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.
DHCS has released the 2019 immunization update, summarized below.
- Flu vaccines for the 2019-2020 flu season are now available at local pharmacies. The CDC recommends everyone who is 6 months of age and older to receive a flu shot every year. It is recommended that people get vaccinated by the end of October, but vaccination should continue to be offered throughout the entire flu season.
- In light of large outbreaks in California and other states, on October 24, 2018, ACIP recommended routine immunization against the Hepatitis A virus for all persons 1 year of age or older experiencing homelessness.
- ACIP recommends catch-up HPV vaccination for all persons 26 years of age or younger. Adults aged 27 through 45 years may benefit, although public health benefit of HPV vaccination in this age range is minimal; shared clinical decision-making is recommended. For more information, providers may refer to the Morbidity and Mortality Weekly Report on the CDC website.
- The CDC advises implementing the interim guidance in the context of a comprehensive infection prevention program to prevent transmission of all infectious agents among patients, health care personnel, and visitors. For more information, refer to the updated Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings, which is available on the CDC website.
- New Pre-kindergarten (Childcare) and School Immunization Requirements in California :
- Two (rather than one) doses of varicella-zoster virus (chickenpox) vaccine are required for entry into transitional kindergarten (TK), kindergarten, or for 7th grade advancement.
- Two doses of measles, mumps, and rubella (MMR) vaccine and three doses of hepatitis B vaccine are required for admission or transfer for most K-12 students.
- Pre-kindergarten children entering childcare facilities are now required to have the varicella-zoster virus chickenpox vaccine at 15 months of age or older, rather than at 18 months of age or older.
- For more information, providers may refer to the New Regulations (July 1, 2019) FAQs on the Shots for School website.
Children 18 years of age or younger are eligible for vaccinations through California Vaccines for Children (VFC) Program. Please contact VFC at 1-877-243-8832 for more information.
Anti-cholinergic medications, including Benztropine and Trihexyphenidyl, are often prescribed to prevent or treat antipsychotic-induced extrapyramidal symptoms (EPS). This bulletin recommends against prophylactic use of anticholinergic medications, and recommends that continued therapy should be re-evaluated in patients with controlled symptoms every three months. The long term use of concomitant anticholinergics and antipsychotics can result in adverse effects including cognitive impairment and worsening of tardive dyskinesia, especially with persons 65 years of age or older.
A Medi-Cal Drug Safety Communication entitled “Sleep Behavior Risks with Select Sleep Aids” has been published on the DHCS website. This bulletin is focused on the warning released by the FDA on April 30, 2019 requiring safety label changes including a Boxed Warning for eszopiclone, zaleplon, and zolpidem because of the risk of complex sleep behaviors, including sleepwalking, sleep driving, and engaging in other activities while not fully awake. The document also includes a summary of previous FDA warnings around insomnia medications.
A Medi-Cal Drug Safety Communication entitled “Risks with Sudden Discontinuation of Opioids” has been published on the DHCS website. The bulletin is focused on the warning released by the FDA on April 9, 2019 that a sudden discontinuation of opioids or a rapid dose decrease can cause serious harm in patients who are physically dependent. The document further includes a list of actions to consider when tapering a patient who is opioid dependent.
The bulletin includes links to resources at the FDA website.
A Medi-Cal Drug Safety Communication entitled “Updated Adverse Effects from Fluoroquinolones” has been published on the DHCS website. The bulletin reiterates the warning that fluoroquinolones may increase the risk of ruptures of an aortic aneurysm or aortic dissection. The FDA has added this warning to the prescribing information for all fluoroquinolones.
Morphine Equivalent Daily Dose
A Medi-Cal Clinical Review Update titled: “Morphine Equivalent Daily Dose” was published on the DHCS website. The bulletin outlines how morphine equivalent daily dose (MEDD) is used to indicate patient risk. It also suggests resources to aid in responsible prescribing, including a mobile MEDD calculator.
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.