{"data":{"id":"us-ok/okla.-stat.-tit.-63-63-5030.4","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 63, § 63-5030.4","heading":"Drug utilization review program","body":"1. The Medicaid Drug Utilization Review Board shall develop and\n\nrecommend to the Oklahoma Health Care Authority Board a\n\nretrospective and prospective drug utilization review program for\n\nmedical outpatient drugs to ensure that prescriptions are\n\nappropriate, medically necessary, and not likely to result in\n\nadverse medical outcomes.\n\n2. The retrospective and prospective drug utilization review\n\nprogram shall be operated under guidelines established by the\n\nMedicaid Drug Utilization Review Board as follows:\n\na. The retrospective drug utilization review program\n\nshall be based on guidelines established by the\n\nMedicaid Drug Utilization Review Board using the\n\nmechanized drug claims processing and information\n\nretrieval system to analyze claims data in order to:\n\n(1) identify patterns of fraud, abuse, gross overuse\n\nor underuse, and inappropriate or medically\n\nunnecessary care,\n\n(2) assess data on drug use against explicit\n\npredetermined standards that are based on the\n\ncompendia and other sources for the purpose of\n\nmonitoring:\n\n(a) therapeutic appropriateness,\n\n(b) overutilization or underutilization,\n\n(c) appropriate use of generic drugs,\n\n(d) therapeutic duplication,\n\n(e) drug-disease contraindications\n\n(f) drug-drug interactions,\n\n(g) incorrect drug dosage,\n\n(h) duration of drug treatment, and\n\n(i) clinical abuse or misuse, and\n\n(3) introduce remedial strategies in order to improve\n\nthe quality of care and to conserve program funds\n\nor personal expenditures.\n\nb. (1) The prospective drug utilization review program\n\nshall be based on guidelines established by the\n\nMedicaid Drug Utilization Review Board and shall\n\nprovide that, before a prescription is filled or\n\ndelivered, a review will be conducted by the\n\npharmacist at the point of sale to screen for\n\npotential drug therapy problems resulting from:\n\n(a) therapeutic duplication,\n\n(b) drug-drug interactions,\n\n(c) incorrect drug dosage or duration of drug\n\ntreatment,\n\n(d) drug-allergy interactions, and\n\n(e) clinical abuse or misuse.\n\n(2) In conducting the prospective drug utilization\n\nreview, a pharmacist may not alter the prescribed\n\noutpatient drug therapy without the consent of\n\nthe prescribing physician or purchaser.","path":["OK Code","Title 63"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os63.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"6f6b3bdfcd292dba9ae088678610d07295f77d27862f68f5350b2a73c1b8fff4","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-63-63-5030.3","next":"us-ok/okla.-stat.-tit.-63-63-5030.4a"},"notice":"GroundRules: Original legal text. Not legal advice."}