Drug Utilization Reviews and Peer to Peer Conferences

CompEx offers Drug Utilization Reviews and Peer to Peer conferences to control the cost of medications throughout the life of the claim or when securing CMS approval of Medicare Set Asides in connection with settlements of workers’ compensation claims.

A DUR is the process which allows a third party expert (doctor of pharmacology) to view the current medications that an injured worker is taking and prepare a report containing suggestions and recommendations to the treating physicians to reduce, change or eliminate the medications.  A DUR is an effective tool to get ahead of the claim by controlling the cost of prescription medications.

A DUR can save a Carrier/TPA/Employer thousands of dollars in medication costs by correctly identifying medications not on the ODG, duplication of medications and alternate, equally effective or more appropriate medications for injured workers.  Savings can be seen in the reduced monthly costs of medications throughout the life of the claim or when settling a claim with a Medicare Set Aside and seeking CMS approval.

In order to prepare a DUR, we will need a copy of the last six months of medical records and a pharmacy printout listing the injured worker’s prescription medications, including dosage, frequency/number of pills and prescribing physician.

A Peer to Peer conference is a conversation between our doctor of pharmacology and an injured worker’s prescribing physician regarding the recommendations contained in a DUR.  It is a more persuasive way to have the treating physician adopt the suggested reductions or changes to the injured worker’s prescription medication regimen.

In order to complete a Peer to Peer conference, we will need a copy of the Drug Utilization Review, contact information for the prescribing physician(s) and current prescription regimen if the DUR was prepared more than three months prior to the Peer to Peer conference.