New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 3 - Policies and Standards Governing Provision of Medical and Dental Care
Part 512 - Drug Utilization Review
Section 512.1 - Scope, purpose and definitions

Universal Citation: 18 NY Comp Codes Rules and Regs § 512.1

Current through Register Vol. 46, No. 39, September 25, 2024

(a) Scope. This Part sets forth the requirements and procedures for the department's medical assistance (MA) prospective drug utilization review program.

(b) Purpose. The purpose of the program is to identify potential problems associated with MA recipient's drug therapy. The problems which the program seeks to identify include, but are not limited to, over-utilization, interactions between and among drugs prescribed for an MA recipient, therapeutic overlap and other drug therapy irregularities. Pharmacies which dispense drugs to MA recipients will have access to a central computerized drug utilization review system which screens ordered drugs against the recipient's drug history file for potential drug therapy problems and informs the pharmacist of identified problems before the pharmacist dispenses a drug. The pharmacist will be able to evaluate this information and perform a prospective drug utilization review to determine whether or not, in the pharmacist's professional judgement, therapeutic intervention as described in section 512.4(d) of this Part is necessary.

(c) Definitions. Terms used in this Part have the same meaning as those defined in section 505.3 of this Title unless otherwise specified.

(1) Prospective drug utilization review means a pharmacist's analysis of an MA recipient's drug use, based on established clinical standards for drug therapy, which is done at the point of service before a drug is dispensed.

(2) Electronic Medicaid eligibility verification system (EMEVS) means the department's on-line computerized system for verification of an individual's eligibility for MA.

(3) National drug code (NDC) means the numerical universal drug product code identifier which is assigned to a drug by the Secretary of Health and Human Services pursuant to the Drug Listing Act of 1972 ( P.L. 92-387).

(4) Pharmacy means any place meeting the definition contained in article 137 of the Education Law and which is registered and licensed by the appropriate authority of the state in which the pharmacy is located.

(5) Pharmacist means a person licensed or otherwise authorized to practice pharmacy by the appropriate authority of the state in which the pharmacist practices.

(6) Drug means both prescription and nonprescription drugs.

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