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 512.4 - Use of prospective drug utilization review program data

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

(a) Information which pharmacies provide through EMEVS will be stored for on-line retrieval and other pharmacies will have access to the information.

(b) The department's use of information obtained through the prospective drug utilization review program will include, but need not be limited to, the following:

(1) an analysis of an MA recipient's drug use patterns for post-payment audit review purposes and potential recipient restriction action; and

(2) an analysis of drug ordering patterns by MA providers for purposes of conducting MA provider audits and reviewing quality control standards used by the provider.

(c) Information which the department provides to pharmacies through EMEVS will allow pharmacists to perform prospective drug utilization reviews. Information provided to pharmacies may include the fact that that the drug ordered was previously dispensed within a certain time period, that a drug similar to the drug ordered was dispensed within a certain time period, and that the drug ordered is incompatible with another drug or drugs which have previously been dispensed to the MA recipient.

(d) The pharmacist may take appropriate action to rectify identified drug therapy irregularities, when necessary, based on the pharmacist's professional judgment. Such action may include, but need not be limited to, the following:

(1) consulting with the ordering practitioner;

(2) counseling the MA recipient; and

(3) refusing to dispense the drug or drugs.

Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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