Drug Utilization Review (DUR) Program consists of Prospective, Retrospective, and Educational programs promoting optimal medication use to prescribers, pharmacists, and members for the Medi-Cal line of business. The Pharmacy DUR activities may focus on identifying medication use patterns to reduce fraud, abuse, waste, inappropriate, unsafe or unnecessary care and develop education programs to optimize medication use.
The SFHP DUR Program is grounded in current, scientifically sound medical evidence and is approved by the SFHP Pharmacy and Therapeutics committee.
This page is periodically updated with new information.
Member Education is located here
DHCS DUR Updates
Below are summaries of the recent educational articles posted by the Department of Health Care Services (DHCS). These articles are intended to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
Starting January 1, 2019, California prescribers are required by Assembly Bill 2760 to offer a prescription to a patient for naloxone or another FDA approved complete or partial opioid-reversal agent as a rescue when one or more of the following is present:
- The dosage is ≥ 90 Morphine Equivalent Daily Dose
- Opioids and benzodiazepines are prescribed concurrently
- The patient has increased risk of overdose (History of overdose, substance use disorder, or risk for returning to a high dose)
The prescriber is also required to educate the patient and/or guardian on overdose prevention and the use of naloxone.
CDC recommends everyone who is 6 months of age and older receive a flu shot every year.
Adults 19 years of age and older can receive many vaccines at their pharmacy covered under SFHP Medi-Cal Outpatient Pharmacy Benefit: influenza, MMR, meningococcal, pneumococcal, varicella, Tdap/Td, Typhoid, Hib, HPV, Hep A & B, and herpes zoster – including SHINGRIX®. Click for a complete list of SFHP covered vaccines.
Children 18 years or younger are eligible for vaccinations through California Vaccines for Children (VFC) Program. Contact VFC at 1-877-243-8832 for more information.
We encourage providers to register and access California Immunization Registry (CAIR), a state wide database of regional registries that consolidate immunization records, in order to see what vaccinations have been administered by participating providers and pharmacies.
It is mandatory to consult the CURES 2.0 database prior to prescribing, ordering, administering, or furnishing a Schedule II-IV controlled substance. This applies to any health care provider with both a DEA Controlled Substance Registration Certificate and California licensure as a:
- Naturopathic Doctor
- Osteopathic Doctor
- Physician Assistant
- Registered Certified Nurse Midwife (furnishing)
- Registered Nurse Practitioner (furnishing)
For more information, please visit the CURES website (https://oag.ca.gov/cures).
A Medi-Cal Prospective DUR Update titled: “Additive Toxicity Alert Now Focused Only On CNS Depressants” was published on the DHCS website. The bulletin outlines the FDA communication regarding the risk of combined use of opioid medications with benzodiazepines or other drugs that depress the central nervous system. The bulletin further outlines changes to the additive toxicity prospective DUR alert in fee-for-service Medi-Cal.
A Medi-Cal DUR drug safety communication titled: “Adverse Effects from Fluoroquinolone Antibiotics” was published on July 31, 2018. The bulletin outlines the strengthened warnings that the FDA is adding to the prescribing information for fluoroquinolones. The new label changes will include that hypoglycemia, can lead to coma, and another new label will also make the mental health side effects more prominent and consistent across the fluoroquinolone drug class. The full safety announcement is available on the Drug Safety and Availability page of the FDA website.
A Medi-Cal DUR educational bulletin titled: “In the Pharmacy: Pharmacists Furnishing Nicotine Replacement Products” was published on March 30, 2018. The bulletin describes strategies to promote smoking cessation, including brief interventions (less than 10 minutes) by health care providers that are shown to be effective. The bulletin summarizes best practices for responsible prescribing of NRT products. A Pharmacologic Product Guide of all FDA-approved medications for smoking cessation is available from the UCSF Rx for Change website.
In January 2018, the FDA announced safety labeling changes required for prescription cough and cold medicines containing codeine or hydrocodone. These products are now limited to use in adults 18 years or older; use in children is no longer indicated or recommended. Codeine/guaifenesin 10mg-100mg/5mL oral liquid for cough is available on SFHP formulary; as of 2/15/18, the age minimum was increased from 12 to 18 in accordance with labeling changes. The FDA announcement, including a full list of affected medications, is available at https://www.fda.gov/Drugs/DrugSafety/ucm590435.htm.