifying Information
12-15-35-35. Prior Approval Program for Outpatient Drugs; Standards
12-15-35-36. Advisory Committees
12-15-35-37. Medicaid State Plan; Inclusion of Retrospective and Prospective Dur Program
12-15-35-38. Dur Program Guidelines and Procedures
12-15-35-39. Retrospective Dur Requisites
12-15-35-40. Prospective Dur Requisites
12-15-35-41. Board Activities Under Ic 34-30-15
12-15-35-43. Confidentiality; Pharmacist Data and Information
12-15-35-44. Confidentiality; Violations; Penalty
12-15-35-45. Outpatient Drug Formulary; Requirements
12-15-35-46. Review of Proposed Formulary
12-15-35-47. Review of Changes to Formulary
12-15-35-48. Board Review of Managed Care Organization Prescription Drug Program
12-15-35-49. Information Provided by Office
12-15-35-50. Maximum Allowable Cost Schedule for Drugs; Pharmacy Participation in Medicaid Program