Okla. Stat. tit. 63, § 63-5030.2: Definitions

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.