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Medication Management Laws
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Drug Utilization Review (DUR)
A process that ensures that prescriptions are filled and used appropriately and safely. It can be prospective, concurrent, or retrospective.
Therapeutic Substitution
The practice of replacing a patient’s prescription drugs with chemically different drugs that are expected to have the same therapeutic effect.
Polypharmacy
The concurrent use of multiple medications by a patient, which is common among older adults. It increases the risk of adverse drug events and interactions.
Prior Authorization
A requirement that your physician obtain approval from your health care provider before prescribing a specific medication.
Generic Drug
A medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, and performance characteristics.
Medicare Part D
A program that helps Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums.
Off-Label Use
The use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration.
Comprehensive Medication Review (CMR)
A systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, and creating a plan to resolve them.
Medication Reconciliation
A process to ensure that patients' medication lists are accurate and up-to-date across transitions of care.
Medication Adherence
The extent to which patients take medication as prescribed by their healthcare providers.
Quantity Limits
A restriction on the amount of a medication that is covered by insurance for a specific period.
Formulary
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
Medication Assistance Programs (MAPs)
Programs that help patients obtain medication, often at low or no cost, particularly those who might not be able to afford them otherwise.
Drug Diversion
The illegal distribution or abuse of prescription drugs or their use for unintended purposes.
Medication Therapy Management (MTM)
A service or group of services that optimize therapeutic outcomes for individual patients, particularly in managing complex medication regimens or chronic diseases.
Controlled Substances Act (CSA)
The federal drug policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated.
Schedule II Drugs
A category of drugs that have a high potential for abuse and risk of addiction but have legitimate medical use.
Adverse Drug Reaction (ADR)
An injury caused by taking medication. ADRs may occur despite proper drug and dosage selection and adherence.
Black Box Warning
The strictest labeling requirement for prescription drugs that may cause serious adverse effects. It appears on the label of the prescription medication.
Step Therapy
A type of prior authorization where a patient must first try, and fail, a preferred drug before coverage is granted for a more costly medication.
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