Innovation is becoming a major focus, as healthcare organizations face unprecedented challenges to improve quality, access, and efficiency, while reducing harm and eliminating fraud, waste, abuse and lowering costs. Sharing of innovative practices between states and new approaches across the Medicaid program creates an emphasis on innovation and helps to accelerate and produce change in important areas of care including prevention, patient centered medicine, and technology enabled care.
The Center for Medicaid and CHIP Services (CMCS) reviews Innovative Practices submitted by the states through the annual DUR Report. We want to share the useful information below on the activities states are performing to improve the quality of care and prudent delivery of their programs.
States have the option of submitting different approaches that they may be using to innovate, streamline and increase efficiency of their Medicaid’s programs while increasing quality of care for beneficiaries. Please note that the examples provided do not reflect all the different approaches that states may be using as these were submitted at state option. If you would like additional information about any of these programs, please contact the person listed in the contact information within the corresponding DUR FFS State individual reports. CMS did not edit the material submitted.
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.
Disclaimer: Please note that the information provided on this web page does not bind or obligate the Centers for Medicare and Medicaid Services (CMS). The statements included on this web page are intended to provide information on CMS Medicaid Drug Utilization Review and do not in any way revise or modify the requirements set forth in Section 1927 of the Act, regulations or program releases.
Page last updated on January 13, 2023