What is a drug utilisation review?

Understanding systematic medication use evaluation to optimise therapy, reduce harm, and control pharmaceutical costs in insurance claims.

Published: 3 April 2026 | Updated: 3 April 2026

Defining Drug Utilisation Review

A drug utilisation review (DUR) is a systematic, authoritative examination of a patient's medication use to assess appropriateness, identify problems, and recommend improvements. It answers critical questions: Are these medications necessary? Are they working? Are they safe in combination? Could they be replaced with safer, more effective, or more cost-effective alternatives? Are there drug interactions, contraindications, or duplications that pose risk?

For insurance claims, you often inherit claimants who have accumulated medications over months or years of treatment by different providers with limited coordination. A drug utilisation review brings expertise and objectivity to medication management. It's conducted by clinical pharmacists who have specialised training in medication appropriateness, pharmacology, and health economics. The review produces actionable recommendations that guide prescribers and inform your claim management decisions.

How Drug Utilisation Reviews Work

Step 1: Comprehensive Medication Audit

The pharmacist obtains the claimant's complete medication list from all sources: prescriptions from multiple doctors, over-the-counter medications, herbal products, supplements. They confirm what the claimant is actually taking (not just what's prescribed, as adherence often differs from prescriptions). They gather dosing information, duration of use, and the indication for each medication.

Step 2: Clinical Assessment

Using clinical guidelines and evidence-based standards, the pharmacist assesses whether each medication is appropriate for the claimant's diagnoses, age, kidney function, liver function, and other clinical factors. For example, certain blood pressure medications are inappropriate in patients with asthma; anticholinergic medications pose risks in older adults; certain pain medications are contraindicated in people with specific liver conditions.

Step 3: Interaction and Duplication Screening

The pharmacist systematically checks for drug-drug interactions, drug-disease interactions, and therapeutic duplication. Do any medications dangerously interact? Is the claimant taking multiple medications from the same class that duplicate benefit? Are there contraindications (conditions where certain drugs shouldn't be used)?

Step 4: Appropriateness and Evidence Evaluation

The pharmacist evaluates whether medications align with current clinical guidelines and evidence. Some medications prescribed are older, less effective options; newer alternatives may offer better outcomes with fewer side effects or drug interactions. The pharmacist identifies where evidence-based switching could improve results or reduce cost.

Step 5: Recommendations Development

Based on findings, the pharmacist develops specific, actionable recommendations. These might include de-escalating unnecessary medications, switching to safer or more cost-effective alternatives, correcting dosing errors, managing interactions, or adding missing medications. Recommendations are prioritised by clinical importance and potential impact.

Types of Drug Utilisation Reviews

Retrospective DUR

Reviews past medication use to identify problems and learn from patterns. This type doesn't change current therapy but informs future decision-making and highlights systemic issues (such as repeated prescribing errors or polypharmacy patterns). Most insurance-initiated reviews are retrospective.

Prospective DUR

Evaluates prescriptions before the patient fills them, allowing intervention before potentially problematic therapy starts. In insurance claims, this might involve your scheme requiring medication review approval before funding new medications (particularly expensive or high-risk drugs).

Concurrent DUR

Occurs during the patient's current treatment, assessing medications as they're being used. This allows real-time adjustment and monitoring. For complex claims, concurrent DUR (such as monthly check-ins with a pharmacy advisor) provides ongoing optimisation.

What Drug Utilisation Reviews Identify

Medication Errors and Dosing Problems

DUR identifies doses that are too high or too low, frequencies that don't align with the medication's half-life, or durations that exceed evidence-based recommendations. For example, a claimant prescribed antibiotic for a month when standard treatment is 5-7 days, or pain medications dosed too low to be effective.

Drug Interactions and Contraindications

DUR systematically screens for dangerous combinations. For example, certain psychiatric medications interact with pain medications to cause potentially fatal respiratory depression. A DUR would identify this risk and recommend adjustments before harm occurs.

Therapeutic Duplication

When a claimant is on two medications from the same class that serve the same purpose, DUR identifies the duplication and recommends consolidating to a single agent. This reduces cost, simplifies medication regimen, and lowers drug interaction risk.

Unnecessary or Ineffective Medications

DUR identifies medications that are no longer needed (such as pain medications after tissue healing is complete) or are not working (such as medications continued despite lack of clinical benefit). This is particularly valuable for long-term claimants who've accumulated medications over years.

Off-Label and Non-Evidence-Based Prescribing

DUR identifies medications used outside their approved indications without strong clinical evidence, allowing discussion about whether off-label use is justified or whether evidence-based alternatives exist.

Cost-Optimisation Opportunities

DUR identifies opportunities to switch to generic equivalents, therapeutic alternatives, or formulary-preferred medications that achieve similar outcomes at lower cost. For example, switching from a branded pain medication to a generic equivalent, or switching from a newer, expensive depression medication to an older, equally effective, cheaper alternative.

Benefits for Your Insurance Scheme

Direct Cost Reduction

By identifying unnecessary medications, outdated expensive drugs, and therapeutic duplications, DUR directly reduces pharmaceutical expenditure. Typical savings range from 15-40% of current medication costs, depending on baseline prescribing patterns.

Improved Clinical Outcomes

By optimising medication appropriateness and reducing interactions, DUR improves claimant outcomes. Claimants often feel better on optimised regimens (fewer side effects, clearer medication purpose) and achieve treatment goals faster.

Reduced Adverse Event Risk

By identifying interactions, contraindications, and inappropriate doses, DUR reduces medication-related harms. This protects your claimants, reduces liability, and may prevent hospitalisation from preventable medication problems.

Faster Claim Resolution

Claimants on optimised, evidence-based medications recover faster and return to work sooner. DUR is an investment in accelerating claim closure and improving claimant function.

Clinical Credibility with Prescribers

When DUR recommendations are evidence-based and clinically sound, prescribers respect them and are more likely to implement suggestions. This builds relationships and creates a foundation for ongoing collaboration.

The Difference Between DUR and Other Reviews

Drug utilisation review is distinct from medication reviews more broadly. A medication review might focus on how well a claimant understands their medications (medication counselling). A DUR specifically evaluates appropriateness, safety, and efficacy. Some reviews combine elements of both; a comprehensive medication management review for insurance might include DUR (appropriateness assessment) plus medication reconciliation (ensuring accuracy of medication list) plus adherence counselling (supporting claimant understanding and compliance).

Key Takeaways for Insurers

• Drug utilisation reviews systematically assess medication appropriateness, safety, and effectiveness
• Reviews identify interactions, duplications, unnecessary medications, and cost-optimisation opportunities
• Conducted by clinical pharmacists with expertise in medication management
• Results in actionable recommendations prioritised by clinical importance and impact
• Directly reduces pharmaceutical costs while often improving outcomes
• Protects claimants from medication-related harms and hospitalisation
• Supports faster claim resolution through improved medication appropriateness
• Most valuable for complex claims, high medication costs, or claimants on multiple medications