Drug Utilization Review

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The primary objectives of Drug Utilization Review (DUR) are to improve the quality of health care for Medicaid members and to assist in containing health care costs. In order to achieve these goals, prescription claims must be reviewed both prospectively and retrospectively. Findings of the reviews are communicated to both prescribers and pharmacists to assure that medications provided are appropriate, medically necessary, and not likely to result in adverse medical effects. Drug Utilization Review is mandated by the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), an amendment to the Social Security Act.

The Drug Utilization Review (DUR) Board is responsible for the establishment of standards and criteria for the prospective and retrospective DUR programs. The DUR Board is charged with making recommendations for educational interventions to prescribers and pharmacists to identify and reduce overuse, abuse, fraud, and inappropriate or medically unnecessary care. Acentra Health ​assists the pharmacy program in conducting population-based educational interventions, approved by the DUR Board, for both medical prescribers and pharmacy providers.

Drugs or drug classes which are reviewed and found to be inappropriately utilized or have significant safety concerns are deemed candidates for prior authorization. These reviews are considered by the DUR Board and appropriate criteria for approval are determined by them, with input from medical and pharmacy providers, drug manufacturers, and other experts.


​Chris Terpening, PharmD, Chair
​​Philip Galapon, MD
​David Gloss, MD, Vice Chair
​​​Lester Labus, MD
​C.K. Babcock, PharmD
Michael Lonsinger, PharmD
​Michael Ballow, PharmD
Ernest Miller, DO
​Christopher Booth, PharmD
Mary Nemeith-Pyles, MSN, RN, CS​
​Scott Brown, RPh

​Kate Forman, PharmD



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