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Sean Hennessy, PharmD, PhD; Warren B. Bilker, PhD; Lan Zhou, PhD; Anita L. Weber, PhD; Colleen Brensinger, MS; Yanlin Wang, MS; Brian L. Strom, MD, MPH

JAMA. 2003;290:1494-1499.

Context  Retrospective drug utilization review is required of all state Medicaid programs and is performed by most private-sector prescription programs. However, it has not been shown to improve clinical outcomes or reduce the rate of potential prescribing errors, known as "exceptions."

Objective  To look for an effect of retrospective drug utilization review on the rate of exceptions and of clinical outcomes in patients with an exception.

Design, Setting, and Participants  Longitudinal ecologic study of the rate of exceptions, controlling for preintervention trends and calendar time; and a cohort study of all-cause and cause-specific hospitalizations in patients with an exception, controlling for potential individual-level confounders in 6 Medicaid programs using the same software in the mid-1990s.

Main Outcome Measures  The rate of exceptions was examined as a function of retrospective drug utilization review implementation. In addition, before-after comparisons were made of the incidence of all-cause and cause-specific hospitalization in patients with exceptions.

Results  We found no reduction in the rate of exceptions coincident with retrospective drug utilization review implementation (rate increase, 0.064 exceptions per 1000 prescriptions per month; 95% confidence interval [CI], -0.006 to 0.133). We also found no effect of retrospective drug utilization review on the incidence of all-cause hospitalization (odds ratio, 0.99; 95% CI, 0.98-1.00) or cause-specific hospitalization. These results persisted in multiple subgroup analyses. Study states intervened using physician alerts in between 1% and 25% of exceptions.

Conclusions  We were unable to identify an effect of retrospective drug utilization review on the rate of exceptions or on clinical outcomes. Given the lack of evidence for effectiveness, and suggestions from previous research of possible harm, policymakers should consider withdrawing the legislative mandate for retrospective drug utilization review.

Author Affiliations: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, and Center for Education and Research in Therapeutics, University of Pennsylvania School of Medicine, Philadelphia.

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RELATED LETTERS

Evaluation of Drug Utilization Review Programs
Robert Berringer, Ellen Friedla, and Karen Rich
JAMA. 2004;291(2):184-185.
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Evaluation of Drug Utilization Review Programs
Dale B. Christensen, William H. Campbell, Thomas R. Fulda, Mark C. Pugh, David H. Smith, Earlene E. Lipowski, Elgene W. Jacobs, Julie W. Kuhle, and Robert A. Crittenden
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Evaluation of Drug Utilization Review Programs—Reply
Sean Hennessy, Warren B. Bilker, Anita L. Weber, Colleen Brensinger, and Brian L. Strom
JAMA. 2004;291(2):185-186.
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