CMS Drug Utilization

This data package contains the Medicaid Drug Utilization Review (DUR) Program promotes patient safety through state-administered utilization management tools and systems that interface with CMS’ Medicaid Management Information Systems (MMIS). Medicaid DUR is a two-phase process that is conducted by the Medicaid state agencies. In the first phase (prospective DUR) the state’s Medicaid agency’s electronic monitoring system screens prescription drug claims to identify problems such as therapeutic duplication, drug-disease contraindications, incorrect dosage or duration of treatment, drug allergy and clinical misuse or abuse. The second phase (retrospective DUR) involves ongoing and periodic examination of claims data to identify patterns of fraud, abuse, gross overuse, or medically unnecessary care and implements corrective action when needed. On an annual basis, states are required to report on their state’s prescribing habits, cost savings generated from their DUR programs and their program’s operations, including the adoption of new innovative DUR practices via the Medicaid Drug Utilization Review Annual Report Survey.

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1. CMS Drug Utilization Review

This dataset contains information on labelers and products in the Medicaid Drug Utilization Review Program as collected through the Newly Revised Medicaid Drug Utilization Review Annual Report Survey, regarding prescriptions and reimbursements. The DUR Annual Report Survey included since 2014 new sections on fraud, waste and abuse, Prescription Drug Monitoring Program and state Managed Care Organizations.

2. CMS Opioid Utilization Review

This dataset contains information about the opioid products in the Medicaid Drug Utilization Review Program as collected through the Newly Revised Drug Utilization Review (DUR) Annual Report Survey. This survey included since 2014 new sections on fraud, waste and abuse, Prescription Drug Monitoring Program and state Managed Care Organizations. This specific dataset is an extraction of the opioids in the main DUR dataset.

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• Each dataset goes through 3 levels of quality review
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Each dataset is manually curated by our team of doctors, pharmacists, public health & medical billing experts:

• Field names, descriptions, and normalized values are chosen by people who actually understand their meaning
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John Snow Labs , an AI and NLP for healthcare company, provides state-of-the-art software, models, and data to help healthcare and life science organizations build, deploy, and operate AI projects.