{"data":{"id":"us/42-cfr-456.702","jurisdiction":"us","citation":"42 CFR 456.702","heading":"Definitions.","body":"For purposes of this subpart—\nAbuse is defined as in § 455.2 of this chapter.\nAdverse medical result means a clinically significant undesirable effect, experienced by a patient, due to a course of drug therapy.\nAppropriate and medically necessary means drug prescribing and dispensing that is in conformity with the predetermined standards established in accordance with § 456.703.\nCriteria is defined as in § 466.1 of this chapter.\nFraud is defined as in § 455.2 of this chapter.\nGross overuse means repetitive overutilization without therapeutic benefit.\nInappropriate and medically unnecessary means drug prescribing and dispensing not in conformity with the definition of appropriate and medically necessary.\nOverutilization means use of a drug in a quantity, strength, or duration that is greater than necessary to achieve a desired therapeutic goal or that puts the beneficiary at risk of a clinically significant undesirable effect, or both.\nPredetermined standards means criteria and standards that have been established in accordance with the requirements of § 456.703.\nStandards is defined as in § 466.1 of this chapter.\nUnderutilization means use of a drug by a beneficiary in insufficient quantity, strength, or duration to achieve a desired therapeutic goal or that puts the beneficiary at risk of a clinically significant undesired effect, or both.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS","PART 456—UTILIZATION CONTROL","Subpart K—Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"f1dfeb53f0cec82efd9720920adec89af7f0cd91055a00dea53daba2d3193706","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-456.700","next":"us/42-cfr-456.703"},"notice":"GroundRules: Original legal text. Not legal advice."}