PDMP6
Utilization and Quality Reports
CMS-required outcome
The system produces reports to contribute to reports to HHS by the State Drug Utilization Review (DUR) Board and for program evaluation, continuous improvement in business operations, transparency and accountability, as well as identify patterns of fraud, abuse, gross overuse, excessive utilization related to limitations identified by the state, inappropriate or medically unnecessary care, or prescribing or billing practices that indicate abuse or excessive utilization among Medicaid physicians, pharmacists and enrollees associated with specific drugs or groups of drugs.
Default metrics
- Number of covered individuals concurrently prescribed opioids and benzodiazepines.
- List of covered individuals who were prescribed opioids from multiple providers.
- number and/or percentage of opioid-related hospitalizations, ER visits, urgent care visits for covered individuals.
Regulatory sources
- Section 1944 (e)(1) of the Act
- Section 1927(g)(2)(B) and (g)(3)(D) of the Act
- Section 1004 of the SUPPORT Act
- 42 CFR 433.112(b)(15)
- CMS FAQs-SUPPORT for Patients and Communities Act
- Centers for Disease Control