As used in ORS 414.350 to 414.415:
(1) “Appropriate and medically necessary use” means drug prescribing, drug dispensing and patient medication usage in conformity with the criteria and standards developed under ORS 414.350 to 414.415.
(2) “Board” means the Drug Use Review Board created under ORS 414.355.
(3) “Compendia” means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources:
(a) The American Hospital Formulary Services drug information.
(b) The United States Pharmacopeia drug information.
(c) The American Medical Association drug evaluations.
(d) The peer-reviewed medical literature.
(e) Drug therapy information provided by manufacturers of drug products consistent with the federal Food and Drug Administration requirements.
(4) “Counseling” means the effective communication of information by a pharmacist, as defined by rules of the State Board of Pharmacy.
(5) “Criteria” means the predetermined and explicitly accepted elements based on the compendia that are used to measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary and not likely to result in adverse medical outcomes.
(6) “Drug-disease contraindication” means the potential for, or the occurrence of, an undesirable alteration of the therapeutic effect of a given prescription because of the presence, in the patient for whom it is prescribed, of a disease condition or the potential for, or the occurrence of, a clinically significant adverse effect of the drug on the patient’s disease condition.
(7) “Drug-drug interaction” means the pharmacological or clinical response to the administration of at least two drugs different from that response anticipated from the known effects of the two drugs when given alone, which may manifest clinically as antagonism, synergism or idiosyncrasy. Such interactions have the potential to have an adverse effect on the individual or lead to a clinically significant adverse reaction, or both, that:
(a) Is characteristic of one or any of the drugs present; or
(b) Leads to interference with the absorption, distribution, metabolizing, excretion or therapeutic efficacy of one or any of the drugs.
(8) “Drug use review” means the programs designed to measure and assess on a retrospective and a prospective basis, through an evaluation of claims data, the proper utilization, quantity, appropriateness as therapy and medical necessity of prescribed medication in the medical assistance program.
(9) “Intervention” means an action taken by the Department of Human Services with a prescriber or pharmacist to inform about or to influence prescribing or dispensing practices or utilization of drugs.
(10) “Overutilization” means the use of a drug in quantities or for durations that put the recipient at risk of an adverse medical result.
(11) “Pharmacist” means an individual who is licensed as a pharmacist under ORS chapter 689.
(12) “Prescriber” means any person authorized by law to prescribe drugs.
(13) “Prospective program” means the prospective drug use review program described in ORS 414.375.
(14) “Retrospective program” means the retrospective drug use review program described in ORS 414.380.
(15) “Standards” means the acceptable prescribing and dispensing methods determined by the compendia, in accordance with local standards of medical practice for health care providers.
(16) “Therapeutic appropriateness” means drug prescribing based on scientifically based and clinically relevant drug therapy that is consistent with the criteria and standards developed under ORS 414.350 to 414.415.
(17) “Therapeutic duplication” means the prescribing and dispensing of two or more drugs from the same therapeutic class such that the combined daily dose puts the recipient at risk of an adverse medical result or incurs additional program costs without additional therapeutic benefits.
(18) “Underutilization” means that a drug is used by a recipient in insufficient quantity to achieve a desired therapeutic goal. [1993 c.578 §1]
Note: 414.350 to 414.415 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
Section: Previous 414.336 414.338 414.340 414.342 414.344 414.346 414.348 414.350 414.355 414.360 414.365 414.370 414.375 414.380 414.385 NextLast modified: August 7, 2008