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
CMS DUR Reference Surveys
Federal Fiscal Year (FFY) 2022 (FFY 2021 data)
The FFY 2022 (FFY 2021 data) Annual DUR reports require both Fee-For-Service (FFS) and Managed Care program survey submission by the state annually. The below posted surveys are for reference only and may not be utilized as the official survey for completion nor submission as these surveys are not in the Medicaid Drug Program (MDP) system compatible format. Please utilize the surveys contained in MDP for official CMS submission upon release on April 1, 2022.
- Reference - FFY 2021 DUR FFS Survey (PDF, 1.22 MB)
- Reference - FFY 2021 DUR MCO Survey (PDF, 1.31 MB)
- Reference - FFY 2021 DUR Abbreviated MCO Survey (PDF, 730.57 KB)
Medicaid Drug Program System
In 2019, CMS released the FFS and Managed Care Organization (MCO) Surveys for FFY 2018 and at that time, CMS introduced the Medicaid Drug Programs (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.
To obtain access to MDP, please visit the Medicaid Drug Programs (MDP) System Access page for information and instructions.
CMS Data References for State DUR Reporting
- Medicaid Drug Rebate Program Data
- National Drug Code and Drug Category file (ZIP, 509.44 KB) extracted from the fourth quarter 2021 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.
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 May 5, 2022