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Previous Volume 296:251-256 February 3, 1977 Number 5 Next

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Abstract

Prescription monitoring evolved from the need of drug firms to obtain marketing information. Today, extensive monitoring is also done by fiscal intermediaries who administer prepaid drug benefit plans, both private and governmental, particularly Medicaid. The most important such agent is PAID Prescriptions. Under various contracts, PAID monitors physician, pharmacy, and patient behavior related to prescriptions and uses review processes that evaluate certain kinds of behavior for appropriateness. The criteria of appropriateness are essentially those that save money. PAID negotiates a program fee with the insurer (public or private) and applies constraints so that prescription and administrative costs do not overrun that fee. PAID and other monitors have contemplated expansion into the realm of defining and encouraging appropriate prescribing under the concept of "drugutilization review." The actual practices of PAID, particularly the background of fiscal enforcement, may impede the development of an actual drug-utilization review process.

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• Lipton, H. L., Agnew, J. D., Stebbins, M. R., Kuo, A., Dudley, R. A. (2005). Managing the Unmanageable: The Nature and Impact of Drug Risk in Physician Groups. Journal of Health Politics, Policy and Law 30: 719-750 [Abstract]