As part of the state-federal partnership in administering Medicaid programs, the Centers for Medicaid and CHIP Services (CMCS) issues technical assistance in the form of letters to State Medicaid Directors (SMD), Center for Medicaid and CHIP Services Informational Bulletins (CIB), Issue Briefs (IB), and Frequently Asked Questions (FAQs) to communicate with states and other stakeholders regarding operational issues related to Medicaid. Drug Utilization Review (DUR) assistance is available to assist state Medicaid agencies in developing, enhancing, implementing, and evaluating regulations and programs to ensure appropriate drug therapy and streamline fraud, misuse and abuse. All Medicaid guidance documents can be found on the federal guidance page. Additionally, notable releases referencing DUR, opioids and prescription drugs can be found below at the following links:
- NPRM: June 17, 2020 - Medicaid Program - Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements
- CIB: August 5, 2019 - State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115-271) (PDF, 509.27 KB)
- CIB: February 22, 2019 - Medicaid Strategies for Non-Opioid Pharmacologic and NonPharmacologic Chronic Pain Management (PDF, 172.18 KB)
- CIB: January 17, 2017 - State Flexibility to Facilitate Timely Access to Drug Therapy by Expanding the Scope of Pharmacy Practice using Collaborative Practice Agreements, Standing Orders or Other Predetermined Protocols (PDF, 67.6 KB)
- SMD: February 11, 2016 - Implementation of the Covered Outpatient Drug Final Regulation Provisions Regarding Reimbursement for Covered Outpatient Drugs in the Medicaid Program (PDF, 148.36 KB)
- CIB: January 28, 2016 - Best Practices for Addressing Prescription Opioid Overdoses, Misuse and Addiction (PDF, 142.72 KB)
42 CFR Subpart K – Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims Section 456.700-456.725 provides the requirements for the DUR program.
Please direct all communications to the CMSDUR@cms.hhs.gov resource mailbox.