TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.451 PROSPECTIVE DRUG REVIEW AND PATIENT COUNSELING
Section 140.451 Prospective Drug Review and Patient Counseling
Each pharmacy must ensure that:
a) The requirements for patient counseling established by the Illinois Department of Professional Regulation at 68 Ill. Adm. Code 1330.65, including the requirements of confidentiality and documentation of refusal of offers of patient counseling by recipients, are met on a continuing basis.
b) Before each prescription is delivered to the recipient or the recipient's care giver, a pharmacist must ensure that a review of the recipient's drug therapy (prospective drug review or drug utilization evaluation) was performed using commonly accepted drug review criteria. The review must include screening to identify potential drug therapy problems of the following types:
1) Therapeutic duplication, including 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 benefit;
2) Drug-disease contraindication when there is the potential for, or the occurrence of, an undesirable alteration of the therapeutic effect of a given drug because of the presence of a disease condition known to the pharmacist or that may reasonably be expected to be known to the pharmacist, or an adverse effect of the drug on the patient's disease condition;
3) Adverse drug-drug interaction when there is the potential for, or occurrence of, a clinically significant adverse medical effect as the result of the recipient using two or more drugs together;
4) Perceived incorrect drug dosage or duration; and
5) Drug-allergy interactions.
c) Commonly accepted drug review criteria are those criteria that are consistent with peer-reviewed medical literature (that is, scientific, medical and pharmaceutical publications in which original manuscripts are rejected or published only after having been critically reviewed by unbiased independent experts) and the following compendia:
1) American Hospital Formulary Service Drug Information;
2) United States Pharmacopeia-Drug Information;
3) American Medical Association Drug Evaluations;
4) DRUG DEX Information System; and
5) Facts and Comparisons.
(Source: Added at 22 Ill. Reg. 16302, effective August 28, 1998)