Okla. Stat. tit. 63, § 63-5030.4: Drug utilization review program

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.