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Drug Utilization Review Guidance

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:

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.