The Prospective Drug Utilization Review process is a vital part of NorthStar’s strategy to improve the health and safety of Medicaid patients while conserving cost.

By screening for potential drug therapy problems, such as drug–drug interactions, duplicate therapy and early refills, prior to the product being dispensed, ProDUR can enhance clinical quality and cost-effective drug use.

Significant patient safety and cost savings improvements can be achieved through Point of Sale clinical messaging to pharmacists on a variety edit issues. Intervention  and messaging occurs only after a careful review and examination of the patient’s profile to determine the possibility of potential drug therapy problems due to therapeutic duplication, drug-disease contraindications, drug-drug interactions, drug-allergy interactions, drug dosage or duration of drug treatment.



NorthStar's approach to Retrospective Drug Utilization Review can offer you greater cost savings and improved healthcare outcomes based on your specific utilization patterns. Our RetroDUR process identifies and eliminates therapeutic duplication and seeks to reduce the incidence of drug-drug and drug-disease interactions.

You’ll never get “canned criteria” or “off the shelf” interventions with NorthStar that can lead to high false positive cases that have received no clinical review or input.
In addition to minimizing false positive cases, our focused approach to RetroDUR gives us the ability to continually identify new areas of intervention utilizing advanced data mining, coordination of care through clinical programs and input from our clients' Utilization Review Boards.

Recommended interventions for optimizing therapy and outcomes may be drug or therapeutic class specific and can be based on detailed data on the recipient level or can be generalized to the disease or treatment standard level. The end result of our drug utilization review programs are customized solutions that ensure more efficient use of scarce resources that can ultimately improve quality of care.


TIDE Program

The Therapeutic Intervention Detailing program seeks to align client prescribing patterns with current medical evidence and best practices to reduce the health complications and unnecessary costs associated with inappropriate drug prescribing.

Academic detailing is a valuable tool for providing prescribers with information to improve the quality of decisions regarding drug prescribing and reinforce the preferred drug list. NorthStar conducts face-to-face and telephonic outreach and education with prescribers regarding the most therapeutic and cost-effective use of prescription drugs based on scientific and medical research, clinical trials and the incidence of adverse effects.

We can also analyze client data to determine which prescribers are deviating from recommended therapies and influence patterns through one-on-one office visits and written communications. One preferred strategy is to select the top ten prescribers and introduce them to your existing or pending clinical programs. Support cards with data on how a provider’s therapeutic treatment choices compare to his colleagues by zip code and specialty provide valuable feedback and generate good will.


STAR Program

Our Strategic Therapy Review is yet another tool that allows us to positively influence prescribing patterns prior to the point of sale. This low cost, high impact program is particularly effective for states with low population density and is essential in keeping prescribers abreast of PDL, formulary, and policy changes. The program is “high touch” with a large volume of providers contacted via telephone and fax.


MAC Program

NorthStar has extensive experience in the development and administration of Maximum Allowable Cost (MAC) programs that ensure providers are paid adequately and appropriately and monitor supply fluctuations.

Our processes include surveying network pharmacies to establish regionally specific data and the use of valid and defensible methodologies to maintain and administer programs. Targeted solutions include:

  • total flexibility in the administration and management
  • willingness to provide MAC or customized versions
  • analytical support to modify MAC or implement MAC


Medication Adherence Program (MAP)/Medication Therapy Management Program

NorthStar’s MAP programs are designed to improve communications on the appropriate use of medications to elevate patient adherence. Our clinical team can interpret existing research and utilization patterns and translate it into educational programs that will address and remove barriers to patient adherence.

The sharing of best practices in adherence management and education is conducted telephonically or via fax with providers to and improve health literacy, outcomes and savings.


Success Solutions

Our outcomes-based solutions start with appropriate therapy selection and targeted solutions that influence the payment spectrum from product selection, point of sale claims edits and post payment. Our success solutions are accomplished by an approach that seeks to influence the choice of therapy before it reaches the point of sale.

In addition, NorthStar recommends and implements appropriate actions and educational outreach to prescribers and patients and ensures that proper systems are in place to monitor results.


Custom Solutions

Need a program not detailed here? NorthStar possesses the experience to develop custom solutions to meet our clients specific needs. Contact us today to discuss what we can do for you.