Access and Utilization of New Antidepressant and Antipsychotic Medications. C. Utilization Management


Health care payers have turned to utilization review (DUR) as a primary means of quality assurance and cost-containment. All of the payers interviewed maintain some form of utilization review program. DUR monitors providers, identifies outliers (i.e., over/under-prescribers), and screens patients (e.g., high cost cases eligible for disease management). The majority of providers use DUR as an educational tool to encourage good prescribing practices. Several providers use DUR as a monitoring tool to enforce compliance with formulary, PA and treatment guidelines.