The Centers for Medicare & Medicaid Services (CMS) requires states to provide annual drug utilization review (DUR) reports on their:
- Nature and scope of the prospective and retrospective drug use review programs
- Summary of DUR interventions
- Cost savings generated from their DUR programs
- Program’s operations
- Adoption of innovative DUR practices
- Description of DUR board activities
Medicaid Drug Program System
In 2019, CMS released the Fee-For-Service (FFS) and Managed Care Organization (MCO) Surveys for Federal Fiscal Year (FFY) 2018 and at that time, CMS introduced the new Medicaid Drug Program (MDP) system, a more efficient way for CMS and states to manage DUR annual FFS and MCO surveys.
The MDP system allows CMS to notify states when surveys are available to be accessed, as well as allows the state complete management of access, survey completion, certification and submission.
MDP system access is granted through the CMS Enterprise Identity Management system (EIDM). Access to EIDM can be found at the following link: EIDM Access, under the heading "DDR Access". The User Guide can be found at User Guide (PDF, 3.26 MB).
CMS Data References for State DUR Reporting
- Medicaid Drug Rebate Program Data
- National Drug Code and Drug Category file (ZIP, 638.4 KB) extracted from the fourth quarter 2020 Medicaid Drug product data file
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.