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State Medicaid Fee-for-Service and Managed Care Organization Drug Utilization Review Program Policies

All state Medicaid programs are required to submit an annual report on the operation of their Medicaid Drug Utilization Review (DUR) programs, which contain information on prescribing patterns, cost savings generated from DUR, program operations, and the adoption of innovative practices. While many DUR policies apply to all pharmaceuticals, the majority of states have policies in place that are specific to controlled substances, including opioids.

In order to provide more information for analyses of existing policies and development of future policies that affect Medicaid, this state policy compendium documents these Medicaid fee-for-service and managed care organization DUR policies in each state and the District of Columbia for fiscal year 2018.

For more information on how states are increasing efforts to address prescription drug misuse, read MACPAC’s issue briefs on Pharmacy and Provider Lock-in Programs in Medicaid Fee for Service and Medicaid Drug Utilization Review Requirements.