DUR programs bring therapy changes for Express Scripts members - Brief Article

Drug Cost Management Report,  July 11, 2003  

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Physicians appreciate drug alerts that warn them of potential safety hazards involving prescriptions they have written, according to research presented at the Express Scripts Outcomes Conference in June. The process, known as retroactive drug utilization review (DUR), is designed to catch potential adverse reactions from therapeutic duplication, drug-drug interactions, incorrect dosages, ingredient duplication, or contraindications for gender, age, pregnancy, or disease.

Under the PBM's retrospective DUR program, approximately 38% of physicians say they change or modify their patient's therapy as a result of these warnings. The study followed 1.5 million health plan members, and 12,000 physician letters sent out during April-August 2002.

Retrospective DUR is the physician counterpart to the concurrent DUR process that Express Scripts and other PBMs normally run on most prescriptions. Concurrent DUR warnings are sent to the pharmacist.

Express Scripts says that last year it sent 33 million safety warnings to pharmacists under its concurrent DUR program--about 10% of total retail claims. Approximately 600,000 of those warnings resulted in a change of therapy.

Information: Steve Littlejohn, (314) 702-7556, slittlejohn@express-scripts.com.

Figure 3. Top 10 Physician Alerts Under
Express Scripts Retrospective DUR
Program

Type of Warning   Drug Combination            % of Total

Drug/Drug         Simvastatin/Fibrate               8.9%
Disease/Drug      Alzheimer/Anticholenergic         7.4%
Disease/Drug      Asthma/Beta Blocker               7.1%
Drug/Drug         Warfarin/Amiodarone               4.8%
Disease/Drug      Gout/Thiazide                     4.2%
Drug/Drug         Warfarin/NSAID                    3.6%
Drug/Drug         Digoxin/Amiodarone                3.2%
Drug/Drug         Warfarin/Macrolide                3.1%
Drug/Drug         Lithium/NSAID                     3.0%

Source: Express Scripts, Inc.

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